Assessing physical disability in children with spina bifida and scoliosis

Design and Implementation of a Position, Speed and Orientation Fuzzy Controller Using a Motion Capture System to Operate a Wheelchair Prototype

The design and implementation of an electronic system that involves head movements to operate a prototype that can simulate future movements of a wheelchair was developed here. The controller design collects head-movements data through a MEMS sensor-based motion capture system. The research was divided into four stages: First, the instrumentation of the system using hardware and software; second, the mathematical modeling using the theory of dynamic systems; third, the automatic control of position, speed, and orientation with constant and variable speed; finally, system verification using both an electronic controller test protocol and user experience. The system involved a graphical interface for the user to interact with it by executing all the controllers in real time. Through the System Usability Scale (SUS), a score of 78 out of 100 points was obtained from the qualification of 10 users who validated the system, giving a connotation of “very good”. Users accepted the system with the recommendation to improve safety by using laser sensors instead of ultrasonic range modules to enhance obstacle detection.

Can children with spina bifida and muscular dystrophy participate in their own health status evaluations?

BACKGROUND

The outcomes movement has emphasized the importance of the patient in evaluating treatment outcome. However, concern has been raised about the ability of children, particularly those with multisystem disease, to evaluate their disability.

PURPOSE

To determine whether children with spina bifida and muscular dystrophy and their parents agree when asked about the relative difficulty of daily activities and the severity of symptoms experienced by the child.

METHODS

First, a list of symptoms and activity restrictions was generated from the literature, clinicians, and interviews with families with spina bifida and muscular dystrophy. Second, another group of parents and children with spina bifida (with hip dislocation or scoliosis) and with muscular dystrophy (with scoliosis), including those before and after surgery, independently rated the severity and importance of their objective and subjective complaints.

RESULTS

The correlation between parents and their children was high for both objective (median Spearman's = 0.70; standard deviation [SD] = ±0.17; range = -0.05-1.00) and subjective (median Spearman's = 0.76; SD = ±0.14; range = 0.13-1.00) complaints, with an overall excellent level of agreement (Kappa = 0.75; 95% confidence interval [CI]: 0.73, 0.76).

CONCLUSION

Children with spina bifida and muscular dystrophy are capable of understanding and assessing their disability.

Children's daily living activities during immobilization of upper-limb fractures with an above- or below-elbow cast

BACKGROUND

The purpose of this prospective study was to assess the impact of cast immobilization on the activities of daily living in children with fractured upper limbs.

METHODS

Using the Activities Scale for Kids (ASK), 52 consecutive children (17 girls, 35 boys), aged 5-15 years (mean, 9 years), with upper limb fractures treated by means of above- or below-elbow casts were assessed. The files were reviewed for background and fracture-related data.

RESULTS

Mean score of the above-elbow group was 65.4 +/- 15.5 points on the ASK capability domain (ASK-c) (with cast) and 98.7 +/- 3 points on the ASK-performance domain (without cast). Corresponding scores for the below-cast group were 89.8 +/- 13 and 99.5 +/- 2. Factors that positively affected overall function were older age, male sex, shorter duration of pain, and less displacement. On multivariate analysis, only age proved to be a potential predictive factor. Cast position and hand dominance had no effect. The specific activities affected were personal hygiene, dressing, making a snack, and reaching high objects.

CONCLUSIONS

To ease their children's adjustment to forearm cast immobilization after fractures, parents should be educated in the areas of daily living that may be affected. This is particularly true for younger children with more displaced fractures that cause more pain.

Measuring physical functioning in children with spinal impairments with computerized adaptive testing

BACKGROUND

The purpose of this study was to assess the utility of measuring current physical functioning status of children with scoliosis and kyphosis by applying computerized adaptive testing (CAT) methods. Computerized adaptive testing uses a computer interface to administer the most optimal items based on previous responses, reducing the number of items needed to obtain a scoring estimate.

METHODS

This was a prospective study of 77 subjects (0.6-19.8 years) who were seen by a spine surgeon during a routine clinic visit for progress spine deformity. Using a multidimensional version of the Pediatric Evaluation of Disability Inventory CAT program (PEDI-MCAT), we evaluated content range, accuracy and efficiency, known-group validity, concurrent validity with the Pediatric Outcomes Data Collection Instrument, and test-retest reliability in a subsample (n = 16) within a 2-week interval.

RESULTS

We found the PEDI-MCAT to have sufficient item coverage in both self-care and mobility content for this sample, although most patients tended to score at the higher ends of both scales. Both the accuracy of PEDI-MCAT scores as compared with a fixed format of the PEDI (r = 0.98 for both mobility and self-care) and test-retest reliability were very high [self-care: intraclass correlation (3,1) = 0.98, mobility: intraclass correlation (3,1) = 0.99]. The PEDI-MCAT took an average of 2.9 minutes for the parents to complete. The PEDI-MCAT detected expected differences between patient groups, and scores on the PEDI-MCAT correlated in expected directions with scores from the Pediatric Outcomes Data Collection Instrument domains.

CONCLUSIONS

Use of the PEDI-MCAT to assess the physical functioning status, as perceived by parents of children with complex spinal impairments, seems to be feasible and achieves accurate and efficient estimates of self-care and mobility function. Additional item development will be needed at the higher functioning end of the scale to avoid ceiling effects for older children.

LEVEL OF EVIDENCE

This is a level II prospective study designed to establish the utility of computer adaptive testing as an evaluation method in a busy pediatric spine practice.

Development and pilot test of the shriners pediatric instrument for neuromuscular scoliosis (SPNS): a quality of life questionnaire for children with spinal cord injuries

BACKGROUND/OBJECTIVE

Children and adolescents who have sustained a spinal cord injury (SCI) are at risk of developing spine deformities and secondary complications that may affect their quality of life. The Shriners Pediatric Instrument for Neuromuscular Scoliosis (SPINS) is a condition-specific instrument that was developed to measure the health-related quality of life (HRQOL) of this patient population. A pilot study was conducted to revise the SPINS and assess comprehensibility.

METHODS

Fourteen children with SCI (ages 6-16 y) from a pediatric hospital were administered either a child version (ages 10-18 y) or a parent version (ages 5-9 y) of the SPINS. Problematic items were identified based on participants' feedback or low statistical variance.

RESULTS

Ten of 14 (71.6%) respondents understood at least 90% of the items, and 13 out of 14 (92.9%) comprehended more than 80% of relevant items on the SPINS.

CONCLUSION

The SPINS has demonstrated comprehensibility. The next step is to measure the validity and reliability of the instrument. The SPINS shows promise as a means of assessing quality of life related to brace effectiveness in children with SCI and neuromuscular scoliosis who primarily use a wheelchair for mobility.

Spinal fusion in children with spina bifida: influence on ambulation level and functional abilities

The aim of this study was to determine the influence of spinal fusion on ambulation and functional abilities in children with spina bifida for whom early mobilization was stimulated. Ten children (three males and seven females) with myelomeningocele were prospectively followed. Their mean age at operation was 9.3 years (standard deviation (SD): 2.4). Spinal curvature was measured according to Cobb. Pelvic obliquity and trunk decompensation were measured as well. The ambulation level was scored according to Hoffer, and functional abilities, as well as the amount of caregiver assistance, were documented using the Pediatric Evaluation of Disability Inventory. All patients were assessed before surgery and three times after surgery, with a total follow-up duration of 18 months after surgery. After spinal fusion, magnitude of primary curvature decreased significantly (p=0.002). Pelvic obliquity and trunk decompensation did not change. In spite of less immobilization as compared with other reported experiences, ambulation became difficult in three out of four patients who had been able to ambulate prior to surgery. Functional abilities and amount of caregiver assistance concerning self-care (especially regarding dressing upper and lower body, and self-catheterization) and mobility (especially regarding transfers) showed a nonsignificant trend to deterioration within the first 6 months after surgery, but recovered afterwards. From pre-surgery to 18 months after surgery, functional skills on self-care showed borderline improvement (p=0.07), whereas mobility did not (p=0.2). Mean scores on caregiver assistance improved significantly on self-care (p=0.03), and borderline on mobility (p=0.06), meaning that less caregiver assistance was needed compared with pre-surgery. The complication rate was high (80%). In conclusion, within the first 6 months after spinal fusion, more caregiver assistance is needed in self-care and mobility. It takes about 12 months to recover to pre-surgery level, while small improvement is seen afterwards. After spinal fusion, ambulation often becomes difficult, especially in exercise walkers. These findings are important for health-care professionals, in order to inform and prepare the patients and their parents properly for a planned spinal fusion.