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Antonellis P, Weightman MM, Fino PC, Chen S, Lester ME, Hoppes CW, Dibble LE, King LA. Relation Between Cognitive Assessment and Clinical Physical Performance Measures After Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2024; 105:868-875. [PMID: 37931890 DOI: 10.1016/j.apmr.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To investigate the relation between cognitive and motor performance in individuals with mild traumatic brain injury (mTBI) and examine differences in both cognitive and motor performance between adults after mTBI and healthy controls. DESIGN Multi-center, cross-sectional study. SETTING Three institutional sites (Courage Kenny Research Center, Minneapolis, MN, Oregon Health & Science University, Portland, OR, and University of Utah, Salt Lake City, UT). PARTICIPANTS Data were collected from 110 participants (N=110), including those with mTBI and healthy controls, who completed cognitive and physical performance assessments. INTERVENTIONS Not applicable. OUTCOME MEASURES Cognitive assessments involved the Automated Neuropsychological Assessment Metrics to evaluate domains of attention, memory, reaction time, processing speed, and executive function. Physical performance was evaluated through clinical performance assessments, such as the 1-min walk test, the modified Illinois Agility Test, the Functional Gait Assessment Tool, the High-Level Mobility Assessment Tool, a complex turning course, and a 4-Item Hybrid Assessment of Mobility for mTBI. Participants also completed additional trials of the 1-min walk test, modified Illinois Agility Test, and complex turning course with a simultaneous cognitive task. RESULTS Individuals with mTBI performed worse on cognitive assessments, as well as several of the physical performance assessments compared with healthy controls. Complex tasks were more strongly related to cognitive assessments compared with simple walking tasks. CONCLUSIONS Combining complex motor tasks with cognitive demands may better demonstrate functional performance in individuals recovering from mTBI. By understanding the relation between cognitive and physical performance in individuals recovering from mTBI, clinicians may be able to improve clinical care and assist in return to activity decision-making.
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Affiliation(s)
| | | | - Peter C Fino
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT
| | - Siting Chen
- School of Public Health, Oregon Health & Science University, Portland, OR
| | - Mark E Lester
- Department of Physical Therapy, University of Texas Rio Grande Valley, Harlingen, TX
| | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, OR
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2
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Bourchtein E, McLaughlin A, Walainis K, Hughes A, Scott EL, Foxen-Craft E. Psychological predictors of performance-based physical functioning among pediatric pain program participants. J Pediatr Rehabil Med 2024:PRM220132. [PMID: 38427508 DOI: 10.3233/prm-220132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2024] Open
Abstract
PURPOSE The purpose of the present study was to evaluate changes in performance-based physical functioning and investigate psychological predictors of physical functioning over time in pediatric patients with chronic pain who completed an interdisciplinary rehabilitation intensive outpatient program (IOP). METHODS Participants (N = 55; mean age = 14.92 years; 12.7% male, 87.3% female; 83.6% White, 5.6% African-American/Black; 9.1% Latinx) completed baseline measures assessing pain intensity and modifiable psychological factors (i.e., pain catastrophizing, kinesiophobia, anxiety and depressive symptoms). Participants were administered performance-based assessments of physical functioning (i.e., physical endurance, high-level motor abilities) before and after IOP completion. RESULTS Pain intensity was not significantly associated with physical functioning at either timepoint. There was significant improvement on measures of physical functioning after completion of the IOP when controlling for the effects of sex, race, and ethnicity. Depressive symptoms were associated with baseline physical endurance, β = - .28, p = .047, while pain catastrophizing was associated with baseline gross motor abilities, β = - .28, p = .032. CONCLUSION Participation in an IOP led to significant improvement in physical endurance and high-level motor ability. Depressive symptoms and pain catastrophizing were associated with physical functioning at baseline but not post-program completion. Integration of pain psychology and physical therapy in an IOP can help address the interrelated psychological and physical factors impacting physical functioning to improve outcomes for children with chronic pain.
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Affiliation(s)
- Elizaveta Bourchtein
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Alix McLaughlin
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA
| | - Kimberly Walainis
- Ambulatory Rehabilitation Therapies Department, Michigan Medicine, Ann Arbor, MI, USA
| | - Amanda Hughes
- Ambulatory Rehabilitation Therapies Department, Michigan Medicine, Ann Arbor, MI, USA
| | - Eric L Scott
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Emily Foxen-Craft
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
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3
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Smith M, Williams G, Jordan M, Willson A, Barker R. The feasibility of a flexible exercise participation programme (FEPP) for individuals with multiple sclerosis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 28:e1988. [PMID: 36536530 DOI: 10.1002/pri.1988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/07/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Individuals with multiple sclerosis (MS) want health advice regarding participation in their choice of exercise. To address this need, a flexible exercise participation programme (FEPP) was developed, underpinned by the MS aerobic exercise guidelines and supported by a physiotherapist using behaviour change techniques. The aim of this study was to investigate the feasibility of the FEPP for individuals with minimal disability from MS. METHODS A feasibility study utilising a single group pre/post-intervention design was conducted. The 12-week FEPP was completed by 10 individuals with MS (EDSS 0-3.5). Exercise progression in duration, intensity or frequency of exercise (in line with MS exercise guidelines) was guided by a self-perceived weekly energy level score, and weekly telephone coaching sessions using behavioural change techniques. Trial feasibility was assessed via measures of process (recruitment and retention), resources/management (communication time; data entry) and scientific feasibility (safety; compliance). Secondary FEPP feasibility outcomes included the Goal Attainment Scale (GAS) T-score, exercise participation (weekly exercise diary), high-level mobility (HiMAT), vitality (Subjective Vitality Scale), biomarkers for inflammation (cytokines levels [IL2, IL4, IL6, IL10, TNF and IFNγ]), and acceptability (participant survey). RESULTS Process: In total, 11 (85%) of 13 eligible participants enroled at baseline with 10 (91%) completing the study. Resources/management: Coaching sessions included a baseline interview-mean 39 min (SD: 6.6) and telephone coaching-mean 10 min (SD: 3.8) per week. Outcome measure data collection time-mean 44 min (SD: 2.1). Scientific feasibility: Two participants experienced a fall during their exercise participation. Self-reported compliance was high (99%). GAS T-scores increased significantly, indicating achievement of exercise participation goals. Secondary outcomes showed trends towards improvement. DISCUSSION The FEPP was feasible, safe and highly acceptable for use with individuals with MS and warrants a larger trial to explore effectiveness.
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Affiliation(s)
- Moira Smith
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Gavin Williams
- Discipline of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Margaret Jordan
- College of Public Health, Medical and Vet Sciences, James Cook University, Townsville, Queensland, Australia
| | - Annie Willson
- College of Public Health, Medical and Vet Sciences, James Cook University, Townsville, Queensland, Australia
| | - Ruth Barker
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
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Tanel MR, Gupta C, Wilson KE, Murphy J, Wright FV, Reed N. The Concussion Challenge Assessment: Development and reliability of a novel gross motor assessment tool for paediatric concussion. Front Sports Act Living 2022; 4:1027339. [PMID: 36589783 PMCID: PMC9795185 DOI: 10.3389/fspor.2022.1027339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022] Open
Abstract
Aims The aim of this study was to develop a gross motor performance clinical assessment tool, the Concussion Challenge Assessment (CCA), for paediatric concussion populations. Methods An expert panel evaluated tasks from the Acquired Brain Injury Challenge Assessment to determine relevant tasks for a paediatric concussion population. These tasks were administered to a convenience sample of 854 healthy youth. An analysis of the response options for each task, considering task difficulty, was performed. The test-retest reliability of each task was considered to finalise the tool. Results The Acquired Brain Injury Challenge Assessment was reduced to six tasks (three coordination, two speed and agility, and one strength) to create the CCA. Population-specific 4-point response options were generated, which, upon examination of task difficulty, were revised as 5-point response sets to better capture performance differences. The test-retest reliability results led to acceptance of all six: three performance tasks and three exertion tasks. Conclusion This development of the CCA is an important step in creating a gross motor performance assessment tool that can assist in the determination of when youth are able to safely return to activity following a concussion.
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Affiliation(s)
- Michelle R. Tanel
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Christopher Gupta
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Katherine E. Wilson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - James Murphy
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - F. Virginia Wright
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nick Reed
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Correspondence: Nick Reed
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Parrington L, King LA, Hoppes CW, Klaiman MJ, Michielutti P, Fino PC, Dibble LE, Lester ME, Weightman MM. Exploring Vestibular Ocular Motor Screening in Adults With Persistent Complaints After Mild Traumatic Brain Injury. J Head Trauma Rehabil 2022; 37:E346-E354. [PMID: 35067602 DOI: 10.1097/htr.0000000000000762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to (1) explore differences in vestibular ocular motor screening (VOMS) symptoms between healthy adults and adults with persistent symptoms after mild traumatic brain injury (mTBI), and (2) explore the relationships between VOMS symptoms and other measures (self-reported vestibular symptoms, clinical measures of balance and gait, and higher-level motor ability tasks). SETTING Research laboratory setting. PARTICIPANTS Fifty-three persons with persistent symptoms (>3 weeks) following mTBI and 57 healthy controls were recruited. Eligibility for participation included being 18 to 50 years of age and free of medical conditions that may affect balance, with the exception of recent mTBI for the mTBI group. DESIGN Cross-sectional. MAIN MEASURES The primary outcomes were the VOMS symptom scores and near point of convergence (NPC) distance. Secondary outcomes included the Dizziness Handicap Inventory (DHI) total and subdomain scores, sway area, Functional Gait Analysis total score, gait speed, and modified Illinois Agility Task completion time, and Revised High-Level Mobility Assessment Tool total score. RESULTS The mTBI group reported more VOMS symptoms ( z range, -7.28 to -7.89) and a further NPC ( t = -4.16) than healthy controls (all P s < .001). DHI self-reported symptoms (total and all subdomain scores) were strongly associated with the VOMS symptom scores (rho range, 0.53-0.68; all P s < .001). No significant relationships existed between VOMS symptoms and other measures. CONCLUSION Significant group differences support the relevance of the VOMS for mTBI in an age-diverse sample with persistent symptoms. Furthermore, strong association with DHI symptoms supports the ability of the VOMS to capture vestibular complaints in this population.
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Affiliation(s)
- Lucy Parrington
- Department of Dietetics, Human Nutrition and Sport, La Trobe University, Victoria, Australia (Dr Parrington); Department of Neurology, Oregon Health & Science University, Portland (Drs Parrington and King); Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, Texas (Drs Hoppes and Lester); Courage Kenny Research Center, Allina Health, Minneapolis, Minnesota (Mr Klaiman and Drs Michielutti and Weightman); Departments of Health and Kinesiology (Dr Fino) and Physical Therapy & Athletic Training (Dr Dibble), University of Utah, Salt Lake City; Department of Physical Therapy, Texas State University, Round Rock (Dr Lester)
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6
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Hill B, Eldridge B, Williams G. Construct Validity of the Revised High-Level Mobility Assessment Tool for Children Who Are Developing Typically. Phys Ther 2022; 102:6604586. [PMID: 35689812 DOI: 10.1093/ptj/pzac076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 01/15/2022] [Accepted: 04/05/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this project was to evaluate the construct validity of the high-level mobility assessment tool (HiMAT) for children who are developing typically with no underlying condition that may affect mobility. METHODS The HiMAT is a revised 8-item measure of high-level mobility. Rasch analysis was used to assess fit to the Rasch model indicating unidimensionality, person separation index local dependency, targeting of items, and differential item functioning. RESULTS Children with typical development aged 5 to 12 years (n = 1091; 554 girls and 537 boys) were recruited from 8 schools. The mean HiMAT score was 22.4/32 (range, 8-32). Data fit the Rasch model, indicating that the HiMAT was a unidimensional scale assessing a single construct (high-level mobility). The person separation index was .86, indicating good reliability. The skip item exhibited differential item functioning by sex. Although items were well targeted, the fit residual mean for persons was 2.40, indicating most found the tasks easy to complete. Unlike in adult populations, 2 items (walk and walk over obstacle) exhibited local dependency >0.2. CONCLUSION The HiMAT is a unidimensional targeted performance measure of high-level mobility for children with typical development aged 5 to 12 years. Further examination of the relationship between the test items "walk" and "walk over an obstacle" may be required to ensure that scores on these items are truly independent of one another.
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Affiliation(s)
- Bridget Hill
- Epworth Monash Rehabilitation Medicine Unit, Epworth HealthCare, Melbourne, Victoria, Australia.,Physiotherapy Department, The University of Melbourne, Victoria, Australia
| | - Beverly Eldridge
- Physiotherapy Department, The University of Melbourne, Victoria, Australia.,The Murdoch Children's Research Unit, Royal Children's hospital, Melbourne, Victoria, Australia
| | - Gavin Williams
- Physiotherapy Department, The University of Melbourne, Victoria, Australia.,Physiotherapy Department, Epworth Healthcare, Melbourne, Victoria, Australia
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Gjesdal BE, Mæland S, Williams G, Aaslund MK, Rygh CB, Cumming KT. Can adults with cerebral palsy perform and benefit from ballistic strength training to improve walking outcomes? A mixed methods feasibility study. BMC Sports Sci Med Rehabil 2021; 13:160. [PMID: 34922592 PMCID: PMC8684268 DOI: 10.1186/s13102-021-00382-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 11/18/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Power bursts of hips and ankle plantar flexors are prerequisites to walking propulsion. However, these power bursts are reduced during gait for persons with cerebral palsy (CP) and mainly in the ankle plantar flexors. Hence, task specific training, such as ballistic strength training, is suggested to increase muscle power in walking but not investigated in adults with CP. Therefore, the aim was to investigate if adults with CP could perform and benefit from ballistic strength training to improve walking, evaluated through physical measures and self-reported measures and interviews. METHODS In this mixed methods feasibility study, eight ambulatory adults (aged 24-56) with spastic CP conducted ballistic strength training on a glideboard targeting the ankle plantarflexors two times a week for eight weeks. The feasibility of the training was assessed through objectives described by Orsmond and Cohn. Before and after the intervention, physical measures (6-Minute Walk Test and the eight-item High-level Mobility Assessment Tool) and self-reported measures (Patient Global Impression of Change, Numeric Pain Rating Scale, Fatigue Impact and Severity Self-Assessment, and Walk-12) were collected. After the intervention, semi-structured interviews explored experiences of this training. RESULTS The participants experienced training the ankle plantar flexor as relevant but reported it took about four weeks to coordinate the exercises successfully. Although we observed no changes in the physical performance measures, most participants reported improvements; some felt steadier when standing, walking, and hopping. CONCLUSION This study demonstrated that ballistic strength training was feasible and suitable in adults with CP. However, guidance and a long (4 weeks) familiarization time were reported necessary to master the exercises. Most participants reported self-experienced improvements, although no physical performance measures improved. Thus, prolonged intervention may be required for perceived physical improvements to emerge. Also, other outcome measures sensitive to power output remains to be investigated.
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Affiliation(s)
- Beate Eltarvåg Gjesdal
- Department of Health and Function, Western Norway University of Applied Sciences, PO Box 7030, 5020, Bergen, Norway.
- Department of Global Public Health and Primary Care, Faculty of Medicine, The University of Bergen, Bergen, Norway.
| | - Silje Mæland
- Department of Global Public Health and Primary Care, Faculty of Medicine, The University of Bergen, Bergen, Norway
- Research Unit for General Practice in Bergen, Norwegian Research Centre, NORCE, Bergen, Norway
| | - Gavin Williams
- Department of Physiotherapy, Epworth Hospital, Richmond, Melbourne, VIC, Australia
- Department of Physiotherapy, The University of Melbourne, Parkville, Melbourne, VIC, Australia
| | - Mona Kristin Aaslund
- Department of Health and Function, Western Norway University of Applied Sciences, PO Box 7030, 5020, Bergen, Norway
| | - Cecilie Brekke Rygh
- Department of Health and Function, Western Norway University of Applied Sciences, PO Box 7030, 5020, Bergen, Norway
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Fino PC, Weightman MM, Dibble LE, Lester ME, Hoppes CW, Parrington L, Arango J, Souvignier A, Roberts H, King LA. Objective Dual-Task Turning Measures for Return-to-Duty Assessment After Mild Traumatic Brain Injury: The ReTURN Study Protocol. Front Neurol 2021; 11:544812. [PMID: 33519659 PMCID: PMC7844093 DOI: 10.3389/fneur.2020.544812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 12/07/2020] [Indexed: 02/05/2023] Open
Abstract
Determining readiness for duty after mild traumatic brain injury (mTBI) is essential for the safety of service members and their unit. Currently, these decisions are primarily based on self-reported symptoms, objective measures that assess a single system, or standardized physical or cognitive tests that may be insensitive or lack ecological validity for warrior tasks. While significant technological advancements have been made in a variety of assessments of these individual systems, assessments of isolated tasks are neither diagnostically accurate nor representative of the demands imposed by daily life and military activities. Emerging evidence suggests that complex tasks, such as dual-task paradigms or turning, have utility in probing functional deficits after mTBI. Objective measures from turning tasks in single- or dual-task conditions, therefore, may be highly valuable for clinical assessments and return-to-duty decisions after mTBI. The goals of this study are to assess the diagnostic accuracy, predictive capacity, and responsiveness to rehabilitation of objective, dual-task turning measures within an mTBI population. These goals will be accomplished over two phases. Phase 1 will enroll civilians at three sites and active-duty service members at one site to examine the diagnostic accuracy and predictive capacity of dual-task turning outcomes. Phase 1 participants will complete a series of turning tasks while wearing inertial sensors and a battery of clinical questionnaires, neurocognitive testing, and standard clinical assessments of function. Phase 2 will enroll active-duty service members referred for rehabilitation from two military medical treatment facilities to investigate the responsiveness to rehabilitation of objective dual-task turning measures. Phase 2 participants will complete two assessments of turning while wearing inertial sensors: a baseline assessment prior to the first rehabilitation session and a post-rehabilitation assessment after the physical therapist determines the participant has completed his/her rehabilitation course. A variable selection procedure will then be implemented to determine the best task and outcome measure for return-to-duty decisions based on diagnostic accuracy, predictive capacity, and responsiveness to rehabilitation. Overall, the results of this study will provide guidance and potential new tools for clinical decisions in individuals with mTBI. Clinical Trial Registration: clinicaltrials.gov, Identifier NCT03892291.
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Affiliation(s)
- Peter C Fino
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
| | | | - Leland E Dibble
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Mark E Lester
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX, United States.,Department of Physical Therapy, Texas State University, Round Rock, TX, United States
| | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX, United States
| | - Lucy Parrington
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Jorge Arango
- Traumatic Brain Injury Center of Excellence, Fort Carson, CO, United States
| | | | - Holly Roberts
- Madigan Army Medical Center, Joint Base Lewis-McChord, WA, United States
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
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9
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Eldridge BJ, Galea MP, Kissane AL, Broder JC, Brilleman SL, Wolfe R, Williams G. High-Level Mobility Assessment Tool Normative Values for Children. Phys Ther 2020; 100:324-331. [PMID: 31742357 DOI: 10.1093/ptj/pzz168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/20/2019] [Accepted: 08/13/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Physical therapists need to be able to evaluate high-level gross motor skills of children to determine their capacity to engage in activities such as running, jumping, hopping, and stair climbing. The High-Level Mobility Assessment Tool (HiMAT) has excellent interrater and retest reliability and is less susceptible to a ceiling effect than existing mobility scales in children who are 6 to 17 years old and have traumatic brain injury. OBJECTIVE The purposes of this study were to develop normative HiMAT score ranges for Australian children and to investigate the relationship between children's HiMAT scores and their age, height, weight, and body mass index (BMI). DESIGN This study used a cross-sectional design. METHODS Children included in this study were 5 to 12 years old, had no condition affecting their mobility, could follow 2-stage instructions, and had written informed consent from their parent or guardian. A total 1091 children were assessed at their local school, where their height, weight, and HiMAT score were recorded. The relationships between children's age, height, weight, and BMI were summarized using Spearman rank correlations. Truncated regression models were used to determine the most appropriate predictor variable for developing sex-specific normative ranges. RESULTS There was a positive correlation between children's HiMAT scores and their age, height, weight, and BMI. Age explained the most variability in HiMAT scores for both boys and girls. LIMITATIONS The reliability, validity, and responsiveness of the HiMAT have not been tested across a broad range of children with mobility limitations. Normative data reported in this study are for Australian children only. CONCLUSIONS HiMAT scores for children in this study increased with age, height, weight, and BMI. Age was the most appropriate variable for developing a normative dataset of HiMAT scores for children of primary school age.
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Affiliation(s)
- Beverly J Eldridge
- Department of Allied Health, La Trobe University, Level 4, The Alfred Centre, Melbourne, Victoria, Australia
| | - Mary P Galea
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Anne L Kissane
- Victorian Paediatric Rehabilitation Service, North Geelong, Victoria, Australia
| | - Jonathan C Broder
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, Monash University
| | - Gavin Williams
- Department of Physiotherapy, Epworth Healthcare; and Department of Physiotherapy, The University of Melbourne, Victoria, Australia
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10
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Lorenz LS, Charrette AL, O'Neil-Pirozzi TM, Doucett JM, Fong J. Healthy body, healthy mind: A mixed methods study of outcomes, barriers and supports for exercise by people who have chronic moderate-to-severe acquired brain injury. Disabil Health J 2017; 11:70-78. [PMID: 28870419 DOI: 10.1016/j.dhjo.2017.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/02/2017] [Accepted: 08/18/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Few people with chronic moderate-to-severe brain injury are following recommended physical activity guidelines. OBJECTIVE Investigate effects of planned, systematic physical activity while cultivating social and emotional well-being of people with chronic moderate-to-severe brain injury. HYPOTHESIS Moderate-to-intensive physical activity would be associated with improvements in impairment and activity limitation measures (endurance, mobility, gait speed) immediately post-intervention and six weeks later (study week 12). METHODS The intervention was a single group pre-/post-intervention study with 14 people with chronic moderate-to-severe brain injury who live in brain injury group homes and exercised 60-90 min, 3 days per week for 6 weeks at a maximum heart rate of 50-80%. Pre-post measures (administered weeks 0, 6 and 12) were the 6 Minute Walk Test, High-level Mobility Assessment Tool and 10 Meter Walk Test. The qualitative component used a brief survey and semi-structured interview guide with participants, family members, and staff. RESULTS Following program completion, post-intervention group changes were noted on all outcome measures and greater than minimal detectable change for people with brain injury. Three transitioned from low to high ambulatory status and maintained this change at 12 weeks. During interviews, participants agreed the program was stimulating. More than eighty percent liked working out in a group and felt better being active. CONCLUSIONS Program impact included physical, cognitive and social/emotional aspects. Social aspects (group format, trainers) were highly motivating and supported by residents, family, and staff. Investments in transportation and recruiting and training interns to assist participants are critical to program sustainability and expansion.
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Affiliation(s)
- Laura S Lorenz
- Supportive Living Inc. Research Council, Brain Injury Wellness Center, 7 Oakland Street, Lexington, MA 02420, USA; Brandeis University, The Heller School for Social Policy and Management, 415 South Street, Waltham, MA 02453, USA. http://www.supportivelivinginc.org
| | - Ann L Charrette
- Supportive Living Inc. Research Council, Brain Injury Wellness Center, 7 Oakland Street, Lexington, MA 02420, USA; Doctor of Physical Therapy Department, MCPHS University, 10 Lincoln Square, Worcester, MA 01541, USA.
| | - Therese M O'Neil-Pirozzi
- Supportive Living Inc. Research Council, Brain Injury Wellness Center, 7 Oakland Street, Lexington, MA 02420, USA; Northeastern University, Department of Communication Sciences and Disorders, 360 Huntington Avenue, Boston, MA 02115, USA; Spaulding/Harvard Traumatic Brain Injury Model System, 300 1st Avenue, Charlestown, MA 02129, USA.
| | - Julia M Doucett
- Community Rehab Care, 51 Water Street, #205, Watertown, MA 02472, USA.
| | - Jeffrey Fong
- School of Pharmacy, MCPHS University, Worcester, MA, USA
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11
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Hill B, Kahn M, Pallant J, Williams G. Assessment of the internal construct validity of the revised High-Level Mobility Assessment Tool for traumatic orthopaedic injuries. Clin Rehabil 2013; 28:491-8. [PMID: 24113726 DOI: 10.1177/0269215513502798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine whether the revised High-Level Mobility Assessment Tool (HiMAT) was valid for measuring mobility for people with multi-trauma orthopaedic lower limb injuries. DESIGN Cross-sectional study. SUBJECTS Participants with lower limb multi-trauma orthopaedic injuries. METHODS One complete revised HiMAT was obtained for 106 people within 12 weeks of being allowed to fully weight bear. Rasch analysis was used to assess the overall fit of the model for individuals and items, differential item functioning, local dependency, targeting of items and dimensionality. RESULTS The mean revised HiMAT score was 10.5 (SD = 6.8) with a range of 5-30. Rasch analysis of revised HiMAT showed adequate overall fit to the model (P = 0.29) with no misfitting items (fit residual SD = 0.69) or persons (fit residual SD = 0.62). The scale showed good internal consistency (Person Separation Index = 0.91). One item (hopping) demonstrated disordered thresholds, however this item had good fit to the model in all other aspects. The revised HiMAT was unidimensional, and no differential item functioning was detected for gender or age. The revised HiMAT was well targeted for this group with a range of items across all ability levels. CONCLUSION The results of this study support the internal construct validity of the revised HiMAT as a well-targeted, unidimensional measure of high-level mobility with no ceiling or floor effect for males and females recovering from multi-trauma orthopaedic lower limb injuries.
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Affiliation(s)
- Bridget Hill
- 1Epworth Monash Rehabilitation Medicine Unit, Epworth HealthCare, Melbourne, Victoria, Australia
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McArthur C, Venkatesh S, Warren D, Pringle D, Doerr T, Salbach NM, Kirkwood G, Wright V. Further development of the response scales of the Acquired Brain Injury Challenge Assessment (ABI-CA). Brain Inj 2013; 27:1271-80. [PMID: 24020440 DOI: 10.3109/02699052.2013.809551] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE To revise the scaling of the response sets of the Acquired Brain Injury Challenge Assessment (ABI-CA) through expert input and determination of empirically based cut-points. RESEARCH DESIGN A measurement development study with a content validity focus. METHODS Response option wording was revised through consultation with six physiotherapists with paediatric ABI expertise. Twenty-nine typically-developing children performed the ABI-CA and empirically-based cut-points for item-specific response options were derived from their time/distance/repetition results (SD values) as benchmark values. Movement quality considerations (compensatory movements) were identified from expert consultation/ABI-CA video observation and built into revised response options. The revised ABI-CA was pilot-tested with four children with ABI, aged 7-15 years, for a feasibility check. RESULTS Nineteen of the 23 items' response scales were revised based on experts' feedback and empirically-based cut-points replaced the previous arbitrarily-determined cut-points. Compensatory movement considerations were re-defined in nine items. The mean score of the refined ABI-CA was 70.0% (SD = 18.5) with four children with ABI. CONCLUSION The new response options in the ABI-CA appeared suitable for testing high-functioning children with ABI and the mid-range mean score in this pilot sample indicates its potential to measure change. Recommendations are outlined for final ABI-CA amendments before large-scale validation.
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Affiliation(s)
- Caitlin McArthur
- Department of Physical Therapy, Faculty of Medicine, University of Toronto , Toronto, Ontario , Canada
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Motor skills at 23 years of age in young adults born preterm with very low birth weight. Early Hum Dev 2013; 89:747-54. [PMID: 23810435 DOI: 10.1016/j.earlhumdev.2013.05.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 05/23/2013] [Accepted: 05/28/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Motor skills have previously not been reported in young adults born with very low birth weight (VLBW), although they are commonly reported in children and adolescents. AIM To compare fine and gross motor skills in VLBW young adults with matched term-born controls, and to study longitudinal changes in the VLBW group. STUDY DESIGN A geographically based follow-up study of a VLBW group and a control group. SUBJECTS Thirty-six VLBW (birth weight ≤ 1500 g) young adults, including four participants with cerebral palsy (CP), and 37 matched controls (birth weight ≥ 10th centile) were examined at 14 and 23 years of age. OUTCOME MEASURES Fine and gross motor skills were assessed using Grooved Pegboard test (GP), Trail Making Test-5 (TMT-5), Movement Assessment Battery for Children-2 (Movement ABC-2) and High-level Mobility Assessment Tool (HiMAT). RESULTS VLBW young adults were slower than controls on GP (p = 0.026) and TMT-5 (p < 0.001). Mean total Movement ABC-2 score was 69.7 ± 20.2 in the VLBW group compared with 74.1 ± 14.4 in the control group (p = 0.017). Differences were also seen in manual dexterity and balance. Additionally, HiMAT showed reduced balance and speed in gross motor skills in the VLBW group. The proportion of participants with motor problems did not change between age 14 and 23. After exclusion of participants with CP, scores were essentially the same. CONCLUSION VLBW young adults had overall poorer fine and gross motor skills compared with controls. Reduced speed seemed to be an underlying problem. Longitudinal findings indicate that VLBW children have not outgrown their motor problems when entering adulthood.
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