Adapting a measure of gross motor skills for individuals with CDKL5 deficiency disorder: A psychometric study

PURPOSE

Validated measures capable of demonstrating meaningful interventional change in the CDKL5 deficiency disorder (CDD) are lacking. The study objective was to modify the Rett Syndrome Gross Motor Scale (RSGMS) and evaluate its psychometric properties for individuals with CDD.

METHODS

Item and scoring categories of the RSGMS were modified. Caregivers registered with the International CDKL5 Clinical Research Network uploaded motor videos filmed at home to a protected server and completed a feedback questionnaire (n = 70). Rasch (n = 137), known groups (n = 109), and intra- and inter-rater reliability analyses (n = 50) were conducted.

RESULTS

The age of individuals with CDD ranged from 1.5 to 34.1 years. The modified scale, Gross Motor-Complex Disability (GM-CD), comprised 17 items. There were no floor or ceiling effects and inter- and intra-rater reliability were good. Rasch analysis demonstrated that the items encompassed a large range of performance difficulty, although there was some item redundancy and some disordered categories. One item, Prone Head Position, was a poor fit. Caregiver-reported acceptability was positive. Scores differed by age and functional abilities.

SUMMARY

GM-CD appears to be a suitable remotely administered measure and psychometrically sound for individuals with CDD. This study provides the foundation to propose the use of GM-CD in CDD clinical trials. Longitudinal evaluation is planned.

Micro-duplications of 1q32.1 associated with neurodevelopmental delay

Distal partial trisomies involving the region 1q32 have been associated with dysmorphic features and developmental delay [1-11]. To further define the critical region for developmental delay and to investigate the genotype-phenotype association of 1q trisomy syndrome, we report two patients with much smaller (3 Mb and 3.5 Mb in size) trisomic regions on 1q32.1. The two micro-duplications largely overlap and both patients exhibited cognitive and motor delays. Case 1 is a 5-year-old boy with global developmental delay, behavioral problems, pervasive developmental disorder not otherwise specified (PDD-NOS), staring spells, headaches, and paresthesias. Case 2 is a 14-year-old girl with seizures, cognitive and motor difficulties, and minor dysmorphic features. These two cases suggest that 1q32.1 region on distal arm of 1q and genes involved are critical to cognitive and motor development in a gene dosage sensitive manner and that other neurological features are variable within this syndrome.

Viability and histopathology of eleven fresh, antibiotic-treated allografts removed three weeks to three years after implantation

Changes in metabolic activity of removed heart valve allografts have been measured. The fresh heart valves were sterilized and stored in antibiotic solution before implantation in patients. Viability was determined before insertion and after removal from patients by two methods: 1) tissue culture, and 2) autoradiography, using tritiated thymidine. The length of storage in the Hank's antibiotic or nutrient-antibiotic medium before insertion did not seem to influence the final metabolic activity nor the structural integrity of the allografts when they were removed. Results from the present study show that the most severe degenerative changes occur in valves stored in Hank's solution and then implanted in the mitral position. The viability percentage declined progressively during the time that a valve treated in this manner was functioning in a patient.