Reliability of the EasyAngle® for Assessing Hip Range of Motion in Healthy Children.

Background: The use of digital goniometry has emerged as a viable alternative to universal goniometry for assessing hip range of motion (ROM). However, few studies have assessed the use of digital goniometry in pediatric populations and there are a limited number of studies that investigate any one device. The EasyAngle® is a digital goniometer that may be beneficial for use in pediatric settings as it requires only one hand to operate the device. Purpose: The purposes of this study were 1) to establish the intrarater and interrater reliability of the EasyAngle® digital goniometer in measuring hip joint ROM in healthy elementary school-aged children, and 2) to establish preliminary normative reference values for each year of age using the EasyAngle® for hip joint ROM in healthy elementary school-aged children. Study Design: Descriptive Laboratory Study. Methods: Passive hip ROM (flexion, abduction, extension, internal rotation, external rotation) was measured on each leg of healthy participants using the EasyAngle®. A total of 40 hip joints were measured. Two blinded raters conducted three trials of each hip motion on both legs. Intrarater and interrater reliability of the recorded hip range of motion were calculated using intra-class correlation coefficients (ICC) (3,1). Results: Twenty healthy children were measured (age 5-10, mean = 7.40 years old, SD = 1.37, 9 males, 11 females). Mean hip ROM was reported by age. Intrarater and interrater reliability were good to excellent for all hip ROM measurements (0.81-0.97 intra rater; 0.77- 0.91 interrater). Hip flexion had the strongest intrarater (0.96, 0.97) and interrater reliability (0.91). Intrarater reliability was lowest for hip abduction for Rater 1 and hip extension for Rater 2. Interrater reliability was lowest for hip external rotation (0.78). Conclusion: The EasyAngle® is a reliable tool for assessing hip range of motion in healthy children ages 5-10. Normative hip ROM values using the EasyAngle® are available to clinicians. Level of Evidence: Level 3- Reliability study.

The reliability and validity of the Timed Up and Go as a clinical tool in individuals with and without disabilities across a lifespan: a systematic review.

PURPOSE: To summarize the available literature related to reliability and validity of the Timed Up and Go in typical adults and children, and individuals diagnosed with the following pathologies: Huntington's disease, stroke, multiple sclerosis, Parkinson's disease, spinal cord injury, Down syndrome, or cerebral palsy. MATERIALS AND METHODS: A search was conducted using MeSH terms and keywords through a variety of databases. Data regarding reliability and validity were synthesized. RESULTS: This review included 77 articles. Results were variable depending on the studied population. The Timed Up and Go showed excellent reliability in typical adults, in individuals with cerebral palsy, in individuals with multiple sclerosis, in individuals with Huntington's disease, individuals with a stroke, and individuals with a spinal cord injury. The TUG demonstrated strong concurrent validity for individuals with stroke and spinal cord injury. Predictive validity data was limited. CONCLUSIONS: Based on the literature assessed, the Timed Up and Go is clinically applicable and reliable across multiple populations. The Timed Up and Go has a wide variety of clinical use making it a diverse measure that should be considered when choosing an outcome an activity based outcome measure. However, there are some limitations in the validity of the utilization of the Timed Up and Go to some populations due to a lack of data and/or poor choice of comparison outcome measures when assessing validity. Additional research is needed for young to middle aged adults.IMPLICATIONS FOR REHABILITATIONOutcome measures are a vital component of clinical practice across all populations.The Timed Up and Go is a highly studied outcome measure in the geriatric population, but lacks research of its applicability to other populations.This study was able to highlight the clinical utility of the Timed Up and Go in populations that under utilize this outcome measure.

Evidence-Based Secondary Transition Predictors for Physical Therapists Working With High School Students.

PURPOSE: Individuals with disabilities experience poorer postschool outcomes compared with their peers without disabilities. Youth with orthopedic or physical disabilities experience challenges during transition particularly in the areas of education and employment. Physical therapists should continue to become more involved in transition planning and providing services for transition-age students with physical disabilities. The purpose of this article is to clarify the role of physical therapists who work with students who have disabilities, as they transition from high school to postsecondary roles as well as provide the current evidence-based predictors of postschool success and recommended practices to school-based physical therapists who work with these students. SUMMARY OF KEY POINTS: Evidence-based instructional practices for secondary students with disabilities and identified in-school predictors of postschool success for students with disabilities are aligned with effective practices for physical therapists. Additionally, suggestions for involving physical therapists in transition planning and increasing collaboration in providing transition services for students with disabilities are provided. STATEMENT OF CONCLUSIONS: Physical therapists can provide critical expertise for many individuals with disabilities; however, they are not always included effectively in transition planning and services for students with disabilities. RECOMMENDATIONS FOR CLINICAL PRACTICE: Recommendations for practice include ways to involve physical therapists in transition planning and services and increasing collaboration between teachers, physical therapists, and other members of the Individualized Education Program team to provide effective, comprehensive transition services.

Effectiveness of Exercise on Functional Mobility in Adults with Cerebral Palsy: A Systematic Review.

Purpose: We identified evidence evaluating the effect of exercise on functional mobility in adults (aged 18 y or older) with cerebral palsy (CP). Method: An exhaustive search was conducted using the electronic databases PubMed, MEDLINE, CINAHL, PsycINFO, SPORTDiscus, and Cochrane Database of Systematic Reviews from the earliest available evidence (1975) to the present (January 2016) for studies whose participants were ambulatory adults with CP receiving conservative treatment to address functional mobility limitations. Two independent reviewers agreed on the eligibility, inclusion, and level of evidence of each study. The Maastricht-Amsterdam List (MAL) was used to assess evidence quality. Results: Five of the six studies included were randomized controlled trials, and one was a pre-post case series. Interventions included whole-body vibration, treadmill training without body-weight support, rhythmic auditory stimulation, dynamic balance and gait activities, progressive resistance training, and interactive serious gaming for balance. All studies were considered high quality, as indicated by their MAL scores. Four studies showed no statistical difference and trivial effect sizes between the intervention and the control group. Rhythmic auditory stimulation and interactive serious gaming were found to be statistically significant in benefiting adults with CP. Conclusions: Evidence of the effect of exercise on functional mobility for ambulatory adults with CP is lacking. A need exists for quality research to determine the best interventions for adults with CP to maximize functional mobility.

Objectif : recenser les données probantes sur l'efficacité de l'exercice sur la mobilité fonctionnelle des adultes (18 ans et plus) atteints de paralysie cérébrale (PC). Méthode : une recherche exhaustive a été menée dans les bases de données électroniques PubMed, MEDLINE, CINAHL, PsycInfo, SPORTDiscus et Cochrane Database of Systematic Reviews à partir des données les plus anciennes (1975) jusqu'à aujourd'hui (janvier 2016) sur des études menées auprès d'adultes ambulatoires atteints de PC recevant un traitement conservateur pour leur mobilité fonctionnelle réduite. Deux examinateurs indépendants ont convenu de l'admissibilité, de l'inclusion et du niveau de données probantes de chaque étude. La liste de critères Maastricht-Amsterdam (MA) a été utilisée pour évaluer la qualité des preuves. Résultats : cinq des six études incluses étaient des essais randomisés et l'autre était une série de cas avant/après. Les interventions incluaient des vibrations transmises à l'ensemble du corps, un entraînement sur tapis roulant sans support du poids corporel, une stimulation auditive rythmique, des activités d'équilibre dynamique et de démarche, des exercices progressifs de musculation et des jeux interactifs d'équilibre. Toutes les études étaient de grande qualité, comme l'indique leur score de la liste de critères MA. Quatre études n'ont montré aucune différence statistique et ont montré une ampleur de l'effet négligeable entre l'intervention et le groupe témoin. La stimulation auditive rythmique et les jeux interactifs ont montré des bienfaits significatifs d'un point de vue statistique chez les adultes atteints de PC. Conclusions : il n'y a pas suffisamment de données probantes sur l'effet de l'exercice sur la mobilité fonctionnelle des adultes ambulatoires atteints de PC. Des recherches de qualité sont nécessaires pour déterminer les interventions les plus efficaces pour améliorer la mobilité fonctionnelle des adultes atteints de PC.

The continuum of care for individuals with lifelong disabilities: role of the physical therapist.

Many individuals with lifelong disabilities (LLDs) of childhood onset are living longer, participating in adult roles, and seeking comprehensive health care services, including physical therapy, with greater frequency than in the past. Individuals with LLDs have the same goals of health and wellness as those without disabilities. Aging with a chronic LLD is not yet well understood; however, impairments such as pain, fatigue, and osteoporosis often present earlier than in adults who are aging typically. People with LLDs, especially those living with developmental disabilities such as cerebral palsy, myelomeningocele, Down syndrome, and intellectual disabilities, frequently have complex and multiple body system impairments and functional limitations that can: (1) be the cause of numerous and varied secondary conditions, (2) limit overall earning power, (3) diminish insurance coverage, and (4) create unique challenges for accessing health care. Collaboration between adult and pediatric practitioners is encouraged to facilitate smooth transitions to health practitioners, including physical therapists. A collaborative client-centered emphasis to support the transition to adult-oriented facilities and promote strategies to increase accessibility should become standard parts of examination, goal setting, and intervention. This perspective article identifies barriers individuals with selected LLDs experience in accessing health care, including physical therapy. Strategies are suggested, including establishment of niche practices, physical accessibility improvement, and inclusion of more specific curriculum content in professional (entry-level) doctorate physical therapy schools.