Social participation of children age 8-12 with SLI.

PURPOSE: Two objectives are being pursued: (1) to describe the level of social participation of children aged 8-12 presenting a specific language impairment (SLI) and (2) to identify personal and family factors associated with their level of social participation. METHOD: This cross-sectional study was conducted among 29 children with SLI and one of their parents. Parental stress and family adversity were measured as risk factors. The measure of life habits (LIFE-H) adapted to children aged 5-3 was used to measure social participation. RESULTS: The assumption that social participation of these children is impaired in relation to the communication dimension was generally confirmed. The statements referring to the "communication in the community" and "written communication" are those for which the results are weaker. "Communication at home" is made easier albeit with some difficulties, while "telecommunication" is totally preserved. A high level of parental stress is also confirmed, affecting the willingness of parents to support their child's autonomy. CONCLUSIONS: The achievement of a normal lifestyle of children with SLI is upset in many spheres of life. Methods of intervention must better reflect the needs and realities experienced by these children in their various living environments, in order to optimize social participation, and consequently, to improve their well-being and that of their families. The need to develop strategies to develop children's independence and to reduce parental stress must be recognized and all stakeholders need to be engaged in the resolution of this challenge. IMPLICATIONS FOR REHABILITATION: The realization of life habits of SLI children is compromised at various levels, especially in the domain related to "communication in the community" and "written communication". Speech-language pathologists must consider providing ongoing support throughout the primary years of these children and during adolescence, to promote and facilitate the continued realization of life habits of SLI persons. Providing ongoing support throughout the primary years and thereafter is needed to facilitate the continuing realization of life habits of SLI persons. Parents of children with SLI experience considerable stress in relation to the exercise of their parental roles. It is important to intervene and to support parents to promote autonomy for their SLI children.

Hand-Held Dynamometry Isometric Torque Reference Values for Children and Adolescents.

PURPOSE: To establish hand-held dynamometry (HHD) maximal isometric muscle torque (MIT) reference values for children and adolescents who are developing typically. METHODS: The MIT of 10 upper and lower limb muscle groups was assessed in 351 Caucasian youth (4 years 2 months to 17 years) using a standardized HHD protocol, previously shown to be feasible, valid, and reliable. RESULTS: The mean MIT and 95% confidence interval of the mean for all muscle groups, for each of the 14 age groups (1 year age span for each group), and for each sex, were reported in both absolute (Nm) and normalized (Nm/kg) values. CONCLUSION: These HHD reference values may be helpful in the identification of muscle strength impairments in several pediatric populations, especially when bilateral impairments are present.

Social participation by children with developmental coordination disorder compared to their peers.

PURPOSE: Two objectives are being pursued: (1) to describe and compare the level of social participation of children aged 5-13 with developmental coordination disorder (DCD) to children of the same age with typical development (TD) and (2) to describe and compare the level of social participation of two subgroups of youths with DCD, e.g. children with dyspraxia affecting both the motor sphere and the verbal sphere (mixed dyspraxia) and children with developmental dyspraxia. METHOD: This cross-sectional study was conducted among 27 youngsters with DCD: 9 having developmental dyspraxia and 18 having mixed dyspraxia, compared to 27 same-age peers with TD. Life habits (LIFE-H) for children was used to measure social participation. RESULTS: Levels of lifestyle achievements among youngsters with DCD are significantly lower than those of TD youngsters in all categories. Noteworthy differences were found between subgroups of youngsters with DCD in the categories of life habits related to communication and education. The group with mixed dyspraxia obtained the lowest scores. CONCLUSIONS: The achievement of a normal lifestyle by youngsters with DCD is upset in all spheres of life. The impact of DCD on the level of participation of these youngsters is quite significant and affects all lifestyles measured in this study. Children with mixed dyspraxia are particularly affected. These facts must be taken into consideration by anyone involved in the lives of these youngsters. IMPLICATIONS FOR REHABILITATION: It is necessary to encourage social participation of DCD sufferers aged 5-13 in all spheres of life. Special attention should be paid to those who have a speech disorder. Life habits concerning communication and education may be related; greater efforts should be made to limit the negative impact on other lifestyles. Social participation of DCD sufferers should be measured periodically and appropriate resources must be made available to promote training and support for clinicians. It is important to provide tools to measure social participation for both stakeholders and parents.

Relationships between lower limb muscle strength and locomotor capacity in children and adolescents with cerebral palsy who walk independently.

This study aimed to quantify relationships between lower limb muscle strength and locomotor capacity for children and adolescents with cerebral palsy (CP) to identify key muscle groups for strength training. Fifty 6- to 16-year-olds with CP (Gross Motor Function Classification System level I or II) participated. Isometric muscle strength of hip flexor and abductor, knee flexor and extensor, and ankle dorsiflexor muscles was measured using hand-held dynamometry. Ankle plantar flexor concentric muscle strength was assessed as the maximal number of unilateral heel rises. Locomotor capacity was evaluated by the 6-min walk test (6MWT), 10-meter Shuttle Run Test (10mSRT), and Timed Up and Down Stairs Test (TUDS). With control for age, sex, and height, hip flexor and ankle plantar flexor strength explained 47.8% of the variance in the 6MWT and 32.9% of variance in the TUDS and hip abductor isometric strength explained 43.5% of the variance in the 10mSRT. Avenues for future research include randomized controlled trials that specifically target hip flexor muscles, as this has not previously been done, and determining factors other than strength that are likely related to locomotor capacity of children and adolescents with CP.

Isometric muscle strength in youth assessed by hand-held dynamometry: a feasibility, reliability, and validity study.

PURPOSE: To determine, with respect to measurement of maximal isometric torque (MIT) using a specific hand-held dynamometer (HHD) protocol, (1) protocol feasibility over a wide age range, (2) intra- and interrater reliability, (3) standard error of measurement, and (4) concurrent validity. METHODS: The MIT of selected upper and lower limb muscle groups was assessed (n = 74; age = 4-17.5 years) using a standardized, HHD protocol. Testing was repeated in 20 adolescents (n = 10 for each muscle group), who were also assessed with a Cybex dynamometer. RESULTS: The protocol was feasible for all participants. Mean intra- and interrater reliability [intraclass correlation coefficient (ICC)] varied from 0.75 to 0.98, except for ankle dorsiflexor interrater reliability (mean ICC = 0.67). The standard error of measurement varied from 0.5 to 4.9 Nm and was highest for hip extensors. Mean concurrent validity (ICC) varied from 0.78 to 0.93, except for ankle plantar flexors (mean ICC = 0.48). CONCLUSIONS: Our HHD protocol was feasible over a wide age range and most MIT values were valid and reliable.

Revisiting therapy assumptions in children's rehabilitation: clinical and research implications.

PURPOSE: This commentary draws on a recent workshop hosted by the Canadian Children's Rehabilitation Research Network that brought together stakeholders to critically examine assumptions embedded in children's rehabilitation in order to advance current debates and suggest areas for further inquiry. METHOD: Six issues are discussed: (1) the wisdom of dichotomising 'fix' versus 'function'; (2) the ethics of it might help and it won't hurt' therapy approaches; (3) the emphasis on early intervention rather than a lifespan approach; (4) the challenges of providing care for new rehabilitation populations; (5) discrepancies between performance outcomes and patient satisfaction; and (6) innovative partnerships to support care transitions of adolescents and their families. RESULTS: Issues identified include: finding the right balance between therapies that focus on 'fixing' children versus enhancing function, judicious design of therapy programs as to not overburden children and families, adopting lifespan approaches to meet the needs of multiple 'paediatric' populations, cautious interpretation of measures and approaches that link well-being with physical performance, and the benefits of including parent and youth facilitators on children's rehabilitation teams. CONCLUSIONS: Ongoing debate, discussion and research are needed in each of these areas to ensure that rehabilitation services are enhancing the well-being of children and families.

Measuring participation in children with disabilities using the Assessment of Life Habits.

The objectives of this study were: (1) to examine the psychometric properties of the Assessment of Life Habits (LIFE-H) for children; and (2) to draw a profile of the level of participation among children of 5 to 13 years of age with various impairments. The research team adapted the adult version of the LIFE-H in order to render it more appropriate for the daily life experiences of children. Content validity was verified by an expert panel of 29 people, made up of parents, paediatric clinicians, and researchers. Reliability and construct validity of the LIFE-H for children (interview-administered form) was tested during an experiment that comprised three sessions of interviews with a group of 94 parents of children with disabilities (36 males, 58 females; mean age 8y 10mo [SD 2y 6 mo]; diagnostic groups: cerebral palsy, myelomeningocoele, sensory-motor neuropathy, traumatic brain injury, and developmental delay). Overall, the LIFE-H showed high intrarater reliability with intraclass correlation coefficient values of 0.78 or higher for 10 out of 11 categories. The correlations between the LIFE-H and the tools used in pediatric rehabilitation varied, and categories with similar constructs generally led to higher correlations. The psychometric properties of the LIFE-H are appropriate and its content allows a complete description of participation among children with disabilities.

Factors in creating sustainable intersectoral community mobilization for prevention of heart and lung disease.

This paper describes factors facilitating and working against successful community mobilization in the implementation of an integrated prevention programme for cardiovascular disease and lung cancer in four community settings in Québec, Canada. Implementation evaluation data from several sources showed that over the 3-year period, mobilization was partly achieved in all four communities, although the degree of success varied. The data support those of previous studies showing that several factors are key to effective intersectoral community mobilization: (i) involvement of concerned and influential community members with a commitment to shared goals and a visible community focus; (ii) formation of multi-organization systems among appropriate organizations, recognizing their strengths, resources and competencies, and preserving both their autonomy and interdependence with an appreciation of divergent perspectives; (iii) development of decision-making mechanisms through the setting up of formal structural arrangements to facilitate decisions with clear leadership; (iv) clear definition of objectives, tasks, roles and responsibilities; and (v) official support and legitimization from participating agencies, government authorities, and organizations with adequate resources devoted to partnership building. This study also replicated a number of barriers to the creation of sustainable intersectoral community mobilization, notably the potentially destructive role of power conflicts among the key institutional partners.