Developing a province-wide hip surveillance program for children with cerebral palsy: from evidence to consensus to program implementation: a mini-review.

Hip displacement is a common orthopedic problem in children with cerebral palsy (CP) that can result in significant morbidity. Hip surveillance has been shown to reduce the incidence of hip dislocations in children with CP and to reduce the need for salvage hip surgeries. Guidelines for hip surveillance have been developed and can be adapted to meet local needs. Implementation of surveillance guidelines for a population of children is complex and highly dependent upon the region, province/state, or country's system of care for children with CP. Recognizing that implementation of the evidence on hip surveillance was necessary in British Columbia, a Canadian province spanning 1 million square kilometers, a comprehensive, coordinated approach to hip surveillance was developed collaboratively by provincial stakeholders. Surveillance guidelines and a desired implementation plan were established based on the best available research evidence, current international practice, and service delivery in British Columbia. Staged implementation preceded full provincial roll out. Implementation was supported by detailed communication, knowledge translation, and evaluation plans. This province-wide hip surveillance program is the first of its kind in North America.

Functional electrical stimulation cycling in youth with spinal cord injury: A review of intervention studies.

CONTEXT: Preliminary research suggests that functional electrical stimulation cycling (FESC) might be a promising intervention for youth with spinal cord injury (SCI). OBJECTIVE: To review the evidence on FESC intervention in youth with SCI. METHODS: Systematic literature searches were conducted during December 2012. Two reviewers independently selected titles, abstracts, and full-text articles. Of 40 titles retrieved, six intervention studies met inclusion criteria and were assessed using American Academy for Cerebral Palsy and Developmental Medicine Levels of Evidence and Conduct Questions for Group Design. RESULTS: The study results were tabulated based on levels of evidence, with outcomes categorized according to the International Classification of Functioning, Disability, and Health framework. Evidence from the six included studies suggests that FESC is safe for youth with SCI, with no increase in knee/hip injury or hip displacement. Results from one level II randomized controlled trial suggest that a thrice weekly, 6-month FESC program can positively influence VO2 levels when compared with passive cycling, as well as quadriceps strength when compared with electrical stimulation and passive cycling. CONCLUSIONS: FESC demonstrates limited yet encouraging results as a safe modality to mitigate effects of inactivity in youth with SCI. More rigorous research involving a greater number of participants is needed before clinicians can be confident of its effectiveness.

Classification of midfoot break using multi-segment foot kinematics and pedobarography.

Midfoot break (MFB) is a foot deformity that can occur when ankle dorsiflexion is restricted due to muscle spasticity or contractures, causing abnormal increased motion through the midfoot. MFB has been previously described in terms of forefoot (FF) and hindfoot (HF) motion in the sagittal plane. The purpose of this study was to further classify MFB by describing FF and HF motion in the coronal and transverse planes along with plantar pressures, with the goal of optimizing treatment of this deformity. Three-dimensional foot kinematics were assessed using a multi-segment foot model in children with MFB (n=30) and children with no foot or gait abnormalities (n=30). The MFB group was subdivided into three categories: (1) Pronated MFB, (2) Supinated MFB and (3) Flat Foot MFB. Unique patterns of plantar pressures and foot kinematics were identified for each MFB group. The Pronated MFB group had increased medial midfoot pressures, increased forefoot pronation, and increased external forefoot rotation (forefoot abductus). The Supinated MFB group had increased lateral midfoot pressures, increased forefoot supination, and increased internal forefoot rotation (forefoot adductus). In the Flat Foot MFB group, midfoot pressures were increased and distributed uniformly between the medial and lateral sides, forefoot pronation was increased, and internal forefoot rotation was present. By combining this new information with previously reported methods of measuring sagittal plane kinematics of MFB, it is now possible to characterize midfoot break in terms of severity and foot-floor contact pattern.

A kinematic description of dynamic midfoot break in children using a multi-segment foot model.

Midfoot break (MFB) is a foot deformity that occurs most commonly in children with cerebral palsy (CP), but may also affect children with other developmental disorders. Dynamic MFB develops because the muscles that cross the ankle joint are hypertonic, resulting in a breakdown and dysfunction of the bones within the foot. In turn, this creates excessive motion at the midfoot. With the resulting inefficient lever arm, the foot is then unable to push off the ground effectively, resulting in an inadequate and painful gait pattern. Currently, there is no standard quantitative method for detecting early stages of MFB, which would allow early intervention before further breakdown occurs. The first step in developing an objective tool for early MFB diagnosis is to examine the difference in dynamic function between a foot with MFB and a typical foot. Therefore, the main purpose of this study was to compare the differences in foot motion between children with MFB and children with typical feet (Controls) using a multi-segment kinematic foot model. We found that children with MFB had a significant decrease in peak ankle dorsiflexion compared to Controls (1.3 ± 6.4° versus 8.6 ± 3.4°) and a significant increase in peak midfoot dorsiflexion compared to Controls (15.2 ± 4.9° versus 6.4 ± 1.9°). This study may help clinicians track the progression of MFB and help standardize treatment recommendations for children with this type of foot deformity.

Parent goals as outcome measures for children receiving treadmill training: a series of case reports.

BACKGROUND: This series of case reports examined attainment of parents' goals for children receiving treadmill training and parents' satisfaction with goal attainment. METHODS: Four children with cerebral palsy completed 5-8 weeks of standardized training while wearing a body weight support harness. Outcome measures were family goals using goal attainment scaling (GAS): a score of 0 equaled goal attainment, scores of -2 and -1 represented lower-than-expected performance and +1 and +2 exceeded expected performance. Parent satisfaction with goal attainment was assessed on a Likert scale from 1 (very satisfied) to 5 (very unsatisfied). RESULTS: All participants achieved GAS levels of ≥0, indicating all goals were met. All parents rated their satisfaction with goal attainment as 'very satisfied'. CONCLUSION: This is the first report using family goals as outcome measures to assess effects of treadmill training. Future studies of treadmill training should include family- and child-centred goals as potential outcomes.

Interrater reliability and convergent validity of the American Academy for Cerebral Palsy and Developmental Medicine methodology for conducting systematic reviews.

AIM: The aim of this study was to evaluate the interrater reliability and convergent validity of the American Academy for Cerebral Palsy and Developmental Medicine's (AACPDM) methodology for conducting systematic reviews (group design studies). METHOD: Four clinicians independently rated 24 articles for the level of evidence and conduct using AACPDM methodology. Study conduct was also assessed using the Effective Public Health Practice Project scale. Raters were randomly assigned to one of two pairs to resolve discrepancies. The level of agreement between individual raters and pairs was calculated using kappa (α=0.05) and intraclass correlations (ICCs; α=0.05). Spearman's rank correlation coefficient was calculated to evaluate the relationship between raters' categorization of quality categories using the two tools. RESULTS: There was acceptable agreement between raters (κ=0.77; p<0.001; ICC=0.90) and between assigned pairs (κ=0.83; p<0.001; ICC=0.96) for the level of evidence ratings. There was acceptable agreement between pairs for four of the seven conduct questions (κ=0.53-0.87). ICCs (all raters) for conduct category ratings (weak, moderate, and strong) also indicated good agreement (ICC=0.76). Spearman's rho indicated a significant positive correlation for the overall quality category comparisons of the two tools (0.52; p<0.001). CONCLUSIONS: The AACPDM rating system has acceptable interrater reliability. Evaluation of its study quality ratings demonstrated reasonable agreement when compared with a similar tool.

Effectiveness of treadmill training in children with motor impairments: an overview of systematic reviews.

PURPOSE: The purpose of this review was to synthesize current evidence from systematic reviews on the effectiveness of treadmill training (TT), including partial body-weight support (PBWS) TT (PBWSTT), TT only, robotic-assist PBWSTT, and mixed TT, in children with motor impairments. METHODS: Systematic literature searches were conducted in 10 databases through May 2010. Two reviewers independently selected titles, abstracts (k = 0.78), and full-text articles (k = 1.0). Of the 1166 titles retrieved, 5 studies met the inclusion criteria. Quality of included studies was assessed using AMSTAR criteria. RESULTS: Results of each systematic review were tabulated on the basis of levels of evidence, with outcomes categorized according to the International Classification of Functioning, Disability, and Health framework. Conflicting interpretations of outcomes were found between reviews, yet conclusions were similar. CONCLUSIONS: TT demonstrates encouraging results, but more rigorous research is needed before clinicians can be confident of its effectiveness and clinical guidelines can be developed.

Comparative predictive validity of the Harris Infant Neuromotor Test and the Alberta Infant Motor Scale.

AIM: We compared abilities of the Alberta Infant Motor Scale (AIMS) and the Harris Infant Neuromotor Test (HINT), during the infant's first year, in predicting scores on the Bayley Scales of Infant Development (BSID) at age 2 and 3 years. METHOD: This prospective study involved 144 infants (71 females, 73 males), assessed with the HINT and AIMS at 4 to 6.5 and 10 to 12.5 months and with the BSID at 2 and 3 years. Inclusion criteria for typical infants (n=58) were the following: 38 to 42 weeks' gestation, birthweight at least 2500g, and no congenital anomaly, postnatal health concern, nor major prenatal or perinatal maternal risk factor. For at-risk infants (n=86), inclusion criteria were any of the following: less than 38 weeks' gestation, birthweight less than 2500g, maternal age older than 35 years or younger than 19 years at infant birth, maternal psychiatric/mental health concerns, prenatal drug/alcohol exposure, multiple births, or use of reproductive technology. RESULTS: For the overall sample, the early (4-6.5mo) HINT had higher predictive correlations than the AIMS for 2-year BSID-II motor outcomes (r=-0.36 vs 0.26), and 3-year BSID-III gross motor outcomes (r=-0.45 vs 0.31), as did the 10- to 12.5-month HINT (r=-0.55 vs 0.47). Correlations were identical for 10- to 12.5-month HINT and AIMS scores and 3-year BSID-III gross motor (r=-0.58 and 0.58) and fine motor (r=-0.35 and 0.35) subscales. When the sample was divided into typical and at-risk groups, predictive correlations were consistently stronger for the at-risk infants. Categorical predictive analyses were reasonably similar across both tests. INTERPRETATION: Results suggest that the HINT has comparable predictive validity to the AIMS and should be considered for use in clinical and research settings.

Comparison of two methods of teaching early childhood professionals to score a developmental screening test.

Increasingly, computer-assisted learning is becoming an educational method of choice. This study compared the effectiveness of in-class versus Internet-based training in achieving reliability when administering a developmental screening test, the Alberta Infant Motor Scale. Forty-eight early childhood professionals, including physical therapists, occupational therapists, nurses, and infant development consultants, took part in the study. Participants in this convenience sample were each assigned to one of the two learning groups. We assessed interrater reliability and participants' satisfaction with training method. Disciplines were equally distributed within the two groups, but geographical locations differed significantly. There was no difference in intraclass correlation coefficients for interrater reliability between the two groups. Although there was no difference in overall satisfaction with the quality of the courses, significant differences were found in the trainees' satisfaction with certain aspects of the courses. Although several study limitations existed, Internet-based training provides a feasible option for training practitioners to reliably use developmental screening tests such as the Alberta Infant Motor Scale.

Concurrent validity of the Harris Infant Neuromotor Test and the Alberta Infant Motor Scale.

We examined concurrent validity of scores for two infant motor screening tools, the Harris Infant Neuromotor Test (HINT) and the Alberta Infant Motor Scale, in 121 Canadian infants. Relationships between the two tests for the overall sample were as follows: r = -.83 at 4 to 6.5 months (n = 121; p < .01) and r = -.85 at 10 to 12.5 months (n = 109; p < .01), suggesting that the HINT, the newer of the two measures, is valid in determining motor delays. Each test has advantages and disadvantages, and practitioners should determine which one best meets their infant assessment needs.

Gross motor development of Asian and European children on four motor assessments: a literature review.

PURPOSE: The purpose of this article is to review the evidence surrounding similarities and differences in motor development in children of Asian and European ethnic backgrounds to ensure the appropriateness of mixed ethnicity normative comparison data. SUMMARY OF KEY POINTS: A review of published studies indicates variability in rate and possibly sequence of motor development in children of European and Asian origins. STATEMENT OF CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE: Assessment tools used to discriminate motor development in children of different ethnic backgrounds should be interpreted with caution until there is sufficient information regarding the appropriateness of comparisons among children of different ethnic origins.