The novel Next Step test is a reliable measure of anticipatory postural adjustments made by children with cerebral palsy prior to taking a step.

BACKGROUND: Children with cerebral palsy (CP) make smaller medio-lateral anticipatory postural adjustments (APAs) than typically developing peers when stepping forward to a medial target. They are also less accurate at reaching the stepping target. The Next Step test involves the biomechanical measurement of APAs and foot placement error. These may be useful outcome measures to evaluate dynamic balance in a clinical trial. The reliability of the measures must be assessed to establish their reliability as research tools. RESEARCH QUESTION: What is the inter-rater and intra-rater reliability of stepping accuracy and measures of APAs made by children prior to taking a step? METHODS: Typically developing (TD) (n = 14) or children with CP (n = 16) were recruited from local clinics. Children stepped to electro-luminescent targets placed medially and laterally to each foot. Stepping responses were measured using a force plate and 3D motion analysis of markers placed on the feet and pelvis. The APA was defined as the movement of the centre of pressure (COP) and the centre of mass (COM) estimated via pelvic markers, prior to lifting the lead leg. Stepping accuracy was defined as the absolute distance between the target and end foot position. Participants undertook two data collection sessions separated by at least one week. In session one, the test was measured by rater 1 who repeated this in session two, along with another data collection by a rater 2 or rater 3, after a rest period. Where data were normally distributed, they were assessed for inter-rater and intra-rater reliability using an intra-class correlation coefficient (ICC) and Bland-Altman plots. The standard error of measurement was calculated to determine the minimum difference needed to detect true change. RESULTS: There was no between-group differences in group characteristics (age, weight, height) or in stepping velocity. We found good to excellent reliability when measuring the amplitude and velocity of medio-lateral APAs (ICC range 0.73-0.89). The reliability of antero-posterior APAs was more variable (ICC range 0.08-0.92). The minimum difference to detect a true change for peak medio-lateral motion of COP ranges from 23.7 mm to 29.6 mm and for peak velocity of medio-lateral COM estimate 41-61.9 mm. Stepping accuracy was not normally distributed. SIGNIFICANCE: The Next Step test is a reliable measure of dynamic balance. The peak medio-lateral motion of the COP and medio-lateral velocity of the COM estimate are reliable when measured during a constrained stepping task in ambulant children with cerebral palsy.

A cross sectional study investigating dynamic balance when stepping to targets in children with cerebral palsy compared to typically developing children.

BACKGROUND: Children with Cerebral Palsy (CP) have altered anticipatory postural adjustments (APAs) during gait initiation. These APAs may affect dynamic balance in tasks such as stepping. RESEARCH QUESTIONS: How are APAs in children with CP affected during stepping to precise targets? How do children with CP modulate APAs when stepping to medial and lateral targets? What is the association between APAs and symptom severity, movement quality and impairment profile? METHOD: Children undertook a stepping task to laterally and medially placed targets with either leg, in a randomised order. Movement of the centre of pressure (COP) and markers at the pelvis and foot were measured via a force plate and 3D motion analysis. Motion of the centre of mass (COM) was estimated via pelvic markers. APAs were assessed prior to leading leg lift-off in medio-lateral and antero-posterior directions. Stepping error was calculated. Baseline characteristics of children with CP included Gross Motor Function Measure (GMFM), Quality Function Measure (QFM), leg muscle hypertonia (Tardieu test) and strength (manual dynamometry). RESULTS: Sixteen ambulant children with CP (12.2 years ± 2.2) and 14 typically developing (TD) children (11.6 years ± 2.9) were assessed. In children with CP, APAs in the medio-lateral direction were 20-30% smaller. Children with CP were less able to modulate their APAs with steps to medial and laterally placed targets, than TD children. Medio-lateral COP motion was associated with movement quality assessed by QFM subsections, GMFM (correlation coefficient r = 0.66-0.80) and hip abductor strength (r = 0.75). Antero-posterior APAs were significantly smaller when stepping with the non-paretic leg in children with CP. APA size was positively related to the length of the contralateral, paretic gastrocnemius (r = 0.77). Stepping error was higher in children with CP and inversely correlated to the size of the medio-lateral APA. DISCUSSION: Children with CP show smaller medio-lateral APAs especially when stepping to medially placed targets. APA size may be limited by proximal muscle strength and gastrocnemius length.

A longitudinal study of multiple lifestyle health risk behaviours among nursing students and non-nursing peers.

AIM: The aim of this paper is to compare the evolution of health risk behaviours between undergraduate nursing and social work students. BACKGROUND: Nursing includes the promotion of health and the shaping of healthy behaviours. An important determinant for providing lifestyle advice is the lifestyle of nurses themselves. DESIGN: Longitudinal comparative study. MEASUREMENTS: We compared lifestyle risk behaviours (binge drinking, cannabis/hashish/marijuana use, smoking, oral hygiene/toothbrushing, breakfast/fruit/vegetable consumption, physical activity and screen time/sedentary behaviours) using a self-administered standardized questionnaire in nursing (n = 121) and social work (n = 140) students at the beginning (2012) and the end of their studies (2015). Adjusted multivariable logistic/Poisson regression models were performed. RESULTS: There were no statistically significant differences between the departments in most risk factors in both assessments. However, in relation to their first year, both nursing and social work students displayed higher relative risk of engaging in more behavioural risk factors at the end of their studies (in delivery/junk food consumption, sunburns, hashish/marijuana use and multiple sexual partners). Social work students displayed better behaviours in physical activity and breakfast intake. CONCLUSION: Nursing students share the patterns of their nonnursing peers in behavioural risk factors compromising their future health and health-promoting role. We need strategies to safeguard the professional nursing practice.

The relationship between smoking and convivial, intimate and negative coping alcohol consumption in young adults.

AIMS AND OBJECTIVES: To explore the gender-specific associations of smoking with convivial, negative coping and intimate drinking contexts in young adults. BACKGROUND: Alcohol and cigarettes co-use is common and to be more effective in prevention activities, we need to understand the drinking contexts that facilitate their co-occurrence. DESIGN: Descriptive cross-sectional survey in the context of the LATO study (Lifestyle & Attitudes in a Student Population) in Greece. METHODS: Of the 1,138 students who provided full data during November-December 2012, those who have smoked ≥1 cigarette/last month were defined as smokers. Based on the "Drinking Context Scale-9", we created low, moderate and high probabilities of drinking in each context and in total. Multivariate logistic regression analyses were performed. RESULTS: Participants reported higher probabilities to drink, in descending order, in the convivial (31.5%), negative coping (10.4%) and intimate (5.4%) contexts. Adjusted odds ratios for smoking were significantly higher for individuals who reported a moderate (OR = 2.15, 95% CI 1.51-3.05) to high (OR = 3.64, 95% CI 2.59-5.11) probability of drinking in any context. Moreover, female participants with high probabilities for drinking in convivial and negative coping contexts had higher odds ratios of engaging in smoking (convivial OR = 1.87, 95% CI = 1.23-2.85; coping OR = 2.66, 95% CI = 1.39-5.10) whereas this association was noticed only for convivial settings in male participants (OR = 2.88, 95% CI = 1.91-4.319). For women only, drinking in intimate contexts was protective against smoking (OR = 0.32, 95% CI = 0.10-0.98). CONCLUSIONS: Smoking is differentially related to drinking context based on gender. Prevention interventions targeting smoking and alcohol co-use in late adolescence may be more effective if employing a context and gender-specific approach. RELEVANCE TO CLINICAL PRACTICE: Nurses have a critical role in providing motivational interviewing in individuals and organise and execute health-promoting activities in larger groups for modifying their health risk behaviours. The social context should be carefully considered during assessments and prevention interventions.