The Screening Hand Assessment for Infants for detecting the risk of unilateral cerebral palsy: Item selection and development.

AIM: To develop a screening tool (the screening Hand Assessment for Infants [s-HAI]) for infants aged from 3.5 months that can identify a high risk of developing unilateral cerebral palsy (CP) based on a selection of items from the HAI. METHOD: Receiver operating characteristic curve analysis was performed on previously collected HAI assessments from 212 infants (104 females, 108 males) aged from 3.5 to 8.5 months, to select items suitable for screening. The area under the curve (AUC), sensitivity, specificity, and cut-off values were derived for the suggested item combination. The clinical outcome (unilateral CP yes or no) at 24 months or older served as the external criterion. RESULTS: About half of the infants developed unilateral CP. The AUC across the items ranged from 0.63 to 0.80, and from 0.85 to 0.87 for different item combinations. Sensitivity for the selected 6-item set was 91% for 8 points or less and 88% for 7 points or less on the contralesional score of each hand, while specificity was 60% and 73% respectively. INTERPRETATION: The s-HAI, designed from six HAI items, has the potential to be used to screen infants at risk of unilateral CP from 3.5 months of age. It is easy to administer, time-efficient, and can be used in different settings. Its measurement properties and feasibility need to be tested in a new data set.

Predictive validity of the Hand Assessment for Infants in infants at risk of unilateral cerebral palsy.

AIM: To evaluate the sensitivity, specificity, and predictive value of the Hand Assessment for Infants (HAI) in identifying infants at risk of being diagnosed with unilateral cerebral palsy (CP), and to determine cut-off values for this purpose. METHOD: A convenience sample of 203 infants (106 females, 97 males) was assessed by the HAI at 3, 6, 9, and 12 months. Sensitivity, specificity, predictive values, and likelihood ratios were calculated using receiver operating characteristic curve analysis. Cut-off values were derived for different ages. The clinical outcome (unilateral CP yes/no) at 24 months or more served as an external criterion to investigate the predictive validity of HAI. RESULTS: Half of the infants developed unilateral CP. The area under the curve ranged from 0.77 (95% CI [confidence interval] 0.63-0.91) to 0.95 (95% CI 0.90-1.00) across HAI scales and age intervals. Likewise, sensitivity ranged from 63% to 93%, specificity from 62% to 91%, and accuracy from 73% to 94%. INTERPRETATION: HAI scores demonstrated overall accuracy that ranged from very good to excellent in predicting unilateral CP in infants at risk aged between 3.5 and 12 months. This accuracy increased with age at assessment and the earliest possible prediction was at 3.5 months of age, when appropriate HAI cut-off values for different ages were applied. What this paper adds The Hand Assessment for Infants (HAI) predicts unilateral cerebral palsy (CP) with high accuracy. HAI cut-off values can guide clinical practice for early identification and diagnosis of unilateral CP.

Administration of the German Pediatric Evaluation of Disability Inventory (PEDI-G) Using the Mode of Observation in Children Undergoing Inpatient Rehabilitation: A Reliability and Validity Study.

Aims: To investigate inter-rater reliability, concurrent validity, and feasibility of the German Pediatric Evaluation of Disability Inventory (PEDI-G) using the mode of observation in a Swiss inpatient rehabilitation setting with the Functional Independence Measure for Children (WeeFIM®) as criterion.Methods: Cross-sectional clinimetric study including 36 children and adolescents with median age 10.8 (quartiles 8.7, 13.0) years with neurological/neuro-orthopedic disorders. Data were collected by healthcare professionals through observation. Analyses were performed using intraclass correlation coefficients (ICC2,1), standard error of measurement (SEMAgreement), Bland-Altman plots, Cohen's Kappa κ, percentage agreement, and correlations.Results: Excellent inter-rater reliability (ICCs2,1 ≥ 0.97), small SEMs and acceptable limits of agreement for the Functional Skills Scale (FSS) and Caregiver Assistance Scale (CAS) were found. No systematic differences between raters existed. Cohen's Kappa for inter-rater agreement of the Modifications Scale (MS) ranged from poor to strong (-0.06 ≤ κ ≤0.85). Excellent concurrent validity for FSS and CAS with the WeeFIM® (ρ ≥ 0.96), and excellent correlations of FSS and CAS with each other (ρ ≥ 0.98) were identified.Conclusion: The German PEDI-G seems to be a reliable and valid, but time-consuming tool when applied in an inpatient setting using observation.

Early prediction of unilateral cerebral palsy in infants with asymmetric perinatal brain injury - Model development and internal validation.

BACKGROUND: Early diagnosis of unilateral cerebral palsy is important after asymmetric perinatal brain injury (APBI). Our objective is to estimate the risk of unilateral cerebral palsy (UCP) in infants with APBI during the first months of life using neuroimaging and clinical assessment. PATIENTS AND METHODS: Prognostic multivariable prediction modeling study including 52 infants (27 males), median gestational age 39.3 weeks with APBI from Sweden (n = 33) and the Netherlands (n = 19). INCLUSION CRITERIA: (1) neonatal MRI within one month after term equivalent age (TEA), (2) Hand Assessment for Infants (HAI) between 3.5 and 4.5 months of (corrected) age. UCP was diagnosed ≥24 months of age. Firth regression with cross-validation was used to construct and internally validate the model to estimate the risk for UCP based on the predictors corticospinal tract (CST) and basal ganglia/thalamus (BGT) involvement, contralesional HAI Each hand sum score (EaHS), gestational age and sex. RESULTS: UCP was diagnosed in 18 infants (35%). Infants who developed UCP more often had involvement of the CST and BGT on neonatal MRI and had lower contralesional HAI EaHS compared to those who did not develop UCP. The final model showed excellent accuracy for UCP prediction between 3.5 and 4.5 months (area under the curve, AUC = 0.980; 95% CI 0.95-1.00). CONCLUSIONS: Combining neonatal MRI, the HAI, gestational age and sex accurately identify the prognostic risk of UCP at 3.5-4.5 months in infants with APBI.

To Explore the Validity of Change Scores of the Children's Hand-use Experience Questionnaire (CHEQ) in Children with Unilateral Cerebral Palsy.

AIMS: To explore the validity of change scores of the Children's Hand-use Experience Questionnaire (CHEQ). METHODS: Analysis of the CHEQ included 44 children (15 girls) between 6-16 years (median 9.0; IQR 8-11) with unilateral cerebral palsy, with baseline and post- (two-week intensive) intervention assessments using the Goal Attainment Scale (GAS) as external anchor for change. Hypotheses on the magnitude of expected change were formulated and correlation coefficients and effect sizes calculated. Receiver operating curve analysis was performed and the area under the curve (AUC) calculated to investigate the ability of CHEQ to discriminate between improvement and non-improvement according to GAS. RESULTS: All hypotheses about the magnitude of change were confirmed supporting longitudinal validity of CHEQ scales to measure change in the perception of bimanual performance. AUCs for the Grasp efficacy and the Time utilization were slightly below, and for the Feeling bothered slightly above the threshold. The latter one accurately discriminating between children that improved and did not improve according to the GAS. CONCLUSIONS: Evidence was found that CHEQ scales capture change in bimanual performance but with limited accuracy for two out of three scales. The validity of CHEQ change scores needs to be further explored in a wider population.

Assisting Hand Assessment and Children's Hand-Use Experience Questionnaire -Observed Versus Perceived Bimanual Performance in Children with Unilateral Cerebral Palsy.

AIMS: To explore the differences, relationship, and extent of agreement between the Assisting Hand Assessment (AHA), measuring observed ability to perform bimanual tasks, and the Children's Hand-Use Experience Questionnaire (CHEQ), assessing experienced bimanual performance. METHODS: This study investigates a convenience sample of 34 children (16 girls) with unilateral cerebral palsy aged 6-18 years (mean 12.1, SD 3.9) in a cross-sectional design. RESULTS: The AHA and CHEQ subscales share 8-25% of their variance (R2). Bland-Altman plots for AHA and all three CHEQ subscales indicate good average agreement, with a mean difference approaching zero but large 95% confidence intervals. Limits of agreement were extremely wide, indicating considerable disagreement between AHA and CHEQ subscales. CONCLUSION: AHA and CHEQ seem to measure different though somewhat related constructs of bimanual performance. Results of this investigation reinforce the recommendation to use both instruments to obtain complementary information about bimanual performance including observed and perceived performance of children with unilateral cerebral palsy.

[Neuralgic amyotrophy: an extrahepatic manifestation of hepatitis E]. / Neuralgische Schulteramyotrophie: Eine extrahepatische Manifestation der Hepatitis E.

History and initial findings | A patient with bilateral pain in his shoulders is presented at the emergency room. Investigations | There were strongly increased transaminases. Diagnosis | Serology and PCR led to the diagnosis of hepatitis E. Neurological examination revealed a neuralgic amyotrophy Treatment and course | The pain in the shoulders disappeared spontaneously after vanishing of HEV viremia. Conclusion | Patients with shoulder pain of unknown origin and elevated transaminases should be tested for hepatitis E.

Methods for the evaluation of hospital cooperation activities (Systematic review protocol).

BACKGROUND: Hospital partnerships, mergers and cooperatives are arrangements frequently seen as a means of improving health service delivery. Many of the assumptions used in planning hospital cooperatives are not stated clearly and are often based on limited or poor scientific evidence. METHODS: This is a protocol for a systematic review, following the Cochrane EPOC methodology. The review aims to document, catalogue and synthesize the existing literature on the reported methods for the evaluation of hospital cooperation activities as well as methods of hospital cooperation. We will search the Database of Abstracts of Reviews of Effectiveness, the Effective Practice and Organisation of Care Register, the Cochrane Central Register of Controlled Trials and bibliographic databases including PubMed (via NLM), Web of Science, NHS EED, Business Source Premier (via EBSCO) and Global Health for publications that report on methods for evaluating hospital cooperatives, strategic partnerships, mergers, alliances, networks and related activities and methods used for such partnerships. The method proposed by the Cochrane EPOC group regarding randomized study designs, controlled clinical trials, controlled before and after studies, and interrupted time series will be followed. In addition, we will also include cohort, case-control studies, and relevant non-comparative publications such as case reports. We will categorize and analyze the review findings according to the study design employed, the study quality (low versus high quality studies) and the method reported in the primary studies. We will present the results of studies in tabular form. DISCUSSION: Overall, the systematic review aims to identify, assess and synthesize the evidence to underpin hospital cooperation activities as defined in this protocol. As a result, the review will provide an evidence base for partnerships, alliances or other fields of cooperation in a hospital setting. PROSPERO registration number: CRD42011001579.

Effects of leg muscle botulinum toxin A injections on walking in children with spasticity-related cerebral palsy: a systematic review.

AIM: To assess treatment effects of botulinum toxin type A (BoNT-A) on walking of children with leg spasticity due to cerebral palsy (CP) compared with usual care. METHOD: We systematically searched the databases CINAHL, Cochrane, PEDro, EMBASE, and PubMed from July 1993 until July 2009 and additionally screened reference lists. Randomized controlled trials assessing functional outcomes on walking of children with CP were included. The intervention had to contain BoNT-A into the lower limb and be compared with usual care. The methodological quality and clinical relevance were independently assessed by two of the authors (UCR, CHGB). If statistical pooling was not feasible, we performed a best-evidence synthesis. RESULTS: Eight trials were included. Trials comparing BoNT-A plus usual care or physiotherapy versus usual care or physiotherapy alone showed moderate evidence for functional outcomes at 2 to 6, 12, and 24 weeks follow-up in favour of BoNT-A. Studies comparing BoNT-A versus casting showed strong evidence for no difference in effects between these interventions. A limitation of our review was the exclusion of studies not published in English, Dutch, or German. The heterogeneity of the included studies, especially for outcome measures and follow-up assessments, prompted us to refrain from statistical pooling, which might also be considered a limitation. INTERPRETATION: The use of BoNT-A with usual care or physiotherapy seems to improve walking of children with CP, but results should be appraised carefully owing to the limited quality of included trials.