Validity of the Test of Infant Motor Performance for discriminating among infants with varying risk for poor motor outcome.

OBJECTIVE: The objective was to assess the ability of the Test of Infant Motor Performance (TIMP) to discriminate among infants with varying degrees of risk for motor developmental morbidity on the basis of perinatal medical complications. STUDY DESIGN: Ninety-eight infants were tested weekly with the TIMP until 4 months of age. Comparisons were made among 5 groups of infants: (1) term infants without significant medical problems (low risk); (2) infants born prematurely with no significant medical problems (medium risk); (3) infants born at <30 weeks' gestational age or with birth weight <1500 g (high risk); (4) infants with chronic lung disease (high risk); and (5) infants with brain insults (high risk). A random-effects growth curve analysis assessed differences between the groups in slope and level of development across time. RESULTS: Infants in the low- and medium-risk groups did not differ from each other but were significantly better performers than infants in the high-risk groups. Infants with brain insults performed significantly less well than all other infants, both in absolute level of performance and in developmental slope across time. Performance by black infants averaged 2 points higher than that of other infants. CONCLUSIONS: The TIMP can discriminate among infants with differing risks for motor developmental delay.

Modifying effects of amlodipine on cyclosporin A-induced changes in renal function in patients with psoriasis.

OBJECTIVE: To assess the benefit of amlodipine, a calcium channel blocker, on renal function and vasoactive hormones in individuals with normal kidneys and blood pressure and who were being treated with cyclosporin A for refractory psoriasis. DESIGN: An open-label, two-stage, longitudinal study was employed. METHODS: Patients were divided into two groups: Group I received cyclosporin A, 5 mg/kg per day for 6 months titrated down to 2.5-3.5 mg/kg per day for 6 months, then concomitant amlodipine 5 mg/day for 6 months; and Group II received concomitant cyclosporin A, 5 mg/kg per day, and amlodipine, 5 mg/day, for 6 months. Blood pressure, serum creatinine, glomerular filtration rate, urinary magnesium, plasma renin activity and urinary kallikrein excretion were measured before and after treatment. RESULTS: Eighteen patients were enrolled, and 12 completed the study. In Group I (n = 7), 12 months of cyclosporin A therapy significantly increased systolic blood pressure and significantly decreased glomerular filtration rate, plasma renin activity and active urinary kallikrein. Amlodipine reversed these changes. In Group II (n = 5), 6 months of concomitant cyclosporin A and amlodipine significantly reduced active urinary kallikrein levels. No significant changes occurred in the other measured parameters in either group. CONCLUSIONS: Cyclosporin A produces a sustained and significant fall in glomerular filtration rate and urinary kallikrein excretion, even in patients with normal kidneys and blood pressure. Amlodipine is potentially capable of reversing these nephrotoxic effects.

The ecological relevance of the Test of Infant Motor Performance elicited scale items.

BACKGROUND AND PURPOSE: The Test of Infant Motor Performance (TIMP) is a new test of motor and postural control for infants under 4 months of age. The purpose of this study was to examine the relationship between the environmental demands placed on infants in daily life and the demands placed on infants during administration of the TIMP Elicited Scale items. SUBJECTS: Twenty-two preterm and full-term infants and their caregivers participated. The infants were evenly divided into groups at low and high medical risk for developmental disability. METHODS: The infants were videotaped while being handled by their caregiver during undressing, bathing, dressing, and 5 minutes of playing in their natural setting (home or hospital). Each videotape recording was analyzed for the environmental demands that were placed on the infant during caregiving. Demands were coded according to predefined definitions, which represented descriptions for administering TIMP items. Interrater agreement for coding of observations ranged from 80% to 96%. RESULTS: Environmental demands that corresponded to 23 of the 25 TIMP items were observed during caregiving activities. The number of environmental demands placed on the infants during caregiving that corresponded to the 25 TIMP Elicited Scale items ranged from 16% to 68% of the items (mean = 37%). The mean rate of all environmental demands placed on the infants was 3.23 per minute, and the mean rate of demands that corresponded to TIMP items was 1.58 per minute. CONCLUSION AND DISCUSSION: Approximately 50% of all environmental demands placed on the infants during caregiving corresponded to TIMP Items, and 98% of TIMP Elicited Scale Items Corresponded to the observed environmental demands. The demands placed on infants during administration of the TIMP appear representative of typical environmental demands.

Positron Emission Tomography (PET) with 1-Aminocyclobutane-1-[(11)C]carboxylic Acid (1-[(11)C]-ACBC) for Detecting Recurrent Brain Tumors.

This study was done to determine whether 1-[(11)C]ACBC PET has any advantages over 2-[(18)F]FDG PET, CT, or MRI in detecting recurrent brain tumors, and whether quantitative 1-[(11)C]ACBC PET information improves the accuracy of "visual" image interpretation.Twenty patients with recurrent brain tumor underwent dynamic PET. Images were analyzed by visual interpretation; in addition, standardized uptake values (SUVs) and Patlak values (k(1)*k(3)/k) were evaluated.1-[(11)C]ACBC identified 19/20 recurrent brain tumors, [18F]FDG 13/19, MRI 13/19, and CT 8/16. Based on SUVs, the average tumor-to-contralateral gray matter ratio of 1-[(11)C]ACBC was 5.0 and 0.5 for 2-[(18)F]FDG. Mean Patlak values of 1-[(11)C]ACBC were 0.044 +/- 0.047 for high and 0.034 +/- 0.026 for low grade tumors. However, visual interpretation was effective without quantitative PET data.1-[(11)C]ACBC, accurately detects recurrent tumors for selecting biopsy sites and treatment planning.

Multidimensional assessment of motor function in a child with cerebral palsy following intrathecal administration of baclofen.

This case report describes an 11-year-old boy with spastic diplegia whose reflex status, range of motion (ROM), strength, and motor performance were measured before and after implantation of an indwelling system for delivery of intrathecally administered baclofen. Before baclofen use, the subject experienced clonus that interfered with walking, needed assistance with transfers, and was unable to independently put on underwear and socks. Measures of spasticity, kinematics and electromyographic activity during voluntary movements, ROM, Gross Motor Function Measure (GMFM) scores, and self-reports of change were obtained at baseline, before and after bolus baclofen injection, during a double-blind placebo-controlled clinical trial of baclofen administration via an indwelling pump, and after 1 and 2 years of baclofen therapy. Spasticity, Babinski reflexes, clonus, strength, and coactivation of antagonist muscles during voluntary movement were decreased shortly after baclofen administration began. Hip and ankle ROM increased, upper-extremity movement speed increased, independence in dressing and transfers improved, and orthoses were discarded. After 1 and 2 years, GMFM scores were 7.8% and 6.4% above baseline, respectively; the subject won a fitness award. After 2 years, ROM was worse than at baseline and concerns regarding hip subluxation arose. Single-joint movement control and independence improved and spasticity decreased during baclofen administration.

High-potency sodium fluoride: a literature review.

A considerable number of clinical studies are documented in the literature on oral products containing 5,000 ppm fluoride (F), mainly nonabrasive gels. Study results show that this level of fluoride provides marked caries protection. These high-potency gels are especially effective for irradiated head and neck cancer patients, who typically develop rampant caries. Radiation therapy causes a marked decrease in salivation (xerostomia), which predisposes the teeth to caries formation and results in devastating consequences. The currently recommended treatment for these patients involves a 2-step regimen using a 5,000 ppm F gel and a conventional 1,000 ppm F dentifrice. Unfortunately, this treatment usually results in noncompliance because two steps are inconvenient for most patients. A 5,000 ppm F dentifrice meets the oral-hygiene needs of these patients. It provides an effective level of fluoride and a convenient one-step application procedure that increases patient compliance.

Quantifying the effects of interventions for movement disorders resulting from cerebral palsy.

The purpose of this article is to review a variety of tests and measures that are useful in documenting and quantifying the outcomes of intervention for persons with cerebral palsy. The topics included are (1) a discussion of the need for meaningful outcome measures, (2) a model of the disabling process for classifying measures used to assess several different dimensions of disablement, and (3) a review of selected tests and measures categorized according to the model described.

Early prediction of pre-eclampsia by measurement of kallikrein and creatinine on a random urine sample.

OBJECTIVE: To assess the measurement of inactive urinary kallikrein (IUK) to creatinine (Cr) ratio (IUK:Cr) on an untimed urine sample, collected between 16 and 20 weeks of pregnancy, as a predictive test for the development of both proteinuric and nonproteinuric pre-eclampsia. DESIGN: A prospective longitudinal study. SETTING: A clinic for antenatal care and a university research department. PARTICIPANTS: Three hundred and seven normotensive women randomly selected (124 nulliparous and 183 parous) attending the antenatal clinic for their booking visit. MAIN OUTCOME MEASURES: 1. Nonproteinuric pre-eclampsia: a rise in diastolic blood pressure of 25 mmHg or more and a crossing of the threshold of 90 mmHg; 2. Proteinuric pre-eclampsia: same as 1. plus the development of significant proteinuria ( > 1 + on urine dipstick). RESULTS: Thirty-seven women developed pre-eclampsia, 12 of whom had proteinuria. Median IUK:Cr ratio in this group was 78.27, compared with 358.19 in the remainder. Analysis of receiver-operator characteristics gave an area under the curve of 0.803. An IUK:Cr ratio of 170 or less in this study predicted nonproteinuric or proteinuric pre-eclampsia with a sensitivity of 70% and a specificity of 86%. Ten of the twelve women who had proteinuria had an IUK:Cr below 170. Median IUK:Cr for those with proteinuric pre-eclampsia was 72.91. CONCLUSIONS: Measurement of IUK:Cr on a urine sample, collected between 16 and 20 weeks of gestation, represents a simple and practical test for the risk of subsequent pre-eclampsia, with a sensitivity and specificity comparable to those reported by other investigators using the widely recognised, but less practical, angiotensin II sensitivity test.

Correlates of physicians' decisions to refer children with cerebral palsy for physical therapy.

Videotapes of ten children with 'suspected' cerebral palsy were used as stimuli to elicit physicians' decisions regarding referral for physical therapy. Respondents were 99 developmental or general pediatricians, orthopaedists, neurologists or physiatrists who were members of the American Academy of Pediatrics or the American Academy of Cerebral Palsy. They rated their belief in the value of therapy; described their experience, training and practices relating to management of cerebral palsy; and responded to cases with their assessment of severity, diagnosis and referral decision. The decision to refer was significantly related to perceived severity of the condition, diagnostic certainty, and belief in the efficacy of physical therapy. Referral rates did not vary with tendency to use physical therapy for other types of patients, nor with training, experience or self-rated expertise in cerebral palsy.

Construct validity of the test of infant motor performance.

BACKGROUND AND PURPOSE: The purpose of this study was to assess the construct validity of the Test of Infant Motor Performance (TIMP), specifically the test's sensitivity for assessing age-related changes in motor skill and correlation with risk for developmental abnormality. SUBJECTS: Subjects were 137 term and preterm infants stratified by postconceptional age, medical complications score on the Problem-Oriented Perinatal Risk Assessment System, and ethnicity and race (non-Latino Caucasian, African-American, and Latino). METHODS: Subjects were tested on the TIMP at ages ranging from 32 weeks postconceptional age to 3.5 months past term-equivalent age. Scores (Rasch logit ability measures) were correlated with postconceptional age. A multiple regression analysis was used to assess the contributions of age, risk, and ethnicity to the variance in TIMP scores. RESULTS: The correlation between postconceptional age and TIMP performance measures was .83. Risk and age together explained 72% of the variance in TIMP performance (R = .85, P < .00001). No differences related to ethnicity were found. CONCLUSION AND DISCUSSION: The TIMP has validity for assessing age-related development of functional motor skills in young infants and is sensitive to risk for poor developmental outcome.

The effects of intrathecally administered baclofen on function in patients with spasticity.

The purpose of this article is to review the literature on the effects of intrathecally administered baclofen on impairment in spasticity and muscle activation patterns, on functional limitations in mobility and self-care, and on disability in daily life roles. We found plentiful evidence of improvement in spasticity, spasms, and bladder function and some reports of improved patterns of muscle activation and kinematics of single-joint movement. Improved ability to accomplish transfers, self-care, and locomotion is less consistently studied but has also been reported in about 60% to 70% of patients. Evidence of improved quality of life is primarily anecdotal but may be found in 10% to 30% of patients. We conclude that research protocols should be developed to clarify effects on control of voluntary movement, functional limitations, and quality of life.

Gender differences in urinary kallikrein excretion in man: variation throughout the menstrual cycle.

1. Urinary kallikrein excretion was measured in healthy male subjects and in healthy pre- and post-menopausal females. 2. Urinary kallikrein excretion was shown to be constant throughout a 24 h period. Individual male subjects showed little fluctuation in urinary kallikrein excretion; within-subject variance accounted for 1.65% of the total. 3. Female subjects with ovulatory menstrual periods excreted significantly more kallikrein than post-menopausal females and males. 4. Pre-menopausal females showed a much greater within-subject variation in urinary kallikrein excretion and this could be related to the stage of the menstrual cycle, with significantly greater urinary kallikrein excretion in the luteal phase than in the follicular phase. 5. Plasma renin activity and plasma aldosterone concentration also showed a menstrual variation, with concentrations in the luteal phase being significantly higher than those in the follicular phase. 6. The rise in urinary kallikrein excretion in the luteal phase could be abolished by oral administration of the aldosterone antagonist spironolactone. 7. Urinary kallikrein excretion in post-menopausal females was similar to the range found in males, and showed no cyclic changes over a 4 week period. 8. Gender and menstrual status should be taken into account in studies of the physiological role of tissue kallikreins.

Biological assay for tissue kallikrein: comparison with the synthetic substrate S2266.

A highly sensitive biological assay for tissue kallikrein is described, using human kininogen as substrate; and quantitation, by radioimmunoassay, of generated kinins. Using purified human urinary kallikrein as a reference standard we have correlated the kininogenase activity of kallikrein with amidase activity as measured by cleavage of the synthetic substrate S2266.

Correlates of physician utilization of physical therapy.

A survey of 200 physicians explored the relationship between their beliefs in the efficacy of physical therapy (PT) and their use of PT for their patients with cerebral palsy (CP). Results show that utilization of PT is related to physicians' use of PT in general and is inversely related to the percentage of CP in physicians' patient loads, but is not related to their opinions of the value of PT services.

Active and inactive urinary kallikrein in man: effects of diuresis and antidiuresis.

1. The urinary excretion of active and inactive kallikrein was studied in volunteers during diuresis induced by water loading or oral frusemide and during antidiuresis induced by desamino-D-arginine-vasopressin. 2. During acute oral water loading, excretion of active kallikrein was unchanged, despite high urine flow rates and low urine osmolalities being achieved. Excretion of inactive kallikrein correlated with the urine flow rate. 3. After desamino-D-arginine-vasopressin in eight water-loaded and six normally hydrated subjects, excretion of inactive kallikrein also correlated with the urine flow rate. There were no significant changes in the excretion of active kallikrein. 4. After frusemide there was a small transient increase in excretion of active kallikrein 1-2 h after dosing which coincided with the maximum diuresis and natriuresis. Excretion of inactive kallikrein again correlated with urine flow rate but the regression relationship between the two variables was different for water-load-induced and frusemide-induced diuresis. 5. These studies do not support a role for urinary kallikrein in the modulation of the antidiuretic action of vasopressin, but suggest that it may contribute to the natriuretic action of frusemide.

Stability of Bayley Motor Scale scores in the first year of life.

The purpose of this study was to determine whether Bayley Motor Scale scores were stable in infants during the first year of life, that is, whether each individual infant's score was essentially the same at each of the five test ages. Subjects were 15 low-risk and 8 high-risk infants with Bayley Scales of Infant Development Motor Scale scores at 2, 3, 4, 8, and 12 months. All high-risk and most low-risk infants also had outcome scores at either 24 or 36 months. For the group as a whole, and for all infants with "normal" outcomes, subjects did not change ranks over the six test ages (ie, high-scoring infants' ranks remained high and low-scoring infants' ranks remained low), but scores varied significantly from test to test. Scores of infants with "non-normal" outcomes did not vary significantly from test to test. The highest and lowest scores of 75% of the infants with normal outcomes and 57% of the infants with non-normal outcomes differed significantly. Four patterns of variations of Bayley Motor Scale scores over the five test ages of the first year after birth were identified. The first pattern included three infants with the most stable scores. The three remaining patterns were different from each other, but a consistent feature of each was a peak at 4 months. Finally, scores at 3 and 8 months were best able to correctly identify outcome. A single Bayley Motor Scale score may not reflect an infant's true abilities; some factor may be inflating scores at age 4 months.

On the importance of being earnest about measurement, or, how can we be sure that what we know is true?

Reliable and valid measurements are essential in research and clinical practice in physical therapy. Despite our slowness in recognizing the importance of more scientific measurement, our profession has witnessed a recent surge of interest in studying and developing reliable and valid measurement techniques. The ultimate results of developing more sophisticated measurement instruments and further refining our measurement techniques will be more scientific practitioners and a greater body of scientific knowledge unique to physical therapy.