Computer adaptive test approach to the assessment of children and youth with brachial plexus birth palsy.

This study examined the psychometric properties of item pools relevant to upper-extremity function and activity performance and evaluated simulated 5-, 10-, and 15-item computer adaptive tests (CATs). In a multicenter, cross-sectional study of 200 children and youth with brachial plexus birth palsy (BPBP), parents responded to upper-extremity (n = 52) and activity (n = 34) items using a 5-point response scale. We used confirmatory and exploratory factor analysis, ordinal logistic regression, item maps, and standard errors to evaluate the psychometric properties of the item banks. Validity was evaluated using analysis of variance and Pearson correlation coefficients. Results show that the two item pools have acceptable model fit, scaled well for children and youth with BPBP, and had good validity, content range, and precision. Simulated CATs performed comparably to the full item banks, suggesting that a reduced number of items provide similar information to the entire set of items.

Evaluation of the box and blocks test, stereognosis and item banks of activity and upper extremity function in youths with brachial plexus birth palsy.

BACKGROUND: One of the greatest limitations to measuring outcomes in pediatric orthopaedics is the lack of effective instruments. Computer adaptive testing, which uses large item banks, select only items that are relevant to a child's function based on a previous response and filters items that are too easy or too hard or simply not relevant to the child. In this way, computer adaptive testing provides for a meaningful, efficient, and precise method to evaluate patient-reported outcomes. Banks of items that assess activity and upper extremity (UE) function have been developed for children with cerebral palsy and have enabled computer adaptive tests that showed strong reliability, strong validity, and broader content range when compared with traditional instruments. Because of the void in instruments for children with brachial plexus birth palsy (BPBP) and the importance of having an UE and activity scale, we were interested in how well these items worked in this population. METHODS: Cross-sectional, multicenter study involving 200 children with BPBP was conducted. The box and block test (BBT) and Stereognosis tests were administered and patient reports of UE function and activity were obtained with the cerebral palsy item banks. Differential item functioning (DIF) was examined. Predictive ability of the BBT and stereognosis was evaluated with proportional odds logistic regression model. Spearman correlations coefficients (rs) were calculated to examine correlation between stereognosis and the BBT and between individual stereognosis items and the total stereognosis score. RESULTS: Six of the 86 items showed DIF, indicating that the activity and UE item banks may be useful for computer adaptive tests for children with BPBP. The penny and the button were strongest predictors of impairment level (odds ratio=0.34 to 0.40]. There was a good positive relationship between total stereognosis and BBT scores (rs=0.60). The BBT had a good negative (rs=-0.55) and good positive (rs=0.55) relationship with the clinical category of BPBP and Raimondi classification, respectively. There was a moderate negative (rs=-0.36) and moderate positive (rs=0.47) relationship between total stereognosis and clinical category of BPBP and Raimondi, respectively. Individual stereognosis items had moderate (rs=0.34 to 0.45) to good (rs=0.52 to 0.74) correlation with total stereognosis score. CONCLUSIONS: In children with BPBP, there was little to no DIF with item banks of activity and UE functioning. The BBT is a good predictor of degree of impairment. Stereognosis with 2 items may provide comparable information as 12 items. LEVELS OF EVIDENCE: Level II.

Rupture Following Biceps-to-Triceps Tendon Transfer in Adolescents and Young Adults With Spinal Cord Injury:: An Analysis of Potential Causes.

BACKGROUND: Tendon transfer surgery can restore elbow extension in approximately 70% of persons with tetraplegia and often results in antigravity elbow extension strength. However, we have noted an almost 15% rupture/attenuation rate. OBJECTIVE: This investigation was conducted to analyze potential causes in adolescents/young adults with spinal cord injury (SCI) who experienced tendon rupture or attenuation after biceps-to-triceps transfer. METHODS: Medical charts of young adults with SCI who underwent biceps-to-triceps transfer and experienced tendon rupture or attenuation were reviewed. Data collected by retrospective chart review included general demographics, surgical procedure(s), use and duration of antibiotic treatment, time from tendon transfer surgery to rupture/attenuation, and method of diagnosis. RESULTS: Twelve subjects with tetraplegia (mean age, 19 years) who underwent biceps-to-triceps reconstruction with subsequent tendon rupture or attenuation were evaluated. Mean age at time of tendon transfer was 18 years (range, 14-21 years). A fluoroquinolone was prescribed for 42% (n=5) of subjects. Tendon rupture was noted in 67% (n=8), and attenuation was noted in 33% (n=4). Average length of time from surgery to tendon rupture/attenuation was 5.7 months (range, 3-10 months). CONCLUSION: Potential contributing causes of tendon rupture/attenuation after transfer include surgical technique, rehabilitation, co-contraction of the transfer, poor patient compliance, and medications. In this cohort, 5 subjects were prescribed fluoroquinolones that have a US Food and Drug Administration black box concerning tendon ruptures. Currently, all candidates for upper extremity tendon transfer reconstruction are counseled on the effects of fluoroquinolones and the potential risk for tendon rupture.

Perceptions of self-image and physical appearance: conversations with typically developing youth and youth with idiopathic scoliosis.

PURPOSE: To report how youths, both with and without idiopathic scoliosis (IS), respond to questions about their self-image and perceptions of body shape. An additional purpose is to describe themes that emerged as important to youths with IS to better understand scoliosis from their perspective. METHODS: Descriptive qualitative and quantitative methods were utilized. Subject interviews were conducted, as part of a larger cognitive interviewing study on the Spinal Appearance Questionnaire, using a cross-sectional sample of 76 females between 8 and 16 years of age with IS and who were typically developing (TD), without scoliosis. RESULTS: IS and TD subjects revealed similar findings when asked what makes them look good versus their peers; self-image ratings were also positive. Predominant themes from open-ended responses include physical appearance, feelings, brace wear, and discomfort. CONCLUSION: Self-image and body shape did not differ significantly between groups. The identified themes warrant further exploration as they are significant and important to youth with scoliosis.

Cognitive testing of the spinal appearance questionnaire with typically developing youth and youth with idiopathic scoliosis.

BACKGROUND: The Spinal Appearance Questionnaire (SAQ) underwent initial psychometric studies, which suggested good reliability and discriminative ability. Although the SAQ is used as a self report of appearance, our center was concerned about its use with youth owing to complex words and vague questions. We conducted this cross-sectional study to evaluate the readability, comprehension, and interpretation of items on the SAQ. METHODS: Cognitive interview methodology of 76 youths (8 to 16 y; average age 13) included 31 with scoliosis and 45 typically developing. Subjects were required to read each SAQ item and think aloud to capture cognitive processes about the items and responses. Interviews were audiotaped and transcribed verbatim. Problems were categorized and frequencies for each category were calculated. RESULTS: There were reading and comprehension problems and problems understanding the illustration with every written and pictorial SAQ item, respectively. The percent of subjects who encountered at least one problem ranged from 16% to 96%. Subjects had difficulty with understanding the intent of every SAQ item and with understanding the meaning of specific words such as "prominence" and "flank." The pictorial illustrations for items 2 and 3 were problematic for 58% and 49% of subjects, respectively. The illustrations of the lungs (item 4) and hips (items 4 and 5) were problematic for 42% and 27% of subjects, respectively. These results were consistent regardless of age or diagnoses. CONCLUSION: This study does not support the use of the SAQ as currently used with youth owing to use of complex medical words, vague questions, difficult illustrations, and various interpretations of the intent of many of the items. LEVEL OF EVIDENCE: Not applicable (not an intervention study).

Outcomes of urinary diversion in children with spinal cord injuries.

PURPOSE: To gain a better understanding of the outcomes of the Mitrofanoff procedure for urinary diversion in children with spinal cord injury (SCI). DESIGN: Descriptive retrospective. PARTICIPANTS/METHODS: Individuals 6 to 27 years of age with SCI with at least 1 year follow-up after the Mitrofanoff procedure. Objective data collected via retrospective chart review include general demographics and medical/surgical history. Data collected via structured telephone interview include history of adverse urological events, bladder management, bladder management independence scores, patient satisfaction, and quality of life. RESULTS: Sixteen subjects (13 female, 3 male) with a mean age of 19 years (range 6-27 y) who underwent the Mitrofanoff procedure were interviewed. Length of postoperative follow-up ranged from 1 to 8 years (mean 4.25 y). Complications included stomal stenosis 25% (n=4) with a mean of 19 months to first occurrence of stenosis; urethral incontinence 75% (n=12); renal/bladder calculi 19% (n = 3); and stomal leakage 44% (n=7). Independence scores for bladder management after the Mitrofanoff procedure improved in 84% of subjects with tetraplegia and 25% of subjects with paraplegia. Eighty-eight percent (n 14) were satisfied with the procedure, while 12% (n=2) were somewhat satisfied. A thematic analysis of quality of life revealed that freedom (35%) and independence (35%) were most commonly cited. CONCLUSION: While some subjects experienced complications, satisfaction was relatively high and level of independence in bladder management was greatly improved. This study demonstrates that the Mitrofanoff procedure is a beneficial option to improve independence and ease of bladder management in children with SCI.

Key elements of bladder and Bowel management for children with spinal cord injuries.

Bladder and bowel management can be one of the most challenging aspects of daily life after spinal cord injury (SCI). Children are especially unique due to their ever-changing growth and developmental considerations. Continence is crucial for children who are still developing self-confidence and self-esteem. Proper bladder and bowel management can impact long-term health and well-being and can also affect quality of life. Providing education and implementation of bladder and bowel management programs are essential for children with SCI. This article will provide a general overview of common bladder and bowel management options for children with SCI. Age-appropriate expectations will be described, as well as patient and family educational strategies, to promote independence when implementing bladder and bowel programs.

Bladder and bowel management for the child with spinal cord dysfunction.

Bladder and bowel management can be a challenge to adults and children with spinal cord dysfunction. Children are especially challenging due to their everchanging growth and developmental considerations. Bladder/bowel incontinence can bring about teasing from a child's peers and lead to social isolation. The achievement of continence is a major developmental landmark in the formation of social autonomy in children. Providing education and implementation of bladder/bowel management programs is essential for a child with neurogenic bladder/bowel. This article provides a general overview of common bladder and bowel management options for children with spinal cord dysfunction. Both traditional and innovative management options for the bladder and bowel will be described. Age-appropriate expectations and factors to assess child readiness as well as patient and family educational strategies to promote independence when implementing bladder and bowel programs are described.