A cross-validation of the Violence Risk Appraisal Guide-Revised (VRAG-R) within a correctional sample.

The Violence Risk Appraisal Guide-Revised (VRAG-R) was developed to replace the original VRAG based on an updated and larger sample with an extended follow-up period. Using a sample of 120 adult male correctional offenders, the current study examined the interrater reliability and predictive and comparative validity of the VRAG-R to the VRAG, the Psychopathy Checklist-Revised, the Statistical Information on Recidivism-Revised, and the Two-Tiered Violence Risk Estimate over a follow-up period of up to 22 years postrelease. The VRAG-R achieved moderate levels of predictive validity for both general and violent recidivism that was sustained over time as evidenced by time-dependent area under the curve (AUC) analysis. Further, moderate predictive validity was evident when the Antisociality item was both removed and then subsequently replaced with a substitute measure of antisociality. Results of the individual item analyses for the VRAG and VRAG-R revealed that only a small number of items are significant predictors of violent recidivism. The results of this study have implications for the application of the VRAG-R to the assessment of violent recidivism among correctional offenders. (PsycINFO Database Record

How reliable is the determination of cervical dilation? Comparison of vaginal examination with spatial position-tracking ruler.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of clinical measurement of cervical dilation with a position-tracking system during vaginal examination. STUDY DESIGN: This prospective study that was conducted in Poissy, France, Brooklyn, NY, and Haifa, Israel, included 333 measurements that were performed in 188 women with term singleton vertex uncomplicated pregnancies during the active stage of labor. Ninety measurements with clinical diagnosis of full dilation were excluded from analysis. Measurements were performed with a sensor attached to the midwife's index fingertip and a position-tracking system that was based on a low magnetic field. Evaluations were done when cervical examinations were clinically indicated. RESULTS: Results were similar in all centers. Mean error was 10.2 +/- 8.4 mm and ranged from 7.5 +/- 7.3 mm, when cervical dilation was > 8 cm, to 12.5 +/- 8.7 mm when cervical dilation was between 6.1 and 8 cm. CONCLUSION: This first evaluation of cervical assessment accuracy during vaginal examination with a position-tracking system shows limited precision.

Pediatric outcomes data collection instrument scores in ambulatory children with cerebral palsy: an analysis by age groups and severity level.

BACKGROUND: The Pediatric Outcomes Data Collection Instrument (PODCI) was developed in 1994 as a patient-based tool for use across a broad age range and wide array of musculoskeletal disorders, including children with cerebral palsy (CP). The purpose of this study was to establish means and SDs of the Parent PODCI measures by age groups and Gross Motor Function Classification System (GMFCS) levels for ambulatory children with CP. METHODS: This instrument was one of several studied in a prospective, multicenter project of ambulatory patients with CP between the aged 4 and 18 years and GMFCS levels I through III. Participants included 338 boys and 221 girls at a mean age of 11.1 years, with 370 diplegic, 162 hemiplegic, and 27 quadriplegic. Both baseline and follow-up data sets of the completed Parent PODCI responses were statistically analyzed. RESULTS: Age was identified as a significant predictor of the PODCI measures of Upper Extremity Function, Transfers and Basic Mobility, Global Function, and Happiness With Physical Condition. Gross Motor Function Classification System levels was a significant predictor of Transfers and Basic Mobility, Sports and Physical Function, and Global Function. Pattern of involvement, sex, and prior orthopaedic surgery were not statistically significant predictors for any of the Parent PODCI measures. Mean and SD scores were calculated for age groups stratified by GMFCS levels. Analysis of the follow-up data set validated the findings derived from the baseline data. Linear regression equations were derived, with age as a continuous variable and GMFCS levels as a categorical variable, to be used for Parent PODCI predicted scores. CONCLUSIONS: The results of this study provide clinicians and researchers with a set of Parent PODCI values for comparison to age- and severity-matched populations of ambulatory patients with CP.

Relationships among functional outcome measures used for assessing children with ambulatory CP.

In ambulatory children with cerebral palsy (CP), practitioners often examine outcomes using measures related to functions necessary for daily life. The Gross Motor Function Measure (GMFM) Dimensions D and E, Pediatric Outcomes Data Collection Instrument (PODCI) Parent and Child versions, Gillette Functional Assessment Questionnaire (FAQ) Walking subscale, Functional Independence Measure for Children (WeeFIM), Pediatric Quality of Life Inventory (PedsQL), temporal-spatial gait parameters, and O(2) cost during ambulation were selected for study. Cross-sectional data were collected in a prospective multicenter study of 562 participants with CP (339 males, 223 females), between 4 and 18 years of age (mean age 11y 1mo). There were 240 classified as Gross Motor Function Classification System Level I, 196 as Level II, and 126 as Level III. The tools that had the best interrelationships and underlying constructs predominately measured changes in physical function. These included portions of the FAQ, Parent PODCI, WeeFIM, and GMFM. GMFM Dimensions D and E exhibited a very strong relationship. Temporal-spatial gait parameters and O2 cost measures represented a different construct of physical function. The Child PODCI reports and both the Parent and Child PedsQL reports did not relate well to other measures, suggesting a pattern of answers not related to question content. The Parent PODCI, the FAQ Walking subscale, and GMFM Dimension E were found to be an appropriate minimum set of instruments for assessment of functional outcomes in patients with ambulatory CP.

Outcome assessments in children with cerebral palsy, part I: descriptive characteristics of GMFCS Levels I to III.

This prospective cross-sectional multicenter study assessed the relationships between Gross Motor Function Classification System (GMFCS) level and scores on outcome tools used in pediatric orthopedics. Five hundred and sixty-two participants with cerebral palsy (CP; 339 males, 223 females; age range 4-18y, mean age 11y 1mo [SD 3y 7mo]; 400 with diplegia, 162 with hemiplegia; GMFCS Levels I-III;) completed the study. The Functional Assessment Questionnaire (FAQ), Gross Motor Function Measure (GMFM) Dimensions D and E, Pediatric Quality of Life Inventory (PedsQL), the Pediatric Outcomes Data Collection Instrument (PODCI), Pediatric Functional Independence Measure (WeeFIM), temporal-spatial gait parameters, and O(2) cost were collected during one session. Descriptive characteristics are reported by GMFCS level clinicians can use for comparison with individual children. Tools with a direct relationship between outcome scores and GMFCS levels were the PODCI Parent and Child Global Function, Transfers & Basic Mobility, and Sports and Physical Function; PODCI Parent Upper Extremity Function; WeeFIM Self-care and Mobility; FAQ Question 1; GMFM Dimensions D and E; GMFM-66; O(2) cost; and temporal-spatial gait parameters. Child report scores differed significantly higher than Parent scores for six of eight PODCI subscales and three of four PedsQL dimensions. Children classified into different GMFCS levels function differently.

Outcome assessments in children with cerebral palsy, part II: discriminatory ability of outcome tools.

Discriminatory ability of several pediatric outcome tools was assessed relative to Gross Motor Function Classification System (GMFCS) level in patients with cerebral palsy. Five hundred and sixty-two patients (400 with diplegia, 162 with hemiplegia; 339 males, 223 females; age range 4-18y, mean 11y 1mo [SD 3y 7mo]), classified as GMFCS Levels I to III, participated in this prospective multicenter, cross-sectional study. All tools were completed by parents and participants when appropriate. Effect size indices (ESIs) for parametric variables and odds ratios for non-parametric data quantified the magnitude of differences across GMFCS levels. Binary logistic regression models determined discrimination, and receiver operating characteristic curves addressed sensitivity and specificity. Between Levels I and II, the most discriminatory tools were Gross Motor Function Measure (GMFM-66), velocity, and WeeFIM Mobility. Between Levels II and III, the most discriminatory tools were GMFM Dimension E, Pediatric Functional Independence Measure (WeeFIM) Self-Care and Mobility, cadence, and Gillette Functional Assessment Questionnaire Question 1. Large ESIs were noted for Parent and Child reports of Pediatric Outcomes Data Collection Instrument (PODCI) Sports & Physical Function, Parent report of PODCI Global Function, GMFM Dimension E, and GMFM-66 across all GMFCS level comparisons. The least discriminatory tools were the Quality of Life and cognition measures; however, these are important in comprehensive assessments of treatment effects.

Comparing functional profiles of children with hemiplegic and diplegic cerebral palsy in GMFCS Levels I and II: Are separate classifications needed?

The goal was to compare children with hemiplegia with those with diplegia within Gross Motor Functional Classification System (GMFCS) levels using multiple validated outcome tools. Specifically, we proposed that children with hemiplegia would have better gait and gross motor function within levels while upper extremity function would be poorer. Data were collected on 422 ambulatory children with cerebral palsy: 261 with diplegia and 161 with hemiplegia, across seven centers. Those with hemiplegia in each level performed significantly and consistently better on gait or lower extremity function and poorer on upper extremity and school function than those with diplegia. In GMFCS Level II, the group with hemiplegia walked faster (p = 0.017), scored 6.6 points higher on Dimension E of the Gross Motor Function Measure (p = 0.017), 6.7 points lower on Upper Extremity subscale of the Pediatric Outcomes Data Collection Instrument, and 9.1 points lower on WeeFIM self-care (p = 0.002). Basing motor prognosis on GMFCS level alone may underestimate lower extremity skills of children with hemiplegia, and overestimate those of children with diplegia.

Sensory cueing effects on maximal speed gait initiation in persons with Parkinson's disease and healthy elders.

Researchers have suggested that sensory cues can improve gait initiation in persons with Parkinson's disease (PD); however, there is little research that documents the effects of sensory cues on gait initiation. The purpose of this study was to examine the effects of auditory and cutaneous sensory cues on maximal speed gait initiation in person's with PD and healthy elderly. Seven persons with PD of moderate severity (mean age=69 years) and seven age, gender, and height matched healthy elders participated. Temporal, kinematic and center of pressure (COP) data were recorded as participants performed eight trials within four randomly ordered conditions (no cue (NC), a single auditory cue (SA), repetitive auditory cues (RA), and repetitive cutaneous cues (RC)). In each condition, participants were instructed to perform each gait initiation trial at their maximal speed. In all conditions, person's with PD reacted more slowly and moved less far than did the matched elders. Relative to conditions with NCs, sensory cueing resulted in decreased double limb support (DLS), and increased COP displacement and velocity in both groups. However, in both groups, displacements and velocities of the swing limb and sacrum during the sensory-cued conditions were less than those during the NC condition. These results suggest that when movement speed is a primary goal, sensory cues may interfere with swing limb and body movement outcomes during the gait initiation task in both person's with PD and healthy elders.

Foot kinematics and kinetics during adolescent gait.

Gait analysis models typically analyze the ankle joint complex and treat the foot as a rigid segment. Such models are inadequate for clinical decision making for patients with foot impairments. While previous multisegment foot models have been presented, no comprehensive kinematic and kinetic databases for normal gait exist. This study provides normative foot joint angles, moments and powers during adolescent gait. Eighteen subjects were evaluated using 19 retroreflective markers, six cameras, a pressure platform and a force plate. A nine-segment model determined 3D angles, 3D moments, and powers in eight joints or joint complexes. A complete sets of sagittal, coronal and frontal plane results are presented. Results indicate that single link models of the foot significantly overestimate ankle joint powers during gait. Understanding normal joint kinematics and kinetics during gait will provide a baseline for documenting impairments in patients with foot disorders.