Interrater reliability of face-to-face, tele- and video-based assessments with the modified Mallet classification in brachial plexus birth injuries.

The modified Mallet classification is widely used to measure motor function in brachial plexus birth injuries. The aim of the study was to investigate agreement and reliability of this classification under three different evaluation conditions: face-to-face; live tele-assessment; and delayed video-based assessment. A total of 100 children aged 4-15 years were included. Children were assessed by two raters except for live tele-assessment, which was performed by four raters. Agreement between the three different assessment conditions for the same rater were between strong and excellent for both raters 1 and 2. The interrater reliability for raters 1 and 2 under different assessment conditions was strong to excellent. Interrater reliability among the four raters was moderate to strong in tele-assessment. The modified Mallet classification may have appropriate reliability to be used in remote medical follow-up.Level of evidence: III.

Asymmetric involvement of hands: Psychometric properties of the Turkish version of the Bimanual Fine Motor Function 2.0 classification in children with cerebral palsy.

BACKGROUND: Manual functions affect more than a half of children with Cerebral palsy (CP). Asymmetric involvement of hands may also affect unilateral and bilateral activities of daily life. The Bimanual Fine Motor Function version 2.0 (BFMF-2.0) is a unique functional classification that categorizes the capacity of each hand (what the child can do) during bimanual functions. PURPOSE: The aim of this study was to investigate the validity and reliability of the Turkish version of the BFMF-2.0 in children with CP. STUDY DESIGN: Clinical measurement and cross-sectional study. METHODS: The study included 91 children with CP (56 girls, mean age; 7.41 ± 4.23 years [4-18 years]) and their parents. The Manual Ability Classification System (MACS), the Quality of Upper Extremity Skills Test (QUEST), and the Box and Block Test (BBT) were used for construct and concurrent validity. Experienced/inexperienced therapists and parents classified fine motor capacities of the children via live or video-based observation to assess inter-rater reliability. Three weeks later, the children were reclassified for intra-rater reliability. RESULTS: The Turkish version of the BFMF-2.0 classification was strongly correlated with the MACS (rho = -0.88, p < 0.001), the QUEST (rho = 0.80, p < 0.001), and the BBT (rho = -0.77, p < 0.001). The inter-rater reliability scores were weak to excellent between the parents and the therapists (via live observation, κw = 0.57) and also between experienced/inexperienced therapists (via live or video-based observation, κw = 0.66-0.79). Intra-rater reliability scores were good to excellent (Intraclass Correlation Coefficient [ICC] = 0.87-0.95). CONCLUSIONS: The Turkish version of the BFMF-2.0 classification is valid and reliable and could be applied by experienced and inexperienced therapists via live or video-based observation and by parents via live observation.

Evaluation of daily and social participation of children with Cerebral Palsy across different age groups with a focus on the 'F'-words: Function, family, fitness, fun, friends and future.

BACKGROUND: The impact of disability differs across cultures. This study aimed to determine the predictors of participation in children with cerebral palsy (CP) in Turkey, based on the six F-words. METHODS: Cross-sectional study exploring participation profiles of 450 children with CP, aged between 2 and 18 years. Pediatric Evaluation of Disability Inventory (PEDI) evaluated functional skills, and Assessment of Life Habits (LIFE-H) version 3.0 assessed daily and social participation. Hierarchical linear regression models were done to determine the predictors of participation in daily activities (PDA) and social roles (PSR) in three age groups (2-4, 5-13 and 14-18 years) based on the 6 F-words (mobility of PEDI for 'fitness'; four classification systems and self-care of PEDI for 'functioning'; social functions of PEDI for 'friends'; demographic information by parents for 'family'; the recreation of LIFE-H for 'fun'; and different stages of development for 'future'). RESULTS: The most important predictors for total PDA by age group were: self-care (p = 0.012) of PEDI in 2-4 y; self-care (p = 0.001) and mobility (p = 0.005) of PEDI in 5-13 y; GMFCS (p = 0.006) and mobility (p = 0.002) of PEDI in 14-18 y. Significant predictors for PSR differed by age group: self-care (p = 0.001) of PEDI in 2-4 y; self-care (p = 0.023) and mobility (p = 0.006) of PEDI in 5-13 y; and GMFCS (p = 0.004) and MACS (p = 0.003) in 14-18 y. CONCLUSIONS: Six F-words of function and fitness focussed on self-care in younger children with an increasing emphasis on mobility and ability levels according to age. Therefore, rehabilitation for different aspects of the functional levels is needed to improve participation in life across the six F-words framework; plus take into consideration context, age-differences, family's expectations, life requirements, environmental needs, and cultural differences.

Effects of Telerehabilitation-Based Structured Home Program on Activity, Participation and Goal Achievement in Preschool Children with Cerebral Palsy: A Triple-Blinded Randomized Controlled Trial.

A home program is implemented as an evidence-based mode of delivering services for physiotherapy and rehabilitation. Telerehabilitation is a method applied in physiotherapy modalities for children. This study aims to determine the effectiveness of usual care plus a Telerehabilitation-Based Structured Home Program on preschool children with cerebral palsy (CP) compared to usual care. Forty-three children aged 3-6 years (mean age 4.66 ± 1.08 years) with CP were randomly assigned to the Telerehabilitation-Based Structured Home Program and usual care groups. Their motor function was assessed with the Gross Motor Function Measure (GMFM); performance and satisfaction were evaluated with the Canadian Occupational Performance Measure (COPM); goal achievement was assessed with the Goal Attainment Scale (GAS); and activity and participation were evaluated with Pediatric Evaluation of Disability Inventory (PEDI). Participants were evaluated at baseline, immediately post-intervention (12 weeks) and at follow-up (24 weeks). There was a statistically significant difference between pre- and post-test GMFM, COPM, GAS and PEDI scores in the intervention and control groups (p < 0.001). The Telerehabilitation-Based Structured Home Program showed statistically significant changes in activity, participation and goal achievement after 12 weeks of intervention (p < 0.001). However, significant results were not obtained in the usual care group. The Telerehabilitation-Based Structured Home Program may be an effective method for preschool children with CP. (Registration number: NCT04807790; no = KA-20124/26.01.2021).

Reliability and validity of the Turkish version of the Selective Control Assessment of the Lower Extremity (SCALE) in children with spastic cerebral palsy.

PURPOSE: This study aims to translate the Selective Control Assessment of the Lower Extremity (SCALE) into Turkish language, assess its reliability and validity in children with spastic cerebral palsy. MATERIALS AND METHODS: Fifty-two children with CP (mean age 9 years 8 months, range 4-18 years) included in this cross-sectional study. Intra- and interrater reliability was assessed by intraclass correlation coefficient (ICC). The SCALE was correlated with the Gross Motor Function Classification System (GMFCS), the Physician's Rating Scale (PRS), and Gross Motor Function Measurement (GMFM) to assess validity. RESULTS: Intra- and interrater reliability of the SCALE were excellent (ICC > 0.75). SCALE and GMFCS (r = -0.786, p < 0.001), SCALE and PRS (r = 0.761, p < 0.001), SCALE and GMFM (r = 0.863, p < 0.001) were highly correlated. SCALE scores differed significantly between GMFCS levels and between types of spastic CP. CONCLUSIONS: The Turkish version of the SCALE appears to be a valid and reliable tool to assess selective voluntary motor control of the lower limbs in children with spastic CP.IMPLICATIONS FOR REHABILITATIONThe Turkish version of the Selective Control Assessment of the Lower Extremity is a valid and reliable assessment for children with spastic CP.The SCALE scores differed significantly between Gross Motor Function Classification System levels I versus II and levels II versus III as well as between types of spastic CP.The current study suggests that the SCALE is a quick and easy outcome measure to assess selective motor control in patients with spastic CP.

The effects of fatigue, gross motor function, and gender on participation in life situations of school-aged children with cerebral palsy: A parental perspective.

OBJECTIVE: To investigate the effects of fatigue, gross motor function, and gender on participation in life situations of school-aged children with cerebral palsy (CP) from a parental perspective. METHODS: The study included 209 children with CP aged between 5 and 13 years (mean age, 8.06 ± 2.41 years; girls, 45.5%) and their parents. Fatigue, gross motor function, and participation status were evaluated with the Pediatric Quality of Life (PedsQL), Gross Motor Function Classification System (GMFCS), and the Assessment of Life Habits (Life-H) questionnaire, respectively. The effects of fatigue, gross motor function, and gender on participation were investigated with linear regression analysis. RESULTS: According to parental reports, 79.9% of the children had fatigue. Children in all GMFCS levels experienced fatigue. Fatigue and GMFCS levels were dependent variables, and therefore only simple linear regression analyses were performed. Fatigue explained 38-43% of the variances in daily activities, social roles, and total Life-H scores, while gross motor function explained 48-65% of the variances in scores (p < 0.001). Gender had no effect on participation scores (p > 0.05). CONCLUSION: More than two thirds of the school-aged children with CP had fatigue. Fatigue and poor gross motor function had a negative effect on participation in daily activities and social roles.

Relationship among four functional classification systems and parent interpredicted intelligence level in children with different clinical types of cerebral palsy.

OBJECTIVE: To investigate the relationships between four functional classification systems in children with cerebral palsy (CP) and parent-interpredicted intelligence level, and the functional status in clinical types of CP. METHODS: Two hundred and twenty-five children with CP ages between 2 and 18 (mean age 6.5 ± 4.4) years included using the Surveillance of CP in Europe (SCPE) database in Turkey. Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Communication Function Classification System (CFCS) and Eating and Drinking Classification System (EDACS) levels were classified by clinical observation, and intelligence quotient (IQ) was determined by parent reports. RESULTS: Correlations were found between all functional levels; the strongest were between GMFCS-MACS (r = 0.784, p < .001), CFCS-EDACS (r = 0.772, p < .001). Strong correlations were found for the IQ-CFCS (r = 0.762, p < .001) and IQ-EDACS (r = 0.634, p < .001). Correlations were stronger in children with bilateral CP and IQ level <70. CONCLUSIONS: Taken together, these four classification systems and reported IQ levels can adequately describe overall functioning for children with CP. Our results can guide clinicians in the rehabilitation of children with CP.

Reliability and Validity of the Turkish Version of the Selective Control of the Upper Extremity Scale in Children with Cerebral Palsy.

AIMS: To investigate the psychometric properties of the Selective Control of the Upper Extremity Scale (SCUES). METHODS: Fifty-two children (27 females and 25 males; mean age 9.8 ± 4.4 years) with spastic type of cerebral palsy (CP) participated in the study. Psychometric analyses included reliability, concurrent validity, construct validity, and discriminant validity. Upper Limb Physician's Rating Scale (ULPRS), Modified Ashworth Scale (MAS), Quality of Upper Extremity Skills Test (QUEST) were used for concurrent validity. Manual Ability Classification System (MACS) was used for construct validity. Differences in SCUES scores were determined between participants categorized according to their limb distribution and MACS levels. RESULTS: Intra-rater reliability (intraclass correlation coefficient [ICC] = 0.98) of the SCUES was excellent. SCUES and ULPRS (r = 0.87, p < 0.001), SCUES and MAS (r=-0.93, p < 0.001), SCUES and QUEST (r=0.81, p < 0.001) were highly correlated. SCUES and MACS (r=-0.67, p < 0.001) was moderately correlated. SCUES scores differed significantly between children classifed as MACS levels I versus II and III and between children with hemiparetic and diparetic CP. CONCLUSION: The SCUES appears to be a valid and reliable tool to assess selective voluntary motor control of the upper extremities in children with spastic CP, which may be useful in selecting and planning interventions.

Effectiveness of Physical Therapy on Ataxia-Telangiectasia: A Case Report.

BACKGROUND AND PURPOSE: This case report investigated the benefits of a 12-week physical therapy program for a child with ataxia-telangiectasia (AT). CASE DESCRIPTION: A 9-year-old girl with a diagnosis of AT participated. The physical therapy program consisted of balance and strength exercise and Wii Fit Balance-based video games training with a pediatric physical therapist for 12 weeks. MEASUREMENTS: The motor performance, Gross Motor Function Measurement (GMFM), Pediatric Berg Balance Scale (PBBS), Trunk Control Measurement Scale (TCMS), participation as measured by the Life Habits Questionnaire (LIFE-H), and the Pediatric Quality of Life Inventory (PedsQL). OUTCOMES: Positive changes were observed in the TCMS, PBBS, GMFM, and motor performance, participation, and quality of life. CONCLUSIONS: Notable improvements were observed in both body structure and function, and activities and participation level. WHAT THIS ADDS TO EVIDENCE: This case report is the first to support the effectiveness of physical therapy in a child with AT.

The functional health status of children with cerebral palsy during the COVID-19 pandemic stay-at-home period: a parental perspective.

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic was effective all over the world. The stay-athome period was proposed to protect against the pandemic. The aim of this study was to investigate the effects of the COVID-19 pandemic stay-at-home period on body structures and functions, activity and participation levels, and environmental factors of children with cerebral palsy (CP) from the parental perspective in Turkey. METHODS: A twenty-question survey, using the International Classification of Functioning, Disability and Health for Children and Youth set to understand the functional changes of children with CP during the stay-athome period, was sent to parents in this prospective study. Motor function levels of children were determined by the Gross Motor Function Classification System parent report. The structural equation model was used for statistical analysis. RESULTS: One hundred and three parents of children with CP participated. At least one of four children with CP had increased levels of anxiety (41.8%), and increased level of a sensation of pain (34%) and sleep problems (25.2%). More than half of the children had increased tonus (67%), decreased range of motion (60.2%), decreased physical activity level (55.3%), and decreased support level of rehabilitation services (82.6%). During the stayat- home period activity and participation levels and environmental factors of children explained the changes of body functions as 70% and 33% (RMSEA=0.077, p < 0.05). CONCLUSIONS: This study is the first study to examine the functional health of children with CP biopsychosocially during the COVID-19 stay-at-home period. According to the parents, the functional health of children with CP was affected at different levels during the COVID-19 pandemic. Body functions may also be affected positively if physical activity level, home program and environmental supports increase.