IQ discrepancy differentiates levels of fine motor skills and their relationship in children with autism spectrum disorders.

PURPOSE: We investigated 1) the impact of differences in intelligence quotient discrepancy (IQD) on motor skills of preschool-aged children with autism spectrum disorders (ASD); 2) the relationships between IQD and motor skills in preschool-aged children with ASD. METHODS: A total of 127 ASD preschool-aged children were divided into three groups according to the size of the IQD: IQD within 1 standard deviation (1SD; EVENIQ; n=81), discrepantly higher verbal intelligence quotient (VIQ; n=22; VIQ>performance intelligence quotient [PIQ] above 1SD [≥15 points]), and discrepantly higher PIQ (n=24; PIQ>VIQ above 1SD [≥15 points]). Children's IQD and motor skills were determined with the Wechsler Preschool and Primary Scale of Intelligence™ - Fourth Edition and the motor subtests of the Comprehensive Developmental Inventory for Infants and Toddlers (CDIIT), respectively. RESULTS: One-way analysis of variance revealed significant group differences for the fine motor domain of the CDIIT and the visual-motor coordination subtest (F=3.37-4.38, p<0.05). Children with discrepantly higher PIQ were associated with better fine motor skills than were children with even IQD and those with discrepantly higher VIQ, and vice versa. IQD (PIQ - VIQ) had significant positive correlations with the fine motor domain and fine motor subtests of the CDIIT (r=0.18-0.29, p<0.05). CONCLUSION: The IQD can identify different levels of fine motor skills in preschool-aged children with ASD. This study suggests important implications for clinicians, therapists, and researchers: discrepantly higher PIQ could be related to better visual-motor coordination, and discrepantly higher VIQ could be related to poor visual-motor coordination. Furthermore, the results support that when therapists are working with preschool-aged children with ASD who are developing fine motor skills or undertaking fine motor tasks related to visual-motor coordination, they may need to pay attention to the children's IQD.

Development of a Computerized Adaptive Test of Children's Gross Motor Skills.

OBJECTIVES: To (1) develop a computerized adaptive test for gross motor skills (GM-CAT) as a diagnostic test and an outcome measure, using the gross motor skills subscale of the Comprehensive Developmental Inventory for Infants and Toddlers (CDIIT-GM) as the candidate item bank; and (2) examine the psychometric properties and the efficiency of the GM-CAT. DESIGN: Retrospective study. SETTING: A developmental center of a medical center. PARTICIPANTS: Children with and without developmental delay (N=1738). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The CDIIT-GM contains 56 universal items on gross motor skills assessing children's antigravity control, locomotion, and body movement coordination. RESULTS: The item bank of the GM-CAT had 44 items that met the dichotomous Rasch model's assumptions. High Rasch person reliabilities were found for each estimated gross motor skill for the GM-CAT (Rasch person reliabilities =.940-.995, SE=.68-2.43). For children aged 6 to 71 months, the GM-CAT had good concurrent validity (r values =.97-.98), adequate to excellent diagnostic accuracy (area under receiver operating characteristics curve =.80-.98), and moderate to large responsiveness (effect size =.65-5.82). The averages of items administered for the GM-CAT were 7 to 11, depending on the age group. CONCLUSIONS: The results of this study support the use of the GM-CAT as a diagnostic and outcome measure to estimate children's gross motor skills in both research and clinical settings.

Improving the utility of the fine motor skills subscale of the comprehensive developmental inventory for infants and toddlers: a computerized adaptive test.

AIM: This study aimed at improving the utility of the fine motor subscale of the comprehensive developmental inventory for infants and toddlers (CDIIT) by developing a computerized adaptive test of fine motor skills. METHODS: We built an item bank for the computerized adaptive test of fine motor skills using the fine motor subscale of the CDIIT items fitting the Rasch model. We also examined the psychometric properties and efficiency of the computerized adaptive test of fine motor skills with simulated computerized adaptive tests. RESULTS AND CONCLUSIONS: Data from 1742 children with suspected developmental delays were retrieved. The mean scores of the fine motor subscale of the CDIIT increased along with age groups (mean scores = 1.36-36.97). The computerized adaptive test of fine motor skills contains 31 items meeting the Rasch model's assumptions (infit mean square = 0.57-1.21, outfit mean square = 0.11-1.17). For children of 6-71 months, the computerized adaptive test of fine motor skills had high Rasch person reliability (average reliability >0.90), high concurrent validity (rs = 0.67-0.99), adequate to excellent diagnostic accuracy (area under receiver operating characteristic = 0.71-1.00), and large responsiveness (effect size = 1.05-3.93). The computerized adaptive test of fine motor skills used 48-84% fewer items than the fine motor subscale of the CDIIT. The computerized adaptive test of fine motor skills used fewer items for assessment but was as reliable and valid as the fine motor subscale of the CDIIT. Implications for Rehabilitation We developed a computerized adaptive test based on the comprehensive developmental inventory for infants and toddlers (CDIIT) for assessing fine motor skills. The computerized adaptive test has been shown to be efficient because it uses fewer items than the original measure and automatically presents the results right after the test is completed. The computerized adaptive test is as reliable and valid as the CDIIT.

Selecting score types for longitudinal evaluations: the responsiveness of the Comprehensive Developmental Inventory for Infants and Toddlers in children with developmental disabilities.

OBJECTIVE: The objective of this study was to examine the responsiveness of the Comprehensive Developmental Inventory for Infants and Toddlers (CDIIT) in children with developmental disabilities (DD). METHODS: The responsiveness of a measure is its ability to detect change over time, and it is fundamental to an outcome measure for detecting changes over time. We compared the responsiveness of four types of scores (ie, raw scores, developmental ages [DAs], percentile ranks [PRs], and developmental quotients [DQs]) in the five subtests of the CDIIT. The CDIIT was administrated three times at intervals of 3 months on 32 children with DD aged between 5 months and 64 months (mean =30.6, standard deviation [SD] =17.8). The CDIIT is a pediatric norm-referenced assessment commonly used for clinical diagnosis of developmental delays in five developmental areas: cognition, language, motor, social, and self-care skills. The responsiveness was analyzed using three methods: effect size, standardized response mean, and paired t-test. RESULTS: The effect size results showed that at the 3-month and 6-month follow-ups, responsiveness was small or moderate in the raw scores and DAs of most of the subtest scores of the CDIIT, but the level of responsiveness varied in the PRs and DQs. The standardized response mean results of the 3-month and 6-month follow-ups showed that most of the subtest scores of the CDIIT had respectively moderate and large responsiveness in raw scores and DAs, but the responsiveness varied (from no to large) in PRs and DQs. CONCLUSION: The findings generally support the use of the CDIIT as an outcome measure. We also suggest using the raw scores and DAs when using a norm-referenced pediatric developmental assessment to evaluate developmental changes and program effectiveness in children with DD.

Intelligence quotient discrepancy indicates levels of motor competence in preschool children at risk for developmental delays.

PURPOSE: This study aimed to establish 1) whether a group difference exists in the motor competence of preschool children at risk for developmental delays with intelligence quotient discrepancy (IQD; refers to difference between verbal intelligence quotient [VIQ] and performance intelligence quotient [PIQ]) and 2) whether an association exists between IQD and motor competence. METHODS: Children's motor competence and IQD were determined with the motor subtests of the Comprehensive Developmental Inventory for Infants and Toddlers and Wechsler Preschool and Primary Scale of Intelligence™ - Fourth Edition. A total of 291 children were included in three groups: NON-IQD (n=213; IQD within 1 standard deviation [SD]), VIQ>PIQ (n=39; VIQ>PIQ greater than 1 SD), and PIQ>VIQ (n=39; PIQ>VIQ greater than 1 SD). RESULTS: The results of one-way analysis of variance indicated significant differences among the subgroups for the "Gross and fine motor" subdomains of the Comprehensive Developmental Inventory for Infants and Toddlers, especially on the subtests of "body-movement coordination" (F=3.87, P<0.05) and "visual-motor coordination" (F=6.90, P<0.05). Motor competence was significantly worse in the VIQ>PIQ group than in the NON and PIQ>VIQ groups. Significant negative correlations between IQD and most of the motor subtests (r=0.31-0.46, P<0.01) were found only in the VIQ>PIQ group. CONCLUSION: This study demonstrates that 1) IQD indicates the level of motor competence in preschoolers at risk for developmental delays and 2) IQD is negatively associated with motor competence in preschoolers with significant VIQ>PIQ discrepancy. The first finding was that preschoolers with VIQ>PIQ discrepancy greater than 1 SD performed significantly worse on motor competence than did preschoolers without significant IQD and preschoolers with PIQ>VIQ discrepancy greater than 1 SD. However, preschoolers with significant PIQ>VIQ discrepancy performed better on motor competence than did preschoolers without significant IQD, though the difference was not statistically significant. The second finding was that preschoolers with larger VIQ>PIQ discrepancy had worse motor competence in visual-motor integration and body-movement coordination. Professionals should pay attention to the motor development of children with VIQ>PIQ discrepancy and evaluate children's IQD along with their motor competence.

Development of a Tablet-based symbol digit modalities test for reliably assessing information processing speed in patients with stroke.

PURPOSE: To develop a Tablet-based Symbol Digit Modalities Test (T-SDMT) and to examine the test-retest reliability and concurrent validity of the T-SDMT in patients with stroke. METHODS: The study had two phases. In the first phase, six experts, nine college students and five outpatients participated in the development and testing of the T-SDMT. In the second phase, 52 outpatients were evaluated twice (2 weeks apart) with the T-SDMT and SDMT to examine the test-retest reliability and concurrent validity of the T-SDMT. RESULTS: The T-SDMT was developed via expert input and college student/patient feedback. Regarding test-retest reliability, the practise effects of the T-SDMT and SDMT were both trivial (d=0.12) but significant (p≦0.015). The improvement in the T-SDMT (4.7%) was smaller than that in the SDMT (5.6%). The minimal detectable changes (MDC%) of the T-SDMT and SDMT were 6.7 (22.8%) and 10.3 (32.8%), respectively. The T-SDMT and SDMT were highly correlated with each other at the two time points (Pearson's r=0.90-0.91). CONCLUSIONS: The T-SDMT demonstrated good concurrent validity with the SDMT. Because the T-SDMT had a smaller practise effect and less random measurement error (superior test-retest reliability), it is recommended over the SDMT for assessing information processing speed in patients with stroke. Implications for Rehabilitation The Symbol Digit Modalities Test (SDMT), a common measure of information processing speed, showed a substantial practise effect and considerable random measurement error in patients with stroke. The Tablet-based SDMT (T-SDMT) has been developed to reduce the practise effect and random measurement error of the SDMT in patients with stroke. The T-SDMT had smaller practise effect and random measurement error than the SDMT, which can provide more reliable assessments of information processing speed.

Differences Between Women and Men in Phase I Cardiac Rehabilitation After Acute Myocardial Infarction: A Nationwide Population-Based Analysis.

Although numerous studies have investigated gender-related differences in patients who have had an acute myocardial infarction (AMI), few studies have examined the gender-related differences among inpatients receiving Phase I inpatient cardiac rehabilitation following AMI.Using data from the Taiwan National Health Insurance Research Database, this study analyzed 6713 adult patients who received inpatient cardiac rehabilitation following AMI between 2002 and 2011. The differences in comorbidity, medical service use, and prognosis between the male and female patients were analyzed to determine whether the comorbidities affecting their prognoses differed.Female patients accounted for 23.18% of the sample, had a higher average age, and exhibited severe comorbidities; furthermore, they had significantly more days of hospitalization and days in an intensive care unit than did male patients. The gender-related differences in hospital mortality rate and 30-day mortality rate were nonsignificant, but female patients exhibited a significantly higher 1-year mortality rate. Moreover, the risk for 1-year mortality was higher among female patients with moderate or severe renal disease (odds ratio: 1.94, 95% confidence interval: 1.29-2.92) than among their male counterparts. However, the 1-year mortality rate for the female patients did not increase after all risk factors were adjusted.Gender-related differences in age, comorbidity, and prognosis were confirmed in AMI patients receiving Phase I inpatient cardiac rehabilitation. In addition, gender-related differences were observed in the comorbidity risk factors affecting prognosis. However, being female did not affect the prognosis.

Genetic Evaluation of Children with Global Developmental Delay--Current Status of Network Systems in Taiwan.

This review article aims to introduce the screening and referral network of genetic evaluation for children with developmental delay in Taiwan. For these children, integrated systems provide services from the medical, educational, and social welfare sectors. All cities and counties in Taiwan have established a network for screening, detection, referral, evaluation, and intervention services. Increased awareness improves early detection and intervention. There remains a gap between supply and demand, especially with regard to financial resources and professional manpower. Genetic etiology has a major role in prenatal causes of developmental delay. A summary of reports on some related genetic disorders in the Taiwanese population is included in this review. Genetic diagnosis allows counseling with regard to recurrence risk and prevention. Networking with neonatal screening, laboratory diagnosis, genetic counseling, and orphan drugs logistics systems can provide effective treatment for patients. In Taiwan, several laboratories provide genetic tests for clinical diagnosis. Accessibility to advanced expensive tests such as gene chips or whole exome sequencing is limited because of funding problems; however, the service system in Taiwan can still operate in a relatively cost-effective manner. This experience in Taiwan may serve as a reference for other countries.

Incidence of severe dysphagia after brain surgery in pediatric traumatic brain injury: a nationwide population-based retrospective study.

OBJECTIVES: To investigate the incidence of dysphagia and medical resource utilization in a nationwide population of pediatric patients with traumatic brain injury (TBI). SETTING: Subjects' data were obtained from the Taiwan National Health Insurance Research Database. PARTICIPANTS: Between 2000 and 2008, 6290 children less than 18 years old who had received surgery post-TBI were included in the study. DESIGN: Retrospective study. MAIN OUTCOME MEASURE: Biographic data and medical utilization results. RESULTS: Of all the children postsurgery after TBI, 12.3% were categorized as having severe dysphagia. The occurrence of severe dysphagia was not related to sex but was statistically and significantly related to a younger mean age. The relationship between age and dysphagia also showed an interestingly biphasic distribution, mostly in the subgroups of 1 to 3 and 16 to 18 years of age. The medical resource utilization was higher in severely dysphagia patients, but only 8.4% received intervention by a speech language pathologist. CONCLUSIONS: Severe dysphagia among postsurgical pediatric patients after TBI is relatively common, and those with severe dysphagia have a greater need for medical services. However, the ratio of such patients who receive swallowing treatment is still low in Taiwan. Clinicians are prompted to pay more attention to the impairment in functional oral intake of children postsurgery after TBI.

An investigation of the factors affecting flatfoot in children with delayed motor development.

This study investigated the prevalence of flatfoot in children with delayed motor development and the relevant factors affecting it. In total, 121 preschool-aged children aged 3-6 with delayed motor development (male: 81; female: 40) were enrolled in the motor-developmentally delayed children group, and 4 times that number, a total of 484 children (male: 324; female: 160), of gender- and age-matched normal developmental children were used as a control group for further analyses. The age was from 3.0 to 6.9 years old for the participants. The judgment criterion of flatfoot was the Chippaux-Smirak index >62.70%, in footprint measurement. The results showed that the prevalence of flatfoot in children with motor developmental delay was higher than that in normal developmental children, approximately 58.7%, and that it decreased with age from 62.8% of 3-year-olds to 50.0% of 6-year-olds. The results also showed that motor-developmentally delayed children with flatfoot are at about 1.5 times the risk of normal developmental children (odds ratio=1.511, p=0.005). In addition, the prevalence of flatfoot is relatively higher in overweight children with delayed motor development, and that in obese children is even as high as 95.8% (23/24). Children with both excessive joint laxity and delayed development are more likely to suffer from flatfoot. The findings of this study can serve as a reference for clinical workers to deal with foot issues in children with delayed motor development.

Impacts of autistic behaviors, emotional and behavioral problems on parenting stress in caregivers of children with autism.

This study examined the effects of autistic behaviors and individual emotional and behavioral problems on parenting stress in caregivers of children with autism. Caregivers were interviewed with the Childhood Autism Rating Scale and completed the Strength and Difficulties Questionnaire and the Parenting Stress Index Short Form. Results revealed that caregivers of children with mild/moderate autistic behavior problems perceived lower parenting stress than did those of children with no or severe problems. In addition, prosocial behaviors and conduct problems respectively predicted stress in the parent-child relationship and child-related stress. The findings can provide guidance in evaluations and interventions with a focus on mitigating parenting stress in caregivers of children with autism.

The ICF-CY-based structural equation model of factors associated with participation in children with autism.

OBJECTIVE: The aim of this study was to apply the International Classification of Functioning, Disability and Health - Child and Youth (ICF-CY) framework to identify the factors related to the participation of children with autism. METHOD: A convenience sample included 162 preschool children with autism ages 36 to 72 months. The raters collected data using the ICF-CY-based questionnaire as an instrument to construct the structural equation modeling of factors associated with participation. RESULTS: The internal structure of the model was acceptable, indicating that the observed variables would suffice in accounting for latent variables. The structural model showed that the performance of participation in children with autism was influenced by body functions and personal factors. All the variables accounted for 77% of the explained variance for activities and for participation by 71% of the children with autism. CONCLUSION: These findings may provide critical information pertaining to predictive factors of participation for parents, educators, and professionals who work with children with autism.

Sensory integration dysfunction affects efficacy of speech therapy on children with functional articulation disorders.

BACKGROUND: Articulation disorders in young children are due to defects occurring at a certain stage in sensory and motor development. Some children with functional articulation disorders may also have sensory integration dysfunction (SID). We hypothesized that speech therapy would be less efficacious in children with SID than in those without SID. Hence, the purpose of this study was to compare the efficacy of speech therapy in two groups of children with functional articulation disorders: those without and those with SID. METHOD: A total of 30 young children with functional articulation disorders were divided into two groups, the no-SID group (15 children) and the SID group (15 children). The number of pronunciation mistakes was evaluated before and after speech therapy. RESULTS: There were no statistically significant differences in age, sex, sibling order, education of parents, and pretest number of mistakes in pronunciation between the two groups (P > 0.05). The mean and standard deviation in the pre- and post-test number of mistakes in pronunciation were 10.5 ± 3.2 and 3.3 ± 3.3 in the no-SID group, and 10.1 ± 2.9 and 6.9 ± 3.5 in the SID group, respectively. Results showed great changes after speech therapy treatment (F = 70.393; P < 0.001) and interaction between the pre/post speech therapy treatment and groups (F = 11.119; P = 0.002). CONCLUSIONS: Speech therapy can improve the articulation performance of children who have functional articulation disorders whether or not they have SID, but it results in significantly greater improvement in children without SID. SID may affect the treatment efficiency of speech therapy in young children with articulation disorders.

ICF-CY based assessment tool for children with autism.

PURPOSE: The objectives of this study was to develop an International Classification of Functioning, Disability and Health-Children and Youth (ICF-CY) based questionnaire for children with autism, investigate the inter-rater reliability of the questionnaire and assess functional performance in children with autism. METHOD: The ICF-CY based questionnaire for children with autism comprised 118 items was designed with reference the ICF-CY structure. The study protocol was divided into two parts. In the first part, the inter-rater reliability of the questionnaire was investigated using information from 26 children (aged 3-6 years) with autism and using the intra-class correlation coefficients to estimate reliability. The second part of the study aimed to assess functional performance of another independent sample (136 children, aged 3-6 years) utilizing the questionnaire. Mean scores were compared by nonparametric statistic. RESULTS: The inter-rater reliability for each domains of the questionnaire was found to be moderate to high (intra-class correlation coefficients ranged from 0.72 to 0.97). Children with autism had major problems in voice and speech functions. They had high dependency when executing individual activities of learning and applied knowledge. They also required maximal assistance while engaging in social activities related to conversation and major life categories. CONCLUSIONS: This preliminary study shows that ICF-CY based questionnaire has good reliability and can reflect the functional profile of preschool children with autism. However, further study is needed to confirm other psychometric characteristics.

Change in flatfoot of preschool-aged children: a 1-year follow-up study.

UNLABELLED: The main purpose of this study is to investigate the changes in the signs of flatfoot of preschool-aged children in a 1-year follow-up study. This study performed follow-up on a total of 580 preschool-aged children (boys, 297 children; girls, 283 children) with a median age of 54 (range 36-71 months), and the average follow-up period was 11.8 months. This study used the Chippaux-Smirak index (CSI) of footprint as the assessment tool, and CSI > 62.70 % was used as the standard for determining whether preschool-aged children suffered from flatfoot. The results showed that the signs of flatfoot of preschool-aged children improved with increasing age. At the 1-year follow-up, the average CSI was 5.1 % lower, and the proportion of children with flatfoot was 14 % lower. The follow-up on the change in the signs of flatfoot showed that 37.6 % of the children originally with flatfoot had improved to normal, verifying that flatfoot indeed improves with increasing age. However, the results also showed that 9.9 % of the children who originally had normal feet had developed flatfoot with increasing age, which deserves subsequent investigation. The results of the follow-up also showed that children who were relatively younger, male, obese, and experiencing excessive joint laxity were more likely to experience the signs of flatfoot. CONCLUSION: The 1-year follow-up found that some preschool-aged children with flatfoot may develop normal feet, while children with normal feet may begin to experience the signs. Relevant factors affecting flatfoot in preschool-aged children continue to require further clarification.

The association of drooling and health-related quality of life in children with cerebral palsy.

OBJECTIVE: To investigate the association between drooling in children with cerebral palsy (CP) and their health-related quality of life (HRQOL), as well as the possible variables that predict their HRQOL. METHOD: A cross-sectional design was used for this study. Children with CP, without other identified disease, aged 2 to 6 years, who drool (n = 33) or did not drool (n = 14), were included. The dependent variables were the physical health summary scores and the psychosocial health summary scores of the Pediatric Quality of Life Inventory version 4.0. The t test, Pearson product-moment correlation, Mann-Whitney U test and stepwise regression analysis were used for statistical analysis. RESULTS: The physical health and psychosocial health summary scores of the children that drooled (16.29 ± 15.97 and 42.92 ± 17.57, respectively) were lower than for the children that did not drool (31.97 ± 22.22 and 57.09 ± 12.21, respectively; P < 0.01). The drooling ranking score was negatively correlated with the physical health summary score (r = -0.355; P < 0.05) and the psychosocial health summary score (r = -0.381; P < 0.01). The stepwise regression showed that gross motor development and the drooling ranking score predicted 56.6% of the variability of the physical health summary score (R(2) = 0.566; P < 0.01). The language development score predicted 25.6% of the variability of the psychosocial health summary score (R(2) = 0.256; P < 0.01). CONCLUSION: Drooling was associated with a lower HRQOL. Prediction of the physical health summary score was more closely associated with gross motor development and the drooling ranking scores. Prediction of the psychosocial health summary score was more closely associated with the language development of children with CP aged 2 to 6 years.

Relevant factors influencing flatfoot in preschool-aged children.

The aim of this study was to discuss the influence of age, gender, obesity status, joint laxity, and the W-sitting habit on flatfoot in preschool-aged children. A total of 1,598 children (833 boys and 765 girls) between 3 and 6 years of age from kindergartens in the central area of Taiwan were studied. The children were divided into a normal group (n = 733), a unilateral flatfoot group (n = 266), and a bilateral flatfoot group (n = 599), and a multinomial logistic regression model was used to analyze the data. The prevalence of flatfoot decreased significantly with increasing age: 54.5% of 3-year-old but only 21% for 6-year-old children had bilateral flatfoot. In the bilateral flatfoot group, the risk decreased with increased age, increased with increasing weight beyond the normal range, and was higher for boys than girls. Age and obesity status were not significantly influential in the unilateral flatfoot group. Children with higher joint laxity and a habit of W-sitting also experienced higher risk in both flatfoot groups. In conclusion, this study demonstrates a significant association of age, gender, obesity status, joint laxity, and the W-sitting habit with the bilateral flatfoot in preschool-aged children. Children with unilateral flatfoot differ from those with normal feet and bilateral flatfoot. It is suggested that the unilateral flatfoot deserves special attention in future studies.

Psychometric properties of functional balance assessment in children with cerebral palsy.

BACKGROUND: Children with cerebral palsy often suffer from a lack of balance compared with typically developing children. Because balance capacity is relevant to functional activities, reliable and valid functional balance measures are crucial for the pediatric clinical setting. OBJECTIVE: This study examined the reliability and validity of 3 functional balance measures. METHODS: Thirty children aged 60 to 142 months with Gross Motor Function Classification System (GMFCS) levels of I to IV were recruited. For test-retest reliability, the same physical therapist administered the Functional Reach Test (FRT), Berg Balance Scale (BBS), and Timed Up and Go (TUG) twice. For interrater reliability, the testing processes were video recorded and later scored by another therapist. For convergent validity, children with cerebral palsy received the Gross Motor Function MEASURES: (GMFM), walking speed, and 10-second sit-to-stand test within 1 week and the results evaluated. RESULTS: The 3 functional balance measures had excellent test-retest reliability (intraclass correlation coefficient [ICC] >0.95) and interrater reliability (ICC = 0.98-1.00). With regard to convergent validity, the BBS and the TUG were highly correlated with GMFM total score, walking speed, and the 10-second sit-to-stand test. The discriminate validity indicates that the FRT can distinguish children with cerebral palsy with different GMFCS levels, whereas the BBS total score and TUG failed to distinguish between children with cerebral palsy with GMFCS levels of I and II. CONCLUSION: The 3 functional balance measures are simple, valid, and reliable for examining children with cerebral palsy and are thus suitable for clinical practice.

Electromyographic analyses of global synkinesis in the paretic upper limb after stroke.

BACKGROUND AND PURPOSE: Global synkinesis (GS), or motor irradiation, is an involuntary movement associated with the coactivation of numerous muscles in one limb when the opposite limb is active. The electromyographic (EMG) patterns of people with stroke and people who were healthy were analyzed to characterize GS development in relation to joint involvement and to attempt to relate these findings to clinical observations. SUBJECTS AND METHODS: Twenty patients with stroke, divided into 2 groups with either greater levels of irradiation (SG, n = 10) or lesser levels of irradiation (SL, n = 10), and 20 subjects in a control group were studied. A dynamometer was used to provide resistance for voluntary isometric muscle contractions of the flexor muscle groups of the shoulder, elbow, and wrist. The summated and standardized net EMG amplitudes of 8 principal muscles of the unexercised (paretic) upper extremity were used to characterize intensity and spatial representation of GS. Clinical measurements included the Fugl-Meyer Assessment Scale (FMA), Barthel Index of Activities of Daily Living (BI), and the stage on the Brunnström Stages of Motor Recovery Scale (BR). RESULTS: In the SG and control groups, a more substantial GS intensity was associated with muscle contractions of the flexor muscles of the opposite proximal joint than was the case for contractions of the flexor muscles of the distal joint, whereas such a gradient change was absent in the SL group. The corresponding spatial patterns of GS exhibited a predominant cross-excitation over the unexercised pectoralis major and extensor carpi radialis muscles in the control group, contrary to the enhanced activation of the brachioradialis and biceps brachii muscles noted in patients with stroke. The SG group had a better FMA score and a more satisfactory BR stage than did the SL group, and the 2 neurological scores were related to GS intensity for patients with stroke, depending on joint involvement. DISCUSSION AND CONCLUSION: Intensity of GS provided an affiliation with motor deficits and a promising window for poststroke recovery mechanisms.

Responsiveness of the H reflex to loading and posture in patients following stroke.

The objective of the research was to examine the effects of loading and posture on motoneuronal excitability of the triceps surae (TS) for patients with hemiplegia. Twelve healthy subjects and 12 patient subjects with post-stroke hemiparesis (onset period: 3-60 months) were enrolled in this study. The subjects were instructed to remain in quiet sitting with the test knee straight and three standing conditions of different superincumbent loads by shifting body weight to the test leg (10%, 50%, and 90% of body weight), while the H reflexes and M waves of the TS were measured. The results clearly indicated that H reflex amplitudes were not affected by different loading conditions in standing for both healthy subjects and patients who had a previous stroke. In addition, the H reflex amplitude in quiet standing for healthy subjects was significantly downward modulated relative to that in relaxed sitting with the test knee straight, but this posturally driven modulation was impaired in patients following stroke. Current electrophysiological findings imply that body weight as a means for rehabilitation facilitation had little immediate effect on paretic TS, and absence in postural gating of reflex excitability appeared to be an incentive for postural instability resulting from post-stroke hemiparesis.