Lost without translation: Selective Control Assessment of the Lower Extremity (SCALE) in German.

Abstract

This commentary is on the original article by Balzer et al. on pages 167–172 of this issue. As clinicians and scientists, translation is an important concept. We translate the meaning of words to students, patients, and families. We have been challenged to translate scientific evidence into practice. When publishing consensus definitions, classifications, evaluations, and outcomes, English language nuances across countries and continents must be considered. During meetings of the Taskforce on Childhood Motor Disorders,1 we spent hours deliberating the optimal words to define various motor impairments, including reduced selective motor control and obtaining consensus among a diverse group of clinicians and researchers – not an easy task. In developing content validity for Selective Control Assessment of the Lower Extremity (SCALE),2 we learned that facilitating plantar flexion by coaching a child to move as if they were pushing on a ‘gas pedal’ was not logical in a country that uses ‘petrol’. Balzer et al.3 translated the English version of SCALE into German for use in the clinical environment. Although, I cannot directly evaluate this translation, the methods used instill confidence in their findings. International guidelines for translation of clinical measures were followed.4 The authors assessed the validity and reliability of the translated version for children with spastic cerebral palsy for which SCALE was designed. The original published SCALE validation results were supported and expanded. Additional validation was performed using the Fugl-Meyer Assessment, which includes evaluation of isolated joint motion. Some limitations were noted. The concentration of participants in Gross Motor Function Classification System level I limits the generalization of their results to children with lower mobility levels. Additionally, this study demonstrated the reliability of scoring but did not address the reliability of administration as all tests were scored from videotaped assessments. Hopefully, the German version of SCALE will fully translate into the clinical environment. As the American Academy for Cerebral Palsy and Developmental Medicine, European Academy of Childhood Disability, and the Australasian Academy of Cerebral Palsy and Developmental Medicine move toward an international alliance that supports clinicians in developing countries, translation must consider not only the meaning of the words but also the values present in diverse cultures.