Manual Ability Classification System Research Articles

Profile of motor abilities of children with cerebral palsy as a predictor of their functional independence in self-care and mobility

Introduction/Objective. Limitations of mobility and motor deficits are identified as predominant in the clinical picture of cerebral palsy. This research aimed to describe the profile of motor abilities of children with cerebral palsy, which included gross motor, manual, and bimanual fine motor functions, and to determine the extent to which their functional independence in self-care and mobility was influenced by the profile of their motor abilities. Methods. A convenience sample of 117 participants with cerebral palsy (56.4% males), aged 7?18 years (M = 13.2, SD = 3.4), was included. The Gross Motor Function Classification System ? Expanded and Revised, Manual Ability Classification System, Bimanual Fine Motor Function and the Functional Independence Measure ? Version for Children, were used. Data was analyzed by descriptive statistics and hierarchical multiple regression. Results. More than a half of sample exhibited different levels of gross motor, manual, and bimanual function. Lower functional independence in self-care and mobility was associated with higher functional limitations. Manual abilities were the strongest predictor of functional independence in self-care (? = -0.63, p < 0.001), while gross motor functions were the strongest predictor in the mobility domain (? = -0.65, p < 0.001). Conclusion. Improvement of gross motor and manual abilities of children with cerebral palsy is confirmed as one of the basic preconditions for achieving a greater independence and for minimizing or eliminating a need for assistance in mobility and in everyday self-care activities.

Investigation of the relationship between quality of life, activity participation and environmental factors in adolescents with cerebral palsy.

The aim of this study is to examine the relationship between quality of life, activity-participation and environmental factors in adolescents with cerebral palsy. Seventy-five (75) adolescents (M:45, F:30) aged between 14-18 years (mean: 15.52±1.60 yrs) were included in the study. Participants were divided into three groups: Level I, Level II and Level III according to the Gross Motor Function Classification System. Gross Motor Function Classification System, Gross Motor Function Measure, Functional Independence Scale, Manual Ability Classification System, Pediatric Quality of Life Inventory and International Classification of Functioning, Disability and Health Child-Youth version Short Form (ICF-CY) (14-18 yrs) were used for assessments. It is found that there is a moderate and high level of correlation between quality of life and activity participation and body functions, a moderate and high level of correlation between quality of life and activity participation and body functions with gross motor function levels, and a moderate and low level correlation between environmental factors and gross motor function levels (p < 0.05). The fact that the ICF-CY short form used for cerebral palsied children is compatible with other assessment scales suggests that the use of ICF-CY short forms may be useful in assessing the health status of individuals.

Establish Registry of Cerebral Palsy in Qalubia Goveronrate

AbstractBackground: Patient registry is“an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves a predetermined scientific, clinical, or policy purpose(s).Aim of Study: To establish registry of Cerebral Palsy (CP) in Qalubia governorate.Subjects and Methods: Children with CP who are receiving physical therapy services of both genders, ranged in age from 2 months to 18 years in govermental hospitals, Health insurance hospitals and private physical therapy centers which deal with children in Qalubia governorate. The number of cases which included in this study was 181 cases. The outcomes measures were Viking speech Scale, Manual Ability Classification System (MACS), Gross Motor Function Classification System (GMFCS) and Gross Motor Function Measure (GMFM).Results: One hundred and eighty one cases were enrolled with a prevalence of 6 per 100.000 live births. The participants in the study, spastic CP was the most common type represent-ing, 84.60% of the total sample, while Hypotonic was 13.20%, Ataxic was 1.7% and Dyskinetik was 0.60%. Percentage of CP based on GMFCS were 1.20% for level I, 21.50% for level II, 12.70% for level III, 9.90% for level IV, and 54.70% for level V. GMFM was used to determine the score of performance for each participant. According to MACS and Viking speech scale high incidences of children with CP were classified at level IV.Conclusion: The current study revealed that prevalence of CP in Qalubia governorate was 181 children representing 6 per 100.000 live births. The spastic type 84.60% was the most common while the ataxic type 1.7% is the least preva-lence. Demography revealed 51.9% of children wereboys and 48.1% were girls, high incidence of children with CP level V using GMFCS, and level IV using MACS and Viking speech scale.

The Impact of Manual Ability Level on Participation of Children with Cerebral Palsy in Life Areas

AbstractObjectivesParticipation is a complex and context-dependent concept, which several factors can influence it. The aim of this study was assessing the relationship between the upper extremity function level of children with cerebral palsy (all type of cerebral palsy and severity) and their participation in different life areas.Materials & MethodsThis cross-sectional study assessed the relationship between the level of upper extremity function of cerebral palsy children and their participation in different life areas. Participants were 274 parents of children with cerebral palsy of the schools of children with pecial needs and occupational therapy clinics in Tehran, Iran in 2018.They completed the Manual Ability Classification System (MACS) to determine the level of upper extremity function of children with cerebral palsy and Children Participation Assessment Scale-Parent version (CPAS-P) (to determine the participation level of children with cerebral palsy) questionnaires separately.ResultsThe mean age of children was 8 yr and 8 months old (at least 6 yr and maximum 12 yr). The correlation between the level of upper extremity function and the overall score of each dimension of participation is significant (P<0.05) and moderate.ConclusionThe upper extremity function of children with cerebral palsy has a moderate and significant relationship with the participation of children with cerebral palsy in different life areas and withdifferent dimensions of participation especially parental satisfaction dimension. Therefore, there is a correlation between upper extremity function and participation in occupations, but this relationship is moderate and is not very strong.

Validating Accelerometry as a Measure of Arm Movement for Children With Hemiplegic Cerebral Palsy.

For children with hemiplegic cerebral palsy (HCP), rehabilitation aims to increase movement of the affected arm. However, no validated measure objectively examines this construct in pediatric practice or daily life. The objective of this study was to evaluate the criterion and known-groups validity of accelerometry as a measure of arm movement in children and adolescents with HCP. This was a prospective cross-sectional study. Twenty-seven children and adolescents with typical development (3.4-13.9 years old) and 11 children and adolescents with HCP (4.7-14.7 years old; Manual Ability Classification System rating I or II) wore accelerometers on their wrists while engaged in 20 minutes of play, which included intermittent intervals of stillness and vigorous movement of the arms. Vector magnitude (VM) values identified the presence (VM > 2.0 counts per epoch) and absence (VM ≤ 2.0 counts per epoch) of arm movement for every 2-second epoch. Video was simultaneously recorded; each 2-second interval of footage was scored as "movement" or "no movement" for each arm. Agreement between accelerometry and video observation was greater than or equal to 81%, and the prevalence-adjusted and bias-adjusted κ value was greater than or equal to 0.69 for both groups of participants; these results supported the criterion validity of accelerometry. The ratio of nondominant arm movement to dominant arm movement measured by accelerometry was significantly greater in participants with typical development (mean [SD]=0.87 [0.09]) than in participants with HCP (mean=0.78 [0.07]) on the basis of 10 age- and sex-matched pairs; these results supported known-groups validity. The small sample size of the group with HCP prevented the stratification of data by age. Participants with HCP had high or moderately high function of the affected arm; hence, the findings do not apply to children and adolescents with more significant hemiparesis. Accelerometry is a valid measure of arm movement in children with HCP and children without HCP. These findings contribute to the development of innovative upper limb assessments for children with hemiparesis.

Predictive Model for Gastrostomy Placement in Adolescents With Developmental Disabilities and Cerebral Palsy.

Factors associated with gastrostomy placement in adolescents with developmental disabilities (DDs) and cerebral palsy (CP) are poorly investigated. We aimed to develop and validate a machine learning (ML) model for gastrostomy placement in adolescents with DDs and CP. We performed a multinational, double-blinded, case-control study including 130 adolescents with severe DD and CP (72 males, 58 females; mean age 16 ± 2 years). Data on etiology, diagnosis, spasticity, epilepsy, clinical history, and functional assessments such as the Eating and Drinking Ability Classification System, Manual Ability Classification System, and Gross Motor Function Classification System were collected between 2005 and 2015. Analysis included Fisher exact test, multiple logistic regressions, and a supervised ML model, named PredictMed, to identify factors associated with gastrostomy placement. "Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis" guidelines were followed. Poor motor function (P < 0.001), trunk muscle tone disorder (P < 0.001), male gender (P < 0.01), epilepsy (P = 0.01), and severe neuromuscular scoliosis (P = 0.04) were factors linked with gastrostomy placement in univariate analysis. Epilepsy (P = 0.03), poor motor function (P = 0.04), and male gender (P = 0.04) were associated with gastrostomy placement in multivariate analysis with 95% accuracy. Epilepsy, poor motor function, trunk muscles tone disorder, and male gender were accurate, sensitive, and specific factors associated with gastrostomy need.

A questionnaire based study of the quality of life of children with cerebral palsy aged 4–12 years

Background: Cerebral palsy (CP) is an umbrella term used to describe a group of non-progressive, but often changing motor impairment syndromes due to heterogeneous causes. Aim: The primary objective was to study the quality of life (QOL) of children aged 4–12 years with CP. The secondary objectives were to determine the correlation between QOL and demographic and clinical aspects. Materials and Methods: CP QOL-child, an Australia based questionnaire was translated and culturally adapted to 45 items. The questionnaire was then retranslated into English to ensure content and concepts were maintained. 50 parent-child dyads were interviewed after training of the primary interviewer. The statistical analysis of the data was done using statistical package for the social sciences software using t-test and Spearman correlation test. Results: The mean QOL score was within the “happy” range (66.38±10.38). The highest score was in “participation” and lowest in “special equipment.” Negative correlation was found in age with caregiver’s health (“your health”) and socioeconomic (SE) status with “others.” There was a positive correlation of paternal literacy with “communication,” “special equipment,” and “your health,” and “negative correlation of the number of siblings with others.” There was a negative correlation of gross motor classification system classes with “health” and manual ability classification system classes with mean QOL scores, “participation” and “health.” Conclusions: Increased access to special equipment is likely to help in improving QOL. There should be adequate support for the physical and mental health of parents and caregivers as well. Furthermore, caregivers must be educated and must be made aware of the disease. Comorbid conditions other than the primary disorder should not be ignored.

Profile of children with cerebral palsy spectrum disorder and a normal MRI study

This study looks at what profile can be expected in children with cerebral palsy spectrum disorder (CP) and a normal MRI. The data were excerpted from the Canadian Cerebral Palsy Registry database. Only patients who had undergone MRI were included in the analysis. Neuroimaging classification was ascertained by university-based pediatric neuroradiologists and split into 2 categories: normal and abnormal MRIs. Six factors were then compared between those 2 groups: prematurity, perinatal adversity, presence of more than 1 comorbidity, CP subtype, bimanual dexterity (Manual Ability Classification System [MACS]), and gross motor function (Gross Motor Function Classification System [GMFCS]). Participants with no perinatal adversity were 5.518 times more likely to have a normal MRI (p < 0.0001, 95% confidence interval [CI] 4.153-7.330). Furthermore, participants with dyskinetic, ataxic/hypotonic, and spastic diplegic forms of CP were 2.045 times more likely to have a normal MRI than those with hemiplegia, triplegia, and quadriplegia (p < 0.0001, 95% CI 1.506-2.778). No significant difference was found in prematurity, GMFCS levels, MACS levels, and the number of comorbidities. Normal MRIs were associated with lack of perinatal adversity as well as with the dyskinetic, ataxic/hypotonic, and spastic diplegic CP subtypes. As MRI normality is not strongly associated with the severity of CP, continuous follow-up in children with normal imaging appears warranted. Further advanced imaging modalities, as well as strong consideration for metabolic and genetic testing, may provide additional insights into causal pathways in this population.

Cross-cultural adaptation and measurement properties of the Arabic version of the ABILHAND-Kids scale

Purpose: To cross-culturally adapt the ABILHAND-Kids into Arabic and to examine its measurement properties in children with cerebral palsy.Materials and methods: The Cross-cultural adaption of the ABILHAND-Kids into Arabic language included forward translation, backward translation, expert committee followed by preliminary testing. Structural validity using Rasch analysis, internal consistency, test–retest reliability, measurement error, and construct validity of the Arabic ABILHAND-Kids were examined in children with cerebral palsy (N = 154; 54% male, mean age 7.4 years).Results: Rasch analysis did not support the structural validity of the Arabic ABILHAND-Kids mainly due to response dependency. Removal of two items addressed the issue of the response dependency and resulted in a unidimensional scale meeting the requirement of the Rasch model. The scale had excellent internal consistency (Person Separation Index = 0.93) and excellent test–retest reliability (intraclass correlation coefficient = 0.98). The results supported 86% of the predefined hypotheses regarding correlation of the Arabic ABILHAND-Kids with the manual ability classification system, gross motor function classification system and the functional independence measure for children.Conclusion: The Arabic ABILHAND-Kids demonstrated adequate evidence supporting its structural validity as a unidimensional measure along with evidence supporting its internal consistency, test–retest reliability and construct validity as a measure of manual ability in children with cerebral palsy.Implications for rehabilitationThe Arabic ABILHAND-Kids is a reliable and valid measure of manual ability in children with cerebral palsy.The Arabic ABILHAND-Kids can be used to quantify manual ability in children with cerebral palsy in clinical practice and for research purposes.

Frequency, Characteristics and Risk Factors of Aggressive Incidents in a Paediatric Rehabilitation Setting: A Prospective Survey

ABSTRACT Aim: Aggressive incidents (AI) are a serious concern in health care and can have negative effects on the physical and emotional well-being staff. This study aimed to determine frequency, characteristics and risk factors for aggressive behavior. Methods: AI were recorded during six months by the staff in a pediatric rehabilitation clinic using the evaluation form for AI (EVA). Patients were divided into the study group (patients who were involved in AI) and controls. Results: 14/105 (13%) of patients were involved in 79 AI. 0.44 AI per day occurred. Most often AI occurred on Mondays and 98% included physical, 22% verbal aggression. Most frequent target (43%) were nurses, followed by therapists (31.6%). Significant risk factors for AI were: previous aggressive behavior (p = .038), lower cognitive and higher mobility sub-scores in the WeeFIM. Conclusion: Findings emphasize the magnitude of AI in pediatric rehabilitation and thus the importance of implement preventive strategies. Abbreviations: ADL: Activity of daily living; AI: Aggressive Incidents; CFCS: Communication Function Classification System; EVA: Recording aggressive incidents (Erfassung von Aggressionsereignissen); GMFCS: Gross Motor Function Classification System; MACS: Manual Ability Classification System; SOAS-R: Staff Observation of Aggression Scale-Revised; WeeFIM: Functional Independence Measure for Children; WPV: Workplace violence

Effectiveness of individualized, goal directed institutional based rehabilitation programme in children with developmental delay disorders, in a region with limited rehabilitation accessibility.

To evaluate effectiveness of individualized, goal directed rehabilitation protocol in improving functional outcomes in children with developmental delay disorders in a region with limited rehabilitation accessibility and to explore if goal setting influences changes observed in functional levels. Children (6 months to 17 years) with developmental delay, who visited as out-patients to the Department of Physical Medicine and Rehabilitation and whose care givers were willing to participate in the study, were enrolled for a period of one year. Individualized rehabilitation protocol targeting the child's specific problems with a simultaneous home programme was performed. A single group pre-post study design was used to assess the protocol's effectiveness. Goal attainment scale (GAS), Gross Motor Function Classification System (GMFCS) Level, Gross Motor Functional Measure (GMFM) and Manual Ability Classification System (MACS) were administered pre and post-intervention monthly for 3 months. Statistical analysis was done using SPSS statistics version-22. Total of 32 children participated in the study. Significant differences between pre and post scores of GAS score (Wilcoxon's signed rank test [W value] = 4.937, p-value < 0.005), GMFCS (W value: -3.435, p-value < 0.005), GMFM (W value: 4.937, p-value < 0.005) and MAC score (W value: -4.714, p-value < 0.005) were noted at 3 months. No correlation was observed between the GAS pre-post score and GMFM, GMFCS and MAC pre-post scores. An effective rehabilitation programme in children with developmental delay should be individualized and should be goal directed to achieve maximum functional improvement. Improvement in the goals set were independent of the improvement in functional outcome levels. Care-givers play a pivotal role in both individualization and goal setting for rehabilitation, especially in a region with limited rehabilitation accessibility.

Sarcopenia among Adults with Cerebral Palsy in South Korea.

Most adults with cerebral palsy encounter newly developing physical health problems and premature functional decline with aging. These physical and functional losses along with the characteristic symptoms of cerebral palsy may heighten the risk of sarcopenia. To determine the prevalence of sarcopenia among a selected group of adults with cerebral palsy and to identify the factors associated with their sarcopenia among them. Cross-sectional study. University hospitals and communities for persons with disabilities. A total of 80 adults with cerebral palsy (46 men and 34 women with mean age of 42.8 ± 8.86 years) were included. Muscle mass, strength, and physical performance were measured to diagnose sarcopenia. Participants also completed a structured questionnaire for physical, psychological, or socioeconomic attributes and health-related quality of life. Prevalence of sarcopenia in adults with cerebral palsy. The prevalence of sarcopenia was 47.9%. Sarcopenia was significantly associated with sex, the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), body mass index (BMI), and trunk fat. Male, higher GMFCS and lower BMI were significant risk factors of sarcopenia. Sarcopenic adults with cerebral palsy showed significantly lower health-related quality of life. The prevalence of sarcopenia in adults with cerebral palsy was higher than that of general population despite the young age of the selected group. Modifiable risk factor was a low BMI. III.

Actigraph assessment for measuring upper limb activity in unilateral cerebral palsy

BackgroundDetecting differences in upper limb use in children with unilateral cerebral palsy (UCP) is challenging and highly dependent on examiner experience. The recent introduction of technologies in the clinical environment, and in particular the use of wearable sensors, can provide quantitative measurement to overcome this issue.This study aims to evaluate ActiGraph GT3X+ as a tool for measuring asymmetry in the use of the two upper limbs (ULs) during the assessment with a standardized clinical tool, the Assisting Hand Assessment (AHA) in UCP patients aged 3–25 years compared to age-matched typically developing (TD) subjects.MethodsFifty children with UCP and 50 TD subjects were assessed with AHA while wearing ActiGraphs GT3X+ on both wrists. The mean activity of each hand (dominant and non-dominant, MADH and MANDH, respectively) and the asymmetry index (AI) were calculated. Two linear mixed model analyses were carried out to evaluate how dependent actigraphic variables (i.e. MANDH and AI) varied by group (TD vs UCP) and among levels of manual ability based on Manual Ability Classification System (MACS). In both models age, sex, side of hemiplegia, presence/absence of mirror movements were specified as random effects.ResultsThe MANDH was significantly lower in UCP compared to TD, while the AI was significantly higher in UCP compared to TD. Moreover, in UCP group there were significant differences related to MACS levels, both for MANDH and AI.None of the random variables (i.e. age, sex, side, presence/absence of mirror movements) showed significant interaction with MANDH and AI.ConclusionsThese results confirm that actigraphy could provide, in a standardized setting, a quantitative description of differences between upper limbs activity.Trial registrationClincalTrials.gov, NCT03054441. Registered 15 February 2017.

Reliability and responsiveness of the Jebsen-Taylor Test of Hand Function and the Boxand Block Test for children with cerebral palsy.

To assess the reliability and to evaluate the responsiveness of both the Jebsen-Taylor Test of Hand Function (JTTHF) and the Boxand Block Test (BBT) in children with cerebral palsy (CP). In this retrospective study, the reliability analyses were conducted with paired t-tests considering a short (mean 14d) and a long (mean 120d) time in between two assessment periods. In addition, an intraclass correlation coefficient (ICC) was used to assess the level of congruency. The responsiveness to therapy was conducted with a paired t-test in the whole sample regarding the age, the manual ability level as classified with the Manual Ability Classification System (MACS), and the topography. Our main results confirmed the tests' reliability in a short time period for the JTTHF in both hands and for the BBT on the less affected hand. These results were consistent with the ICC. The responsiveness was confirmed, except on the less affected hand for the JTTHF, with similar results for age, MACS, and topography approach. This study supports the use of the JTTHF and the BBT to examine changes after short-term interventions for children with CP. These results should be interpreted with association to normative values or with a control group when used over long assessment periods. The Boxand Block Test (BBT) is reliable in a brief period of assessment in children with cerebral palsy (CP). The Jebsen-Taylor Test of Hand Function (JTTHF) is reliable in a brief period of assessment in children with CP. The JTTHF and BBT are responsive to changes in a brief period of intensive therapy in children with CP. The reliability and responsiveness of the JTTHF and BBT are weak over long assessment periods.

The Cerebral Palsy Profile of Health and Function: Upper-Extremity Domain’s Sensitivity to Change Following Musculoskeletal Surgery

The Cerebral Palsy Profile of Health and Function (CP-PRO) Computerized Adaptive Tests (CAT) are quality of life measures developed specifically for use in children with cerebral palsy. This study examined the ability of the upper-extremity (UE) CP-PRO CAT to detect change in function after UE surgery compared with the Pediatric Outcomes Data Collection Instrument (PODCI), ABILHAND-Kids, and Box and Blocks test. From 2009 to 2013, children with cerebral palsy who had UE musculoskeletal surgery completed the UE CP-PRO CAT, PODCI-UE, ABILHAND-Kids, and Box and Blocks tests before surgery (97 children) and at 3 postoperative intervals: 6 months (80 children), 12 months (73 children), and 24 months (52 children). Mean, SD, effect size (ES), and standardized response mean (SRM) values for each measure at each time interval and each level of the Manual Ability Classification System were calculated and compared. Finally, the minimal detectable change at the 90% confidence level was determined. Values for the ES (0.40) and SRM (0.53) for the UE CP-PRO CAT at baseline to 6months were moderate and significantly greater than the PODCI-UE (ES, 0.18; SRM, 0.25). The ES and SRM for the PODCI-UE, ABILHAND-Kids, and Box and Blocks tests were not significantly greater than for the UE CP-PRO CAT at any period. From baseline to 6 months, the UE CP-PRO CAT detected a large and significant improvement for Manual Ability Classification System level II (SRM, 0.70; ES, 0.70). The minimal detectable change for the UE CP-PRO CAT was 5.20. The UE CP-PRO CAT is significantly better in detecting change in UE function inthe first 6 months after surgery and is comparable to other measures at 12 and 24 months. Diagnostic II.

PREDIKTORI SOCIJALNE PARTICIPACIJE KOD DECE SA CEREBRALNOM PARALIZOM U OSNOVNIM ŠKOLAMA U REPUBLICI SRBIJI

Pojam socijalna participacija predstavlja kvalitet interakcije između individue i njenog okruženja. Danas se uspešno participovanom osobom smatra pojedinac koji je aktivno uključen u život zajednice a ne osoba koja samo može ili želi da se uključi u aktivnosti sredine u kojoj živi. Cerebralna paraliza (CP) podrazumeva pre svega poremećaj razvoja pokreta i posture sa čestim dodatnim simptomima kao što su senzorna, intelektualna, govorna, druga neurološka oštećenja, psihološke i emocionalne smetnje. S obzirom na činjenicu da je ustanovljeno da je kvalitet participacije učenika sa CP u školskom okruženju veoma važan indikator njihove uspešne društvene participacije u budućnosti, smatramo da je dublje razumevanje faktora koji utiču na njihovu društvenu uključenost tokom osnovnoškolskog obrazovanja od velikog značaja za unapređenje kvaliteta njihovog života.&#x0D; Glavni cilj ovog rada je da identifikuje faktore koji unapred mogu da determinišu kvalitet socijalne participacije učenika sa CP u osnovnim školama u Srbiji. Studija obuhvata 75 dece sa CP između 6 i 12 godina koja pohađaju osnovne škole od prvog do šestog razreda u četiri oblasti Republike Srbije. Glavni upitnik korišćen u ovom istraživanju je prvi i treći deo upitnika The School function assessment (prev. Procena školskog funkcionisanja). Takođe su uzete u obzir i vrednosti grubih motoričkih funkcija (izmerene pomoću GMFCS - Gross motor function classification system (prev. Sistem klasifikacije grubih motoričkih funkcija) i manipulativne spretnosti (izmerene MACS skalom – Manual ability classification system (prev. Sistem klasifikacije manuelnih sposobnosti)) za svakog pojedinačnog učenika.&#x0D; Rezultati pokazuju detaljan uvid u nivo socijalne participacije učenika sa CP u osnovnim školama u Srbiji i objašnjavaju potencijalne faktore koji mogu da utiču na njihovu socijalnu participaciju: nivo grubih motornih funkcija, manipulativna spretnost, kognitivni status i uzrast učenika.

Stability of the Manual Ability Classification System in young children with cerebral palsy.

To examine the stability over time of the Manual Ability Classification System (MACS) levels in children with cerebral palsy (CP) aged 18 to 60months. This was a prospective longitudinal population-based study of 252 Australian children (160 males [63%] 92 females [37%]; mean age [SD] 41.7mo [14], range 17.2mo-69.2mo) with CP. Children were classified at 18months (n=70), 24 months (n=131), 30months (n=173), 36months (n=209), 48months (n=226), and 60months (n=221) of age. Stability of the MACS was examined using the proportion of specific positive agreement and transition proportions, which are measures of agreement. There were 1030 unique observations, with each of the 252 participants seen between two and six occasions (median=4). Average specific positive agreement over the study period was 76% for MACS level I, 67% for level II, 50% for level III, 51% for level IV, and 83% for level V. MACS levels I and V have the highest degree of stability, while levels III and IV have the lowest. We show how this may be explained by the proportion of children in each MACS level. Using measures of agreement rather than measures of reliability provides accurate information when measuring stability over time of an ordinal classification system. The relative stability of MACS levels can be explained by the proportion of children in each level. Children classified in Manual Ability Classification System (MACS) levels III and IV change levels at next assessment about 50% of the time. Children should be assessed with the MACS regularly, particularly those in levels III and IV. Stability within ordinal classification level categories can be predicted using a measurement error model. Transition proportions or specific agreement is recommended for reporting stability of ordinal classification systems.

Presence and severity of dystonia and choreoathetosis overflow movements in participants with dyskinetic cerebral palsy and their relation with functional classification scales

Background: This cross-sectional study aims to investigate the presence and severity of overflow movements of dystonia and choreoathetosis in dyskinetic cerebral palsy (CP) and to assess the relationship of overflow movements with functional classification scales.Methods: Fifty-two subjects with dyskinetic CP were included. Presence and severity of dystonia and choreoathetosis overflow movements were assessed with the Dyskinesia Impairment Scale. Functional abilities were classified with the Gross Motor Function Classification System, Manual Ability Classification System, Viking Speech Scale, Communication Function Classification System, and Eating and Drinking Ability Classification System.Results: Dystonia and choreoathetosis overflow movements were simultaneously present. Median scores of dystonia overflow movements were significantly higher than choreoathetosis overflow movements. Dystonia and choreoathetosis overflow movements were significantly higher in extremities than in the central body. Correlations between dystonia and choreoathetosis overflow movements were fair. Moderate to good correlations were found between dystonia overflow score and Gross Motor Function Classification System, Manual Ability Classification System, and Eating and Drinking Ability Classification System.Conclusions: This is the first study to assess overflow movements in dyskinetic CP. All participants presented with dystonia and choreoathetosis overflow movements, with higher values for dystonia overflow movements. Dystonia overflow movements seem to have a larger impact on functional abilities.Implications for rehabilitationDystonia and choreoathetosis overflow movements are both present in children with dyskinetic cerebral palsy, with dystonia overflow movements being more severe than choreoathetosis overflow movements.Overflow movements impact heavily on daily functional ability and the execution of voluntary activities.Dystonia overflow movements show good correlations with functional classification scales.The measurable characteristics of overflow movements can be used as a guideline for targeted treatment with, e.g., botulinum-toxin-A injections.

Dysphagia-Related Quality of Life in Adults with Cerebral Palsy on Full Oral Diet Without Enteral Nutrition.

There have been no quantitative studies on dysphagia and its impact on quality of life (QOL) of adults with cerebral palsy (CP). In this cross-sectional study, we aimed to investigate the characteristics of dysphagia symptoms and their impact on QOL in adults with CP on a full oral diet compared with healthy adults. Additionally, we aimed to determine the factors affecting dysphagia-related QOL in this population. We enrolled adults with CP on full oral diet (N=117) and healthy individuals (N=117) and interviewed them using the swallowing-quality of life (SWAL-QOL) questionnaire which includes 14 items regarding dysphagia symptoms and 30 items regarding swallowing-related QOL. The functional status of each participant with CP was evaluated using the gross motor function classification system, the manual ability classification system (MACS), and the Functional Oral Intake Scale (FOIS). Among pharyngeal symptoms, choking on food was reported most frequently (sometimes or more 76.9%), followed by coughing and choking on liquid. Among oral symptoms, chewing problems were reported most frequently (sometimes or more 59.8%), followed by food dribbling from the mouth (sometimes or more 53.8%). Compared to healthy adults, those with CP reported worse QOL across all SWAL-QOL items, with the lowest scores obtained for meal duration, followed by communication, burden, fatigue, sleep, and eating desire. On multiple linear regression analysis, higher MACS level, lower FOIS level, and older age were predictors of worse SWAL-QOL score. Among adults with CP, it is necessary to evaluate swallowing function and establish an active intervention plan even if a full oral diet is established.

Motor performance of children and adolescents with cerebral palsy during the execution of computer tasks with different peripherals

ABSTRACT Objective: to assess the effectiveness of using different input devices for computer access by children and adolescents with cerebral palsy and to verify the relationship of performance with age and level of motor classification. Methods: the study included 14 children and adolescents with cerebral palsy, aged 6 to 14 years, with Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) levels from I to V. The participants’ performance was observed during the use of touch screen, conventional mouse and eye tracking mouse in performing specific tasks with softwares Discrete Aiming Task 2.0, Tracking Task 2.0 and Single Switch Performance Test (SSPT) 1.0. The following variables were analyzed: response time, frequency of errors, mean time to activate input devices, relationship between satisfaction with input devices and motor skill level. Results: results indicated significant differences in response time, frequency of errors, and triggering mean time depending on the input device used, and correlation between the motor ability level and satisfaction, using the device, and between the level of manual ability and satisfaction with the mouse. Conclusion: the eye tracking mouse and the touch screen were the most effective devices during the execution of tasks on the computer by study participants.