Pediatric Evaluation Of Disability Inventory Scores Research Articles

Relationship between static postural control and the level of functional abilities in children with cerebral palsy.

Background: Postural control deficits can impair functional performance in children with cerebral palsy (CP) in daily living activities. Objective: To verify the relationship between standing static postural control and the functional ability level in children with CP. Method: The postural control of 10 children with CP (gross motor function levels I and II) was evaluated during static standing on a force platform for 30 seconds. The analyzed variables were the anteroposterior (AP) and mediolateral (ML) displacement of the center of pressure (CoP) and the area and velocity of the CoP oscillation. The functional abilities were evaluated using the mean Pediatric Evaluation of Disability Inventory (PEDI) scores, which evaluated self-care, mobility and social function in the domains of functional abilities and caregiver assistance. Results: Spearman's correlation test found a relationship between postural control and functional abilities. The results showed a strong negative correlation between the variables of ML displacement of CoP, the area and velocity of the CoP oscillation and the PEDI scores in the self-care and caregiver assistance domains. Additionally, a moderate negative correlation was found between the area of the CoP oscillation and the mobility scores in the caregiver assistance domain. We used a significance level of 5% (p <0.05). Conclusions:We observed that children with cerebral palsy with high CoP oscillation values had lower caregiver assistance scores for activities of daily living (ADL) and consequently higher levels of caregiver dependence. These results demonstrate the repercussions of impairments to the body structure and function in terms of the activity levels of children with CP such that postural control impairments in these children lead to higher requirements for caregiver assistance.

Applicability of the Pediatric Evaluation of Disability Inventory among Saudi children

Purpose: To determine the cross-cultural applicability of the Pediatric Evaluation of Disability Inventory (PEDI) among Saudi children. Methods: The PEDI score form was translated into Arabic then back translated to English. The Arabic translated PEDI was administered by specialized physical therapists to 52 nondisabled Saudi children (30 boys, 22 girls) aged between 1 and 7 years, from five schools. The sample was divided into age groups and the mean of each group score was compared to the US normative value using one sample t-test with a reference mean of 50. Consistency was tested using Cronbach’s α and the influence of demographic factors was assessed using univariate analysis of variance. Results: Data analysis showed lower scores from the Saudi children sample in both the Functional Skills scale and the Caregiver Assistance scale in some age groups compared to US PEDI reference values. Cronbach’s α was found to be high to moderate, and no demographic factors were shown to have influenced the outcome, except PEDI scores differed significantly in children with working mothers compared to those with non-working mothers. Conclusion: Saudi children scored significantly lower than US PEDI reference values in some age groups. We highly attribute this to parental attitude and the more behaviour of Saudi mothers towards their children. The study also reinforces that children of working mothers are more independent, an encouraging finding for those mothers facing resistance and lack of support for their work.Implications for RehabilitationSaudi children perform less than their U.S. peers, certifying the need for cultural norming of PEDI prior to its use among Saudi children.The surrounding environment and culture has remarkable influence on Saudi children neuro-development, as reflected by the delay from original PEDI reference values.While designing rehabilitation programs for disabled children, physical therapists must consider that mothers’ attitude, home environment and local culture have an obvious impact on children’s capability and performance in functional activity.Working mothers’ children were more independent than nonworking mothers; hence, it is useful to consider this trait in the initial evaluation.

A Double-Blind, Randomised, Crossover Trial of Two Botulinum Toxin Type A in Patients with Spasticity

BackgroundBotulinum toxin type A (btxA) is one of the main treatment choices for patients with spasticity. Prosigne® a new released botulinum toxin serotype A may have the same effectiveness as Botox® in focal dystonia. However, there are no randomized clinical trials comparing these formulations in spasticity treatment. The aim of our study was to compare the efficacy and safety of Prosigne® with Botox® in the treatment of spasticity.Methodology/Principal FindingsWe performed a double-blind, randomized, crossover study consisting of 57 patients with clinically meaningful spasticity. The patients were assessed at baseline, 4 and 12 weeks after Prosigne® or Botox® administration. The main outcomes were changes in the patients’ Modified Ashworth Scale (MAS), Functional Independence Measure (FIM) and Pediatric Evaluation of Disability Inventory (PEDI) scores and adverse effects related to the botulinum toxin. Both of the toxins were significantly effective in relieving the level of spasticity in adults and children. There were no significant differences found between the Prosigne® and Botox® treatments regarding their MAS, FIM and PEDI scores. Likewise, the incidence of adverse effects was similar between the two groups.ConclusionOur results suggest that Prosigne® and Botox® are both efficient and comparable with respect to their efficacy and safety for the three month treatment of spasticity.Trial RegistrationClinicalTrials.gov NCT00819065.

Effects of hyperbaric oxygen on motor function in children with cerebral palsy

We conducted a randomized, double-blind, controlled clinical trial to determine whether hyperbaric oxygen (HBO) improves gross motor function in children with cerebral palsy. Forty-nine children aged 3 to 8 years with spastic cerebral palsy were randomized to 40 treatments of HBO (100% oxygen at 1.5atm) or hyperbaric air (HBA, 14% oxygen at 1.5atm) over an 8-week period. The primary outcome was the Gross Motor Function Measure (GMFM) global score. Other outcomes included the Pediatric Evaluation of Disability Inventory (PEDI). Assessments were made before and immediately, 3 months, and 6 months after the treatment period. Within-group changes were analyzed with paired t tests or repeated measures analysis of variance. Analysis of covariance was used for between-group comparisons. Forty-six children (24 HBO, 22 HBA) were analyzed at the second interim analysis, which was scheduled to take place when at least half of the required number of patients in each group had completed pre- and post-treatment testing. No changes occurred in the GMFM from pre- to post-treatment in either group or between groups. Statistically significant increases occurred in both groups on the PEDI, with no difference between groups. The study was stopped because the calculated conditional probability of obtaining a difference between groups if the study continued to the end was only between 0.5% and 1.6%. HBO was not effective in improving GMFM scores, and was no more effective than HBA in improving PEDI scores. These results do not support use of HBO as a therapy for cerebral palsy in young children who did not have neonatal hypoxic-ischemic encephalopathy.

Responsiveness of Goal Attainment Scaling in comparison to two standardized measures in outcome evaluation of children with cerebral palsy

Objectives: To assess the responsiveness of Goal Attainment Scaling compared with the Pediatric Evaluation of Disability Inventory (PEDI) and the 66-item Gross Motor Function Measure (GMFM-66) in multidisciplinary rehabilitation practice. Design: Observational study. Pretest–posttest design. Subjects/patients: Twenty-three children with cerebral palsy, aged 2–13 years. Methods: Goal Attainment Scaling, PEDI and GMFM-66 assessments were performed before and after six months of treatment. Physical, occupational and speech therapists constructed and scored 6-point Goal Attainment Scaling scales meeting predetermined criteria, describing the main functional goal per discipline. The contents of the three measures were compared using International Classification of Functioning, Disability and Health child and youth version (ICF-CY) codes. Spearman’s rho correlations between Goal Attainment Scaling change scores per discipline and change scores obtained with the PEDI functional skills scales and GMFM-66 were calculated. Complete goal attainment was compared with significant change in terms of the standardized measures. Results: Twenty per cent of the Goal Attainment Scaling items were not covered by items of the PEDI or the GMFM-66. Inconclusive correlations were found between Goal Attainment Scaling and PEDI change scores (r 0.28–0.64). Even after exclusion of the non-corresponding items, correlations were moderate (r 0.57–0.73). Of 39/64 Goal Attainment Scaling scales scored as complete goal attainment, 16 individual PEDI scores did not show change on the corresponding scale. Low correlation was found between Goal Attainment Scaling change scores and GMFM-66 change scores. Conclusion: Goal Attainment Scaling, PEDI and GMFM-66 were complementary in their ability to measure individual change over time in children with cerebral palsy. Using only the standardized instruments could have caused many individual rehabilitation goals actually attained being missed in the outcome evaluation.

Efeito da orientação domiciliar no desempenho funcional de crianças com necessidades especiais

Children with special needs are known to have neurosensorymotor disorders that lead to both difficulties and limitations in their functionality and social participation. The care provided by caregivers to these children may reduce such limitations improving participation. The purpose of the present study was to verify the effect of in-home instruction on the functional performance of children with special needs during their daily activities. Thirty-one caregivers of children were randomly divided into two groups: Instructed (IG, n = 17) and Control (CG, n = 14). Both groups were submitted to the Pediatric Evaluation of Disability Inventory (PEDI) at baseline and after three months. The IG received individualized in-home instruction over this three-month period on how to bathe, change clothes, feed and carry the child with special needs. The PEDI evaluation revealed that IG significantly increased PEDI score in the self-care and social function on the functional skills scale as well as in the self-care on the caregiver assistance scale. Individualized in-home instruction to caregivers is suggested to be effective in improving the level of independence of children with special needs in the self-care and social function in the PEDI. This is a simple and effective intervention with the family.

The relation between children’s pain behaviour and developmental characteristics: a cross-sectional study

To determine whether children with developmental disabilities show responses to pain that vary according to developmental level. Factor analytical methods were used to explore whether pain behaviour is independent of developmental characteristics. As part of a longitudinal study, caregivers of 123 children (67 males, 56 females; age range 40 mo-21 y 6 mo) completed the Non-communicating Children's Pain Checklist-Revised (NCCPC-R), the Vineland Adaptive Behavior Scales, Second Edition (VABS-II), and the Pediatric Evaluation of Disability Inventory (PEDI). Deviation intelligence quotients (DIQs) were also generated. Two varimax rotated principal components analyses (PCAs) included the NCCPC-R subscales, DIQs, and age. One also included VABS-II subdomain scores and the other, PEDI scores, to allow examination of whether pain and developmental scores produced distinct components to evaluate the independence of pain behaviour from developmental factors. Children's mean age equivalents on the VABS-II were: Communication (36.4 mo, SD 34.8), Daily Living Skills (31.8 mo, SD 35.9), Socialization (43.2 mo, SD 49.9), and Motor Skills (21.6 mo, SD 20.3). Pain behaviour was distinct from developmental characteristics. The PCA including the VABS-II accounted for 78.4% of variance, with four components: Developmental Level, Pain Behaviour, Motor Development, and Chronological Age. The PCA that included the PEDI accounted for 69.4% of variance, with three corresponding components: Pain Behaviour, Developmental Level, and Chronological Age. Pain behaviour was distinct from developmental factors in two separate analyses using two functional measures. Clinicians can be confident that pain assessment with the NCCPC-R is not affected by children's developmental level.

Predictors of functional ability of Australian children with acquired brain injury following inpatient rehabilitation

Objective: Recently, Bedell reported data from the US on functional changes during inpatient rehabilitation for children with ABI. Similar data for Australia is not available. The aim of this study was to measure functional outcomes of children admitted to rehabilitation in Victoria, Australia and to explore predictors of outcome to contribute to international benchmarking of paediatric services.Method: The Pediatric Evaluation of Disability Inventory (PEDI) was administered to 72 children (aged 8 months to 16 years) within 3 days of admission to rehabilitation and again in the 3 days prior to discharge to measure functional skills in self-care, mobility and social function. Outcome data for the three domains are described and baseline and injury characteristics explored as predictors of outcome using linear regression models.Results: Significant improvements in PEDI scores across all domains were demonstrated from admission to discharge. Older age at injury, higher baseline scores and being female were all predictive of better outcomes at discharge.Conclusions: Findings revealed that patterns of recovery in this sample were similar to those reported in previous studies. Continued use of the PEDI for inpatient rehabilitation is recommended to further investigate effects of injury type and the impact of therapy on outcome.

Applicability and Intrarespondent Reliability of the Pediatric Evaluation of Disability Inventory in a Random Danish Sample

To examine the applicability of US reference data from the Pediatric Evaluation of Disability Inventory (PEDI) in a random Danish sample and to assess intrarespondent reliability. The PEDI was administered as a mailed questionnaire that was completed by the parents. Linear regression models and comparisons of item difficulty were performed in the data analysis. Intraclass correlation coefficients were used in the intrarespondent analysis. US and Danish children differed on 3 of the 6 subscales of the PEDI. Danish children had significantly lower scores on the caregiver assistance subscales (self-care and mobility) and significantly higher scores on the functional skills subscale (social function). Item difficulty was found to be comparable (r = 0.82-0.97) on all 6 subscales. Intrarespondent reliability was good (intraclass correlation coefficient = 0.62-0.97). The PEDI reference values seem partly applicable in a Danish population. In a Danish rehabilitation setting, interpreting PEDI scores with regard to detecting functional delays must be done cautiously.

Activities of daffy living performance in children with cerebral palsy with different gross motor function

Objective To analyze the activities of daily living (ADL) performance in children with cerebral palsy (CP) with different gross motor function and the correlation between gross motor function and ADL perform-ance. Methods A total of 118 children (81 boys and 37 girls; mean age: 47.7 months, SD: 20.1 months, age range: 18-90 months) with CP were recruited from three different rehabilitation centers in Shanghai. Types of CP included hemiplegia (n = 27), spastic diplegia (n = 53), spastic quadriplegia(n = 29), athetoid (n = 4), dystonic (n = 4), ataxic (n = 1). Gross motor function classification system (GMFCS) and Gross motor function measure (GMFM) were adopted to assess and classify the gross motor function. Pediatric evaluation of disability inventory (PEDI) was adopted to assess ADL performance. Differences of PEDI scores were compared among different levels of GMFCS; and the correlation between GMFCS levels, GMFM scores and PEDI scores were analyzed. Resnlts PEDI scores showed significant differences among CP children with different levels of GMFCS. The PEDI score usually de-creased with the increase of the GMFCS level, and mobility ability was the lowest. Significant correlations were found between PEDI scaled scores and GMFCS (rs = 0.85～0. 50, P < 0.001). Various levels of correlations (r = 0. 85～ 0.54, P<0.001) were found between GMFM scores and PEDI scaled scores. Higher correlations were found between GMFCS levels, GMFM scores and mobility ability. Conclusion ADL performance was significantly different among CP children with different gross motor function. The higher the gross motor function, the better the performance of ADL. Mobility would be improved by promoting gross motor function in CP children. The training of self-care and so-cial communication ability should be emphasized. Key words: Cerebral palsy; Gross motor function; Activities of daily living

Screening for motor deficits using the Pediatric Evaluation of Disability Inventory (PEDI) in children with language impairment

Objective: To evaluate the association between the Pediatric Evaluation of Disability Inventory (PEDI) motor and self-care domains with the Peabody Developmental Motor Scales-second edition (PDMS-2) gross motor and fine motor sub-scales.Methods: Forty children (35–62 months) with primary language impairment (PLI) were recruited. The PEDI was completed at admission and the PDMS-2 was administered within 1 month by an OT, who was unaware of the PEDI results.Results: Correlation between PEDI mobility and PDMS-2 gross motor domains was r = 0.23 (p = 0.15) and between PEDI self-care and PDMS-2 fine motor domains was r = 0.12 (p = 0.47). Associations between PEDI and PDMS-2 scores for age, gender and severity of language impairment sub-groups were poor-to-moderate.Conclusion: Findings indicate the PEDI is not sufficiently accurate to screen for motor deficits in children with PLI. More sensitive measures of motor performance are needed to detect subtle motor deficits in children with PLI.

Achieving a minimally important difference in physical function during pediatric inpatient rehabilitation

Our objectives were to examine the proportion of children who achieved a minimally important difference (MID) in physical function during inpatient rehabilitation and to identify factors related to achievement of MID. For a consecutive series of 452 inpatient admissions to a pediatric rehabilitation hospital in the northeastern United States, change scores were calculated by subtracting Pediatric Evaluation of Disability Inventory (PEDI) self-care and mobility functional skills and caregiver assistance admission scores from discharge scores and then evaluated for MID. Logistic regression analyses were used to determine the contributions of demographic and clinical variables as predictors of MID for each PEDI scale. More than 55% of the children achieved MID. The highest proportion of children achieving MID was in mobility functional skills (78%) and caregiver assistance (67%). Children who were older at admission (>10 years) had a greater chance of achieving MID on all scales. In addition, associated with achieving MID were longer length of stay, lower admission PEDI score, and a diagnosis of brain injury. More than half of all children admitted achieved MID in physical function. In this pediatric inpatient rehabilitation center, older children with brain injury who have low functional abilities at admission, and are able to extend their length of stay for a safe, planned discharge are most likely to achieve MID. Identifying children who are most likely to make functional progress can help program administrators and clinicians set realistic functional goals and expectations for an episode of inpatient care.

Motor performance and functional ability in preschool- and early school-aged children with Juvenile Idiopathic Arthritis: a cross-sectional study

ObjectiveTo describe the level of motor performance and functional skills in young children with JIA.MethodsIn a cross-sectional study in 56 preschool-aged (PSA) and early school- aged children (ESA) with JIA according to ILAR classification, motor performance was measured with the Bayley Scales of Infant Development II (BSID2) and the Movement Assessment Battery for Children (M-ABC). Functional skills were measured with the Pediatric Evaluation of Disability Inventory (PEDI). Disease outcome was measured with a joint count on swelling/range of joint motion, functional ability and joint pain.ResultsTwenty two PSA children (mean age 2.1 years) with a mean Developmental Index of the BSID2 of 77.9 indicating a delayed motor performance; 45% of PSA children showed a severe delayed motor performance. Mean PEDI scores were normal, 38% of PSA scored below -2 SD in one or more domains of the PEDI. Thirty four ESA children (mean age 5.2 years) with a mean M-ABC 42.7, indicating a normal motor performance, 12% of ESA children had an abnormal score. Mean PEDI scores showed impaired mobility skills, 70% of ESA children scored below -2 SD in one or more domains of the PEDI. Disease outcome in both age groups demonstrated low to moderate scores. Significant correlations were found between age at disease onset, disease duration and BSID2 or M-ABC and between disease outcome and PEDI in both age cohorts.ConclusionMore PSA children have more impaired motor performance than impaired functional skills, while ESA children have more impairment in functional skills. Disease onset and disease duration are correlated with motor performance in both groups. Impaired motor performance and delayed functional skills is primarily found in children with a polyarticular disease course. Clinical follow up and rehabilitation programs should also focus on motor performance and functional skills development in young children with JIA.

Relation between muscle thickness, spasticity, and activity limitations in children and adolescents with cerebral palsy

The aim of this study was to investigate the relation between muscle thickness of the quadriceps femoris muscle, knee joint function (spasticity and range of motion), and activity and participation measures in children and adolescents with cerebral palsy (CP). Thirty-eight children and adolescents with mild to severe CP (20 males, 18 females; mean age 12y 8mo [SD 3y 7mo], range 6-18y) participated. The severity and type of CP of participants covered all five levels of the Gross Motor Function Classification System and three types: spastic (quadriplegia, hemiplegia, and diplegia), athetotic, and hypotonic. The thickness of the quadriceps femoris muscle (MTQ) was measured from B-mode ultrasound images. Activity limitations were evaluated by the Gross Motor Function Measurement-66 (GMFM-66) and the Pediatric Evaluation of Disability Inventory (PEDI). Spasticity was assessed with the modified Ashworth scale (MAS). After adjustment for age and body mass index, the MTQ showed significant positive correlations with GMFM-66 and PEDI scores; however, there was no significant correlation with MAS ratings. The degree of knee flexion contracture correlated positively with the MAS rating of the knee flexor muscles and negatively with the MTQ. These results established the clinical relevance of assessment of muscle thickness across a broad spectrum of individuals with CP.

Functional outcomes of school-age children with acquired brain injuries at discharge from inpatient rehabilitation

Objective: To examine functional outcomes of school-age children with acquired brain injuries (ABI) at discharge from one inpatient rehabilitation programme in the Northeast, USA.Methods: A cross-sectional design was used to examine admission and discharge data on 176 children with ABI, aged 5–18 years. Functional outcomes included discharge Pediatric Evaluation of Disability Inventory (PEDI) self-care, mobility, social function scores and length of stay. General patterns of change in PEDI scores were analysed using paired t-tests and effect sizes. Correlation analyses were used to determine associations among continuous variables. Differences in outcomes related to independent variables were examined using independent t-tests and analysis of variance and covariance.Results: PEDI scores improved significantly at discharge. Less improvement was found in social function scores than mobility and self-care scores. Higher scores were associated with shorter LOS. Differences in most outcomes were found related to family's primary language, race/ethnicity and primary insurance. Younger children had significantly lower social function scores than older children.Conclusions: Findings provided insights about potential effects of selected variables on functional outcomes and suggest where future inquiry and efforts might be needed (e.g. social function and socio-cultural variables). Information not recorded in the programme's database could offer additional insights to assist with team decision-making.

Responsiveness of evaluative measures for children with cerebral palsy: The Gross Motor Function Measure and the Pediatric Evaluation of Disability Inventory

Purpose. The aim of this study is to describe responsiveness of the Gross Motor Function Measure (GMFM) and the Pediatric Evaluation of Disability Inventory (PEDI) in a group of children with cerebral palsy (CP).Method. The subjects were 55 children with cerebral palsy aged 2 to 7 years (mean 4.6 years). We described the responsiveness of the GMFM and PEDI for all children (n = 55), for children younger than 4 years of age (n = 22) and those older or equal to 4 years (n = 33).Two frames of references for determining responsiveness were used: change over time and external criterion. Responsiveness was calculated with help of the Effect Size (ES), Standardised Response Mean (SRM) and Spearman rank order correlations of change on both the PEDI and GMFM, with change in motor functioning according to the parents as external criterion.Results. The PEDI has ES and SRM values higher than 0.8. The GMFM has ES and SRM values higher than 0.5. For all dimensions of the PEDI and for almost all dimensions of the GMFM, the ESs and SRMs of the younger group are higher than those of the older group. The ES and the SRM of the GMFM increase with the complexity of the task. When looking at the correlations of the PEDI and GMFM change scores with the opinion of parents, the results are less unequivocal.Conclusions. Both the GMFM and the PEDI are responsive for change in motor ability over time in children with CP, the most in children younger than 4 years of age.

Spina bifida at the sacral level: more than minor gait disturbances.

To investigate functional outcome in two groups of children with sacral level paralysis: myelomeningocele (MMC) versus lipomyelomeningocele (LMMC). Additionally both groups were compared with each other and when possible with reference values. Cross-sectional study by means of (1) clinical assessment, and (2) disability measurement. Spina bifida outpatient clinic at a university hospital in the Netherlands. Sample of 30 children with MMC and 14 with LMMC. Mean age (SD) 6.0 (4.9) and 8.4 (4.9) years respectively. Muscle strength, ambulation level, motor performance (Bayley Scales of Infant Development (BSID) and Movement Assessment Battery for Children), and the Pediatric Evaluation of Disability Inventory (PEDI). The majority of patients in both groups were normal ambulant, 14/21 (67%) in MMC and 9/14 (64%) in LMMC. Ambulation was strongly associated with muscle strength of hip abductors (odds ratio (OR): 13.5, 95% confidence interval (CI) 2.5-73.7), and ankle dorsal-flexor muscles (OR: 110, 95% CI 8.9-135.9). No significant differences were found in lesion and ambulation level. Muscle strength and motor performance were significantly lower in the MMC group than in the LMMC group (p < 0.05). PEDI scores were comparable in both groups. Most problems were noted in mobility skills and caregiver assistance in self-care, especially regarding bladder and bowel management. Gross motor and functional problems were seen in both groups. The MMC group showed more muscle weakness and motor problems. However, in both groups caregiver assistance was needed for a prolonged period, especially regarding bladder and bowel management. These findings need special attention, particularly in children who attend regular schools.

Establishing Minimal Clinically Important Differences for Scores on the Pediatric Evaluation of Disability Inventory for Inpatient Rehabilitation

Standardized pediatric assessment tools such as the Pediatric Evaluation of Disability Inventory (PEDI) numerically quantify changes during rehabilitation through test scores, but they are unable to provide client-specific information regarding important changes in function. The purpose of this study was to identify the smallest change in PEDI scores during inpatient rehabilitation that was considered to be a minimal clinically important difference (MCID) by physical therapists and other clinicians. A retrospective review was done of the medical charts of 53 children and youth (1-19 years of age) discharged from an inpatient rehabilitation hospital. Fifteen clinicians (5 physical therapists, 6 occupational therapists, and 4 speech and language pathologists) who were masked to the PEDI scores provided ratings of the magnitude of functional changes during inpatient rehabilitation using a Likert scale and a visual analog scale (VAS). Ratings by clinicians were reduced to 4 categories, including the MCID, and compared with PEDI change scores. The MCIDs ranged from 6 to 15 points (X=11.5, 95% confidence interval= +/- 2.8) for all PEDI scales. Likert scale and VAS ratings were correlated (tau =.73-.80). Across all scales, PEDI change scores on the order of about 11% (0-100 scale) appear to be meaningful to clinicians during a child's or adolescent's inpatient rehabilitation. These data can serve as a starting point for interpreting group and individual changes on the PEDI during physical therapy intervention in inpatient rehabilitation.

Validity of care assessment in disabled and mentally retarded children

16 children with spastic cerebral palsy and 25 mentally retarded children were assessed via the scales "Self-Care" and "Mobility" of the Pediatric Evaluation of Disability Inventory (PEDI). Age-adjusted PEDI scores were compared with the classification according to the three levels of the German statutory nursing insurance. Good correlations and highly significant dependence were found in children with spastic cerebral palsy but no dependence was seen in mentally retarded children. Apparently, assessment guidelines of the German statutory nursing insurance do not guarantee a valid assessment in all disabled children. In conclusion, future assessments of nursing needs in children should employ standardised assessment methods.

Functional performance following selective posterior rhizotomy: long-term results determined using a validated evaluative measure.

Selective posterior rhizotomy (SPR) may result in considerable benefit for children with spastic cerebral palsy. To date, however, there have been few studies in which validated functional outcome measures have been used to report surgical results beyond 3 years. The authors analyzed data obtained from the McGill Rhizotomy Database to determine long-term functional performance outcomes in patients who underwent lumbosacral dorsal rhizotomy performed using intraoperative electrophysiological monitoring. The study population was composed of children with debilitating spasticity who underwent SPR and were evaluated by a multidisciplinary team preoperatively and at 6 months and 1 year postoperatively. Quantitative standardized assessments of activities of daily living (ADL) were obtained using the Pediatric Evaluation of Disability Inventory (PEDI). Of 57 patients who met the entry criteria for the study, 41 completed the 3-year assessments and 30 completed the 5-year assessments. Statistical analysis demonstrated significant improvement in the mobility and self-care domains of the functional skills dimension at 1 year after SPR. The preoperative and 1-, 3-, and 5-year postoperative scaled scores for the mobility domain were 56, 64, 77.2, and 77.8, respectively. The scaled score for the self-care domain increased from 59 presurgery to 67.9, 81.6, and 82.4 at the 1-, 3-, and 5-year postoperative assessments, respectively. The results of this study support the presence of significant improvements in functional performance, based on PEDI scores obtained 1 year after SPR. The improvements persisted at the 3- and 5-year follow-up examinations. The authors conclude that SPR performed using intraoperative stimulation is valuable in the augmentation of motor function and self-care skills essential to the performance of ADL.