Pediatric Evaluation Of Disability Inventory Research Articles

A study on the effectiveness of training in the operation of an electric mobility aid in severely mentally and physically handicapped children.

We examined whether operation training for children with severe mental and physical disabilities using recently developed electric mobility aids improves their skills in operating such aids and their daily activities. By doing so, we aimed to clarify the effectiveness of electric mobility aid operation training for children with severe mental and physical disabilities. Operation training and normal training using an electric mobility aid were conducted for 42 school-aged children with severe mental and physical disabilities, aged 8-18 years old. The trainee children were randomly assigned to two groups: 21 to the intervention group to receive operation training and 21 to the control group to receive general training. The intervention lasted 20 minutes/training session, with three sessions/week over a period of eight weeks. The Powered Mobility Program (PMP) and Pediatric Evaluation of Disability Inventory (PEDI) were used for pre- and post-intervention assessments, and SPSS was used for two-way analysis of variance (ANOVA). PMP scaled scores significantly increased (p = 0.001) in both groups, but there was no interaction effect. The PEDI scaled scores did not significantly increase in either of the two groups. The effects of the intervention and use of the electric mobility aid on the operating skills of children with severe mental and physical disabilities were explicitly demonstrated. Future long-term studies are required to clarify the effects of training in the operation of electric mobility aids on the subsequent development of severely physically and mentally handicapped children.

Contribution of static and dynamic balance skills to activities of daily living in children with intellectual disabilities.

Static and dynamic balance skills can be related to the activities of daily living (ADL) in children with non-syndromic intellectual disabilities, and the type of balance skills affecting ADL can differ depending on the domain of ADL (self-care, mobility, and social function). The ADL capabilities of 66 children with intellectual disabilities were assessed using the Pediatric Evaluation of Disability Inventory (PEDI) and were examined in relation to static and dynamic balance skills. Significant positive correlations were found between the one-leg standing and PEDI (r = .841 for self-care, r = .700 for mobility, and r = .760 for social function). Our analysis showed that static balance skills affected self-care, dynamic balance skills affected mobility, and intelligence quotient affected social function. Improving balance skills is important for enhancing ADL capabilities, and the type of balance skills that need enhancement vary based on the domain of ADL.

Asociación entre el desempeño funcional y la calidad de vida familiar en pacientes con parálisis cerebral de un instituto especializado categoría III-2 en Perú: Un estudio transversal

Objective. To relate functional performance and quality of family life in children and adolescents with cerebral palsy from the Instituto Nacional de Salud del Niño during 2021. Materials and methods. A retrospective analytical study that analyzed 80 children and adolescents between 2 and 18 years old with cerebral palsy, in a non-probabilistic way, who attended the Physical Medicine and Rehabilitation Service for outpatient consultation. The Pediatric Evaluation of Disability Inventory and the Beach Center Family Quality of Life Scale adapted to Latin America were applied. Results. There were 56% males and a median age of 7 (3-9). The most frequent diagnoses were spastic hemiparesis (32%) and spastic quadriparesis (31%). Slight correlations were observed between functional performance and satisfaction with support for people with disabilities (rho = 0.25; p = 0.026). At the same time, self-care (rho = 0.26; p = 0.022) and social performance (rho = 0.26; p = 0.021) were associated with satisfaction with support for people with disabilities. Conclusion. Functional performance was associated with quality of life domains such as satisfaction with health and safety and support for people with disabilities.

A pilot randomised controlled trial of ride-on cars and postural combinations of standing and sitting for mobility and social function in toddlers with motor delays

Purpose Locomotor experiences in upright postures are essential for developing toddlers’ mobility and social functions. This pilot randomised controlled trial aimed to examine the effectiveness of using a modified ride-on car (ROC) with postural combinations of standing and sitting on mobility and social function in toddlers with motor delays. Materials and methods Nineteen participants aged 1–3 years with mild, moderate or severe motor delays were randomly assigned to four ROC groups. The ROC groups had different combinations of standing and sitting, namely standing for 70 min (ROC-Stand70, five participants), standing for 45 min (ROC-Stand45, four participants), standing for 25 min (ROC-Stand25, five participants) and sitting for 70 min (ROC-Sit70, five participants). All participants participated in 2-h sessions twice a week for 12 weeks. The Pediatric Evaluation of Disability Inventory, Goal Attainment Scaling and Bayley-III tests were administered before and after the intervention, and after 12 weeks of follow-up. A mixed-model analysis of variance was used to compare inter- and intra-group differences. This trial was registered at ClinicalTrials.gov (NCT03707405). Results All groups showed significantly improved mobility, social function and goal achievement at the post-test (p < .001). However, no significant changes were observed in Bayley scores. Conclusions Combining physical and social environmental modifications with active exploration is crucial for early power mobility training in toddlers with motor delays. To enhance the robustness and generalisability of our findings, future studies should include larger sample sizes, consider variations in motor delays, and measure energy expenditure during the intervention. Implications for rehabilitation Providing active exploratory experience using ride-on cars (ROCs) with various postural combinations can improve a child’s mobility. The ROC training with various postural combinations can improve social function, and the degree of improvement may depend on the severity of motor delays. Setting goals with caregivers and incorporating their roles in the training process can empower them to interact with children more frequently and actively.

Go Zika Go: feasibility study with modified motorized ride-on cars for the mobility of children with Congenital Zika Syndrome (CZS)

Purpose To explore the feasibility of an intervention using modified ride-on cars in terms of acceptability and potential changes in goal attainment, mobility, social function, and participation of children with Congenital Zika Syndrome (CZS). Materials and Methods A pre- and post-intervention feasibility study was conducted with children with CZS, levels IV and V of the Gross Motor Function Classification System (GMFCS). The intervention consisted of 12 weeks of training (3 times a week for 40 min per session) and 4 weeks of follow-up. The primary outcomes included adherence, satisfaction, and learning in mobility. Secondary outcomes encompassed goal attainment, mobility, social/cognitive function, and participation. Descriptive statistics were performed. To explore potential individual changes with the intervention, Wilcoxon test was used to analyze Pediatric Evaluation of Disability Inventory – Computer Adaptive Test (PEDI-CAT) data and Young Children’s Participation and Environment Measure (YC-PEM)/Participation and Environment Measure for Children and Youth (PEM-CY), along with standard error measurements of the PEDI-CAT domains Results Four children participated (median age 4.75 years; two females: three at level V on the GMFCS). Adherence was 75% of the total intervention time, and family members reported being satisfied or very satisfied. Children showed gains in learning the use of the modified ride-on cars and an increase in goal attainment after the intervention. Individual changes were observed in the PEDI-CAT domains (mobility and social/cognitive), but there were no significant changes in participation outcomes. Conclusions Children with CZS at GMFCS levels IV and V can learn to use motorized ride-on cars, attainment goals, and experience satisfaction.

The Effects of Family Functioning on Gross Motor Function, Activity, and Participation in Children with Cerebral Palsy.

The present study aimed to investigate whether family functioning (FF) could impact gross motor function, activity, and participation in children with cerebral palsy (CP). Sixty-seven children with spastic diplegic CP who were admitted to the Special Education and Rehabilitation Clinic were included in the study. The guidelines of the American Academy of Neurology were followed for the diagnosis of spastic diplegia. The type of home where the family lives, the family's average income, the child's age, gender, and number of siblings, and the age and educational level of the child's primary caregiver were recorded. The gross motor function capacity of children with CP was assessed with the Gross Motor Function Classification System (GMFCS). The Pediatric Evaluation of Disability Inventory (PEDI) was used to evaluate activity and participation performance. The children living in detached houses had statistically higher PEDI mobility levels than those living in apartments (p < 0.05). PEDI's social function and self-care levels were higher in 12 to 18-year-old children with two siblings (p < 0.05). The age and educational status of the primary caregiver were found to have an important impact on the PEDI scores. According to the results, social function and self-care levels were higher in children whose primary caregivers were 30 to 65 years old and had high levels of education above high school (p < 0.05 The effects of family income and gender on PEDI scores were statistically non-significant (p˃ 0.05). Variables related to family functioning had no statistically significant effect on GMFCS scores (p˃ 0.05). These factors can enable healthcare providers to collaborate with the families to develop more comprehensive intervention plans emphasizing family strengths and supporting their needs.

Percepção de cuidadores de pré-escolares com TEA sobre seu comportamento e desempenho ocupacional durante a pandemia da COVID-19

Abstract Introduction Children with Autism Spectrum Disorder (ASD) face behavioral, sensory processing, cognitive, and language challenges that affect their ability to perform activities of daily living (ADL) and necessitate access to educational, therapeutic, and health services. The COVID-19 pandemic limited access to these essential services, exacerbating the challenges faced by this vulnerable population due to imposed social distancing measures. Objective To explore the perceptions of parent caregivers of preschoolers with ASD regarding their children’s behavior and performance in ADL during the COVID-19 pandemic. Method This cross-sectional, descriptive study utilized both quantitative and qualitative approaches, interviewing 60 caregivers of preschoolers with ASD. Participants were asked about any observed changes in their child’s behavior and ability to engage in ADL during the pandemic. Child characterization involved the Autism Classification System of Functioning: Social Communication (ACSF:SC), the Pediatric Evaluation of Disability Inventory - Computer Adaptive Test (PEDI-CAT), and the Sensory Profile 2 (SP-2). Interviews were documented, with 15 recorded and transcribed for thematic content analysis. Results Participants included 43 mothers, 15 couples, and two fathers, totaling 60 children, of whom 46 (76.7%) were boys aged between 3 and 5 years (mean age 53.6 ±10.18 months). Caregivers reported changes in behavior and performance in ADL, predominantly noting deterioration. Increases in stereotypic behaviors, rigidity, and hyperfocus were observed, along with decreased participation in ADL. While the presence of caregivers benefited some children, it also led to reported stress, particularly among mothers. Conclusion The study found a predominant trend of deteriorating behavior and performance in ADL among children with ASD during the pandemic, based on caregiver reports.

Self-care and hand function in preschool children with unilateral or bilateral cerebral palsy: A cross-sectional study.

To describe self-care capabilities among children with cerebral palsy (CP) and explore associations between self-care and hand function for children with unilateral cerebral palsy (UCP) and children with bilateral cerebral palsy (BCP) separately. Cross-sectional data on self-care capabilities (Pediatric Evaluation of Disability Inventory, PEDI), manual abilities (Manual Ability Classification System, MACS) and hand use during bimanual performance (Assisting Hand Assessment, AHA; Both Hands Assessment, BoHA) were retrieved from the Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP). Eighty-seven children with CP (UCP, n = 61, mean age 4 years 1month, SD 1 year 3 months, range 56) or BCP (n = 26, mean age 4 years 4 months, SD 1 year, range 41), classified at MACS level I (n = 26), II (n = 40) or III (n =21), were included. No significant differences in self-care capabilities were found between children with UCP and children with BCP. Analysis of variance showed significant differences in self-care between MACS levels for the whole group. No significant differences in self-care between MACS levels were observed for children with UCP (p = 0.36), but significant differences were found for those with BCP (p < 0.001). Whereas a small correlation (r = 0.3) between PEDI and AHA scores was found for children with UCP, a large correlation (r = 0.6) was found for those with BCP. Children with BCP with symmetric hand use during bimanual performance (BoHA) had higher PEDI scores than children with asymmetric hand use. Though children with UCP and children with BCP who were classified at MACS I-III exhibited similar self-care capabilities, the limited hand use seems to contribute differently between the two groups. The two different measures of hand use exhibit different associations with self-care capabilities for young children with UCP and BCP, respectively, and illustrate the need to treat UCP and BCP as two distinct groups, each requiring tailored interventions according to their specific needs.

Functional measures on PEDI are associated with BSID-3 scales at 2 years, following neonatal surgery

BackgroundNeonates requiring early surgical intervention for major non-cardiac congenital anomalies are at high risk of adverse neurodevelopmental outcomes. Early recognition of potential neuro-developmental delay is critical to facilitate access to early childhood intervention services and therefore maximise the functional capabilities of these children. AimsThis study aims to compare Bayley's Scales of Infant and Toddler Development (BSID-3) and the Paediatric Evaluation of Disability Inventory (PEDI) as early screening tools in predicting neuro-developmental disability across multiple domains. In addition, it looks at determining which pre, peri and post-operative risk factors lend themselves to more adverse outcomes. Study designRetrospective cohort study. SubjectsNeonates requiring surgical intervention at the Royal Children's Hospital from 2012 to 2018 who subsequently underwent neurodevelopmental assessment at 2 years of age. Outcome measuresThe main outcome was the relationship between performance on the PEDI compared with the BSID-3, in 2-year-olds following neonatal surgery. ResultsParent -reported functional measures across all domains on PEDI strongly related to the more formal measures of cognition, language, and motor development assessed on BSID-3 (p < 0.05). ConclusionsThe questionnaire-based PEDI tool could be considered a reliable replacement to the formal Bayley (BSID-3) scale in low-risk infants and provide a more accessible means of assessment where there are deficiencies in availability of suitably trained clinicians or limited resource centres.

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

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

Factors associated with capability and performance in children with neurodevelopmental disorders: an exploratory cross-sectional study

Background Children with neurodevelopmental disorders (NDD) have a lower level of independence and major need of assistance to perform daily living skills is one the main concerns of caregivers and therapists of children, adolescents and adults with these disabilities. Aim To identify factors associated with capability and performance in self-care, mobility and social activities in children with NDD. Method A cross-sectional study was performed with 96 children with NDD, most were male (69.8%), with a mean age of 8.53 (± 1.83) years. The Pediatric Evaluation of Disability Inventory was used to evaluate capability and performance outcomes. The explanatory variables were intellectual function, motor skills, economic level, and maternal education. Stepwise multiple linear regression models were used. Results The motor skills were the main factor that explained self-care, mobility and social function capability outcomes and, self-care and mobility performance outcomes (p < 0.05). The intellectual function explained only the social function performance outcome (p < 0.05). Moreover, highest economic extracts increased the explanation of outcomes. Conclusion The findings are relevant to understanding the factors associated with performance and capability and performance in self-care, mobility and social activities to help clinicians to make an informed decision based on the best practice evidence for these children. An expanded assessment of functioning and of the environmental factors is necessary to help the planning interventions to improve capability and performance of the children with NDD.

Effect of Swiss Ball Stabilization Training on Trunk Control, Abdominal Muscle Thickness, Balance, and Motor Skills of Children With Spastic Cerebral Palsy: A Randomized, Superiority Trial

ObjectivesTo compare the effects of Swiss ball stabilization training (SBST) and stable surface stabilization training (SSST) on the trunk control, abdominal muscle thickness, balance, and motor skills of children with spastic cerebral palsy (CWSCP). DesignSingle-blind, randomized superiority trial. SettingGeneral Community and Referral Center. ParticipantsThirty CWSCP, aged 6-12 years, with Gross Motor Function Classification System levels I-III were randomly assigned to the SBST and SSST groups (N=30). InterventionsThe participants were randomized to receive either SBST or SSST for 5 weeks, 3 days a week. Outcome MeasuresThe Trunk Control Measurement Scale (TCMS), abdominal muscle thickness, Pediatric Balance Scale (PBS), standing and walking sections of Gross Motor Function Measure (GMFM-88), and mobility section of the Pediatric Evaluation of Disability Inventory (PEDI) were assessed. ResultsAfter 5 weeks of the intervention and 9 weeks of follow-up, the SBST group showed statistically significant improvements in the TCMS, GMFM-88, PEDI, thickness of the internal oblique muscle at rest and contraction, and thickness of the transverse abdominis muscle at rest and contraction compared with the SSST group (P<.0001). Contrarily, the thickness of the external oblique muscle increased statistically significantly in the SSST group compared with the SBST group after 5 weeks of the intervention and 9 weeks of follow-up both at rest (P<.0001 and P=.0001, respectively) and contraction (P=.015 and P=.017, respectively). No statistically significant difference was found between the groups regarding the PBS score after 5 weeks of intervention. ConclusionThe SBST could improve the trunk control, balance, and motor skills of CWSCP and increase the thickness of local abdominal muscles. Also, SBST was more effective than SSST for CWSCP.

The Investigation of Relationship between Functional Mobility Levels of Children with Chronic Disability and Caregivers’ Quality of Life

Purpose: This study aims to look at the relationship between carers' quality of life and the functional mobility levels of children with chronic disabilities.Methods: The study included 30 children (22 boys, 8 girls) with chronic disabilities and their caregivers. The socio-demographic characteristics of the children and caregivers were collected.Caregivers' quality of life was evaluated with the Adult Carer Quality of Life Questionnaire (AC-QoL), and children’s functional mobility was evaluated with the mobility subscale of the Pediatric Evaluation Of Disability Inventory (PEDI-Mobility). Results: The age of the children included in the study was 7.0 (5.0-12.0) years and the age of their caregivers was 38.00 (32.75-41.25) years. The AC-QoL score of caregivers was 85.00 (72.00-93.50) out of a total of 120 points, and the PEDI-Mobility score was 33.00 (3.75-53.00) out of a total of 58 points. In the correlation analysis, no significant correlation was found between the PEDI-Mobility total score and the AC-QoL total score (p&amp;gt;0.05).However, there was a negative correlation between the PEDI-Mobility total score and the AC-QoL “ability to care” subscale score(r= -0.403; p=0.027). Conclusion: According to the results of the study, no relationship was found between the functional levels of children and the quality of life of their caregivers. Studies with a larger sample size and consideration of aspects including sociocultural level, economic considerations, and health services that may affect the quality of life of families are regarded to be necessary in order to achieve more conclusive findings on this subject.

Combining Unimanual and Bimanual Therapies for Children with Hemiparesis: Is There an Optimal Delivery Schedule?

Constraint-induced movement therapy (CIMT) and bimanual therapy (BT) are among the most effective hand therapies for children with unilateral cerebral palsy (uCP). Since they train different aspects of hand use, they likely have synergistic effects. The aim of this study was to examine the efficacy of different combinations of mCIMT and BT in an intensive occupational therapy program for children with uCP. Children (n = 35) participated in intensive modified CIMT (mCIMT) and BT, 6 weeks, 5 days/week, 6 h/day. During the first 2 weeks, children wore a mitt over the less-affected hand and engaged in functional and play activities with the affected hand. Starting in week 3, bimanual play and functional activities were added progressively, 1 hour/week. This intervention was compared to two different schedules of block interventions: (1) 3 weeks of mCIMT followed by 3 weeks of BT, and (2) 3 weeks of BT followed by 3 weeks of mCIMT. Hand function was tested before, after, and two months after therapy with the Assisting Hand Assessment (AHA), Pediatric Evaluation of Disability Inventory (PEDI), and Canadian Occupational Performance Measure (COPM). All three groups of children improved in functional independence (PEDI; p < 0.031), goal performance (COPM Performance; p < 0.0001) and satisfaction (COPM Satisfaction; p < 0.0001), which persisted two months post-intervention. All groups showed similar amounts of improvement, indicating that the delivery schedule for mCIMT and BT does not significantly impact the outcomes.

Intensive Neurophysiological Rehabilitation System for children with cerebral palsy: a quasi-randomized controlled trial

BackgroundRecent research indicates that intensive rehabilitation tends to be effective for children with cerebral palsy (CP). Intensive Neurophysiological Rehabilitation System (INRS) is a multi-component approach that combines various interventions and addresses different functional goals.. This study aimed to examine the effectiveness of the INRS treatment in children with bilateral CP.MethodsIn this quasi-randomized controlled study, 48 children with spastic bilateral CP (age 5–12 years, GMFCS Levels I-IV, MACS Levels I-IV) were assigned to an experimental or control group in order they have been enrolled. The experimental group underwent INRS treatment in the tertiary care facility for about four hours daily for ten days and continued routine home treatment for four weeks. After the first evaluation, participants from the control group stayed on the waiting list for four weeks receiving home treatment and then starting the INRS treatment. Thereby, all participants were assessed three times. The primary outcome measure was a Gross Motor Function Measure 66 Item Set (GMFM). The secondary outcome measures included the Jebsen-Taylor Hand Function test, Box and Blocks test, ABILHAND-Kids Questionnaire, Self-care and Mobility domain of the Pediatric Evaluation of Disability Inventory, and the ankle dorsiflexion passive range of motion.ResultsThere was a statistically significant increase in the GMFM score after the INRS treatment in both the experimental group (mean difference (MD) 2.0, P < 0.01) and control group (MD 1.5, P < 0.05), with a large size effect (partial eta squared (η2) = 0.21 and η2 = 0.14). The mean difference between groups during the first study period was 2.89 points (p < 0.01) in the GMFM score with a medium effect size (η2 = 0.12). Statistically significant superiority of the INRS treatment over home treatment was also obtained by Jebsen-Taylor Hand Function Test and the Box and Blocks Test in both dominant and non-dominant hands.ConclusionsThe study indicates that the INRS treatment can be beneficial for improving both gross motor functions and hand function in children with bilateral CP. Further longitudinal studies are required to evaluate the effects of the INRS treatment on the participation level of children with CP.Trial registrationThe study protocol was registered on ClinicalTrials.gov under the identifier: NCT04093180 on 17/09/2019.

Effect of Photobiomodulation Combined with Physiotherapy on Functional Performance in Children with Myelomeningo-Cele-Randomized, Blind, Clinical Trial.

This study aimed to evaluate the electrical activity of the rectus femoris, tibialis anterior, and lateral gastrocnemius muscles during the sit-to-stand task and functional mobility after a neurofunctional physiotherapy protocol associated with PBM. Twenty-five children were randomly allocated to either Active PBM + physiotherapy (n = 13) or PBM sham + physiotherapy (n = 12). PBM was carried out with a LED device (850 nm, 25 J, 50 s per point and 200 mW) at four points over the area with absence of a spiny process. Both groups completed a twelve-week supervised program with two weekly 45-60 min sessions. Pre-training and post-training assessments involved the Pediatric Evaluation of Disability Inventory (PEDI). Muscle activity was assessed using portable electromyography (BTS Engineering) and the electrodes were positioned on the lateral gastrocnemius, anterior tibialis, and rectus femoris muscles. The RMS data were recorded and analyzed. After 24 sessions of the treatment protocol, improvements were found in the PEDI score. The participants presented greater independence in performing the tasks, requiring less assistance from their caregivers. More significant electrical activity was found in the three muscles evaluated between the rest period and execution of the sit-to-stand tasks, both in the more compromised or less compromised lower limbs. Neurofunctional physiotherapy with or without PBM improved functional mobility and electrical muscle activity in children with myelomeningocele.

Preparing “the Activities of Daily Living Inventory for Children with Disabilities” (ADLIC-D) and Investigating Its Psychometric Properties in Children with Autism Spectrum Disorder, Intellectual Disability and Cerebral Palsy

Background: The difficulties to perform self-care or basic activities of daily life are among the concerns of families, and rehabilitation professionals. In this issue, culturally adapted assessment tools help in the accurate assessment and treatment planning in rehabilitation. Objectives: The present study aimed to survey the validity, and reliability of Activities of Daily Living Inventory for Children with Disabilities (ADLIC-D) in preschool children with autism spectrum disorder (ASD), cerebral palsy (CP), intellectual disability (ID), and typical children. Methods: The face validity examined by 60 parents of children with disabilities. Content validity studied by 10 occupational therapists. The sample included 205 (70 normal, 45 ASD, 45 CP, and 45 ID) children aged 3 - 6 years whose parents completed ADLIC-D. Face and content validity, convergent validity with the Pediatric Evaluation of Disability Inventory (PEDI), discriminant validity, test-retest reliability, and the internal consistency of instrument were examined. Result: Intra-class correlations coefficient for test-retest reliability was excellent (above 0.9). Cronbach's alpha for all items was excellent (0.977). The ADLIC-D had convergent validity with the PEDI (r = 0.95). The discriminant validity demonstrated that the measure distinguishes between normal and disabled groups. In addition, the number of final items on the new scale grew from 73 in the original to 76. Conclusions: ADLIC-D had validity, and reliability for children with ASD, CP, and ID. It measured the desired construct, i.e., the activities of daily living in children with the disabilities and differentiated between normal groups, and groups with disabilities.

Association of activities of daily living and cognitive function with thickness of the upper extremity muscles in children and adults with cerebral palsy

We examined the association of activities of daily living (ADL) and cognitive function with the upper extremity muscle thickness and upper extremity range of motion (ROM) and spasticity in children and adults with cerebral palsy (CP). The subjects were 20 children and adults with CP. The ADL performed using the upper extremities and cognitive function were assessed using the self-care domain of the Pediatric Evaluation of Disability Inventory (PEDI) and the full-scale intelligence quotient (FSIQ) of the Wechsler Intelligence Scale for Children, fourth edition (WISC-IV), respectively. The WISC-IV was assessed in only seven of 20 subjects able to undergo evaluation. The thickness of the upper extremity muscles was measured using an ultrasound imaging device. Moreover, ROM and spasticity of the upper extremities were assessed using the Modified Ashworth Scale (MAS). Manual manipulation ability was also assessed using the Manual Ability Classification System (MACS). Stepwise regression analysis revealed that the extensor digitorum muscle thickness and MACS level were significant and independent factors of self-care in the PEDI. Partial correlation analysis with MACS level and age as control variables showed that the FSIQ of the WISC-IV was significantly associated with the thickness of the anterior fibers of the deltoid and flexor digitorum superficialis muscles. Reduced ADL performed using the upper extremities is associated with decreased extensor digitorum muscle thickness rather than ROM and spasticity of the upper extremities in children and adults with CP.

Longitudinal evolution of central nervous system anomalies in fetuses with open spina bifida fetoscopic repair and correlation with neurologic outcome

Open spina bifida is associated with central nervous system anomalies such as abnormal corpus callosum and heterotopias. However, the impact of prenatal surgery over these structures remains unclear. This study aimed to describe longitudinal changes of central nervous system anomalies before and after prenatal open spina bifida repair and to evaluate their relationship with postnatal neurologic outcomes. Retrospective cohort study of fetuses with open spina bifida who underwent percutaneous fetoscopic repair from January 2009 to August 2020. All women had presurgical and postsurgical fetal magnetic resonance imaging, at an average of 1 week before and 4 weeks after surgery, respectively. We evaluated defect characteristics in the presurgical magnetic resonance images; and fetal head biometry, clivus supraocciput angle, and the presence of structural central nervous system anomalies, such as abnormalities in corpus callosum, heterotopias, ventriculomegaly, and hindbrain herniation, in both presurgical and postsurgical magnetic resonance images. Neurologic assessment was performed using the Pediatric Evaluation of Disability Inventory scale in children who were 12 months or older, covering 3 different sections, namely self-care, mobility, and social and cognitive function. A total of 46 fetuses were evaluated. Presurgery and postsurgery magnetic resonance imaging were performed at a median gestational age of 25.3 and 30.6 weeks, with a median interval of 0.8 weeks before surgery, and 4.0 weeks after surgery. There was a 70% reduction in hindbrain herniation (100% vs 32.6%; P<.001), and a normalization of the clivus supraocciput angle after surgery (55.3 [48.8-61.0] vs 79.9 [75.2-85.4]; P<.001). No significant increase in abnormal corpus callosum (50.0% vs 58.7%; P=.157) or heterotopia (10.8% vs 13.0%; P=.706) was observed. Ventricular dilation was higher after surgery (15.6 [12.7-18.1] vs 18.8 [13.7-22.9] mm; P<.001), with a higher proportion of severe ventricular dilation after surgery (≥15mm) (52.2% vs 67.4%; P=.020). Thirty-four children underwent neurologic assessment, with 50% presenting a global optimal Pediatric Evaluation of Disability Inventory result and 100% presenting a normal social and cognitive function. Children with optimal global Pediatric Evaluation of Disability Inventory presented a lower rate of presurgical anomalies in corpus callosum and severe ventriculomegaly. When analyzed as independent variables to global Pediatric Evaluation of Disability Inventory scale, the presence of abnormal corpus callosum and severe ventriculomegaly showed an odds ratio of 27.7 (P=.025; 95% confidence interval, 1.53-500.71) for a suboptimal result. Prenatal open spina bifida repair did not change the proportion of abnormal corpus callosum nor heterotopias after surgery. The combination of presurgical abnormal corpus callosum and severe ventricular dilation (≥15 mm) is associated with an increased risk of suboptimal neurodevelopment.

Benefits of a Wearable Cyborg HAL (Hybrid Assistive Limb) in Patients with Childhood-Onset Motor Disabilities: A 1-Year Follow-Up Study.

Rehabilitation robots have shown promise in improving the gait of children with childhood-onset motor disabilities. This study aimed to investigate the long-term benefits of training using a wearable Hybrid Assistive Limb (HAL) in these patients. Training using a HAL was performed for 20 min a day, two to four times a week, over four weeks (12 sessions in total). The Gross Motor Function Measure (GMFM) was the primary outcome measure, and the secondary outcome measures were gait speed, step length, cadence, 6-min walking distance (6MD), Pediatric Evaluation of Disability Inventory, and Canadian Occupational Performance Measure (COPM). Patients underwent assessments before the intervention, immediately after the intervention, and at 1-, 2-, 3-month and 1-year follow-ups. Nine participants (five males, four females; mean age: 18.9 years) with cerebral palsy (n = 7), critical illness polyneuropathy (n = 1), and encephalitis (n = 1) were enrolled. After training using HAL, GMFM, gait speed, cadence, 6MD, and COPM significantly improved (all p < 0.05). Improvements in GMFM were maintained one year after the intervention (p < 0.001) and in self-selected gait speed and 6MD three months after the intervention (p < 0.05). Training using HAL may be safe and feasible for childhood-onset motor disabilities and may maintain long-term improvements in motor function and walking ability.