Performance-based Measures Research Articles

An innovative rehabilitation program for the veterans affairs post-acute skilled nursing setting: Preliminary results.

Skilled nursing rehabilitative care plays a critical role in older adults' functional recovery impacting post-discharge outcomes. Variations across post-acute rehabilitative care services and patient outcomes indicate a need to improve rehabilitative care in this setting. We adapted a successful outpatient care program (Live Long Walk Strong-LLWS) to address this need in post-acute care settings within the Veterans Health Administration. LLWS differs from standard PT care by treating impairments linked to functional decline that are not traditionally targeted by standard care, providing formalized coaching to optimize behavior change, and providing post-discharge case management to optimize long-term outcomes. The purpose was to adapt, refine and implement the LLWS program for the Community Living Center (CLC), determine its acceptability and feasibility, and evaluate its preliminary effectiveness among older adults. The design of the program was adapted from the original outpatient LLWS program to the CLC setting through quality improvement methods and the Replicating Effective Programs (REP) framework. Primary outcomes included measures of feasibility and acceptability of >80% enrollment and completion of sessions as well as preliminary effectiveness using performance-based and patient-reported measures of function including the Short Physical Performance Battery (SPPB), AM-PAC, a Global Rating of Change questionnaire, and a satisfaction survey. After 18 months, 51 Veterans had enrolled in the LLWS program, with 94.1% maintaining enrollment. We observed >80% completion of the inpatient and home follow-up sessions. Most patients were highly satisfied with care. Improvements in the SPPB (2.3 (SD 2.2) points), gait speed (0.17 (0.14) m/s) and the AM-PAC (6.5 (SD 5.7)) surpassed clinically meaningful thresholds. This novel care program is feasible and acceptable to Veterans, demonstrating preliminary effectiveness with improving functional outcomes. Future research is needed to further examine the program's impact on other important outcomes relative to standard modes of care.

Parental Competences and Academic Competences in School Children: The Mediator Role of Executive Functions

The role of parenting in the development of children’s learning constitutes, at present, part of the discussion in the psychoeducational field. Although parental competences (pc) and executive functions (ef) have been investigated by psychology and neuropsychology, their relationship with academic competences remains to be fully studied. The aim of this investigation was to analyze the effect of pc perceived by parents on behavioral ef and performance-based measures of reading and mathematical competences in children. We worked with 131 school children of both sexes, between 9 and 11 years old, and their respective parents. Multivariate Analysis of Variance (manova) and structural equation model (sem) were used. The results indicate that parental skills from the parents’ perspective have a significant effect on ef, reading, and mathematical skills. However, the best fit model indicates that efs mediate the relationship between parenting skills and reading and math skills.

Pre- and Post-Operative Rehabilitation Interventions in Patients at Risk of Poor Outcomes Following Knee or Hip Arthroplasty: Protocol for Two Systematic Reviews.

Total knee (TKA) and hip arthroplasty (THA) are successful procedures in treating end-stage osteoarthritis when nonoperative treatments fail. However, a growing body of literature has been reporting suboptimal outcomes following TKA and THA. While pre- and post-operative rehabilitation is imperative to recovery, little is known about their effectiveness for patients at risk of poor outcomes. In the 2 systematic reviews with identical methodology, we aim to evaluate the effectiveness of (a) pre-operative and (b) post-operative rehabilitation interventions for patients at risk of poor outcomes following TKA and THA. The 2 systematic reviews will follow the principles and recommendations outlined in the Cochrane Handbook. Only randomized controlled trials (RCTs) and pilot RCTs will be searched in 6 databases: CINAHL, MEDLINE, Embase, Web of Science, Pedro, and OTseeker. Eligible studies including patients at risk of poor outcomes and evaluating rehabilitation interventions following and preceding arthroplasty will be considered for inclusion. Primary outcomes will include performance-based tests and functional patient-reported outcome measures, and secondary outcomes will include health-related quality of life and pain. The quality of eligible RCTs will be evaluated using the Cochrane's risk of bias tool, and the strength of evidence will be assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE). These reviews will synthesize the evidence regarding the effectiveness of pre-and post-operative rehabilitation interventions for patients at risk of poor outcomes, which in turn may inform practitioners and patients in planning and implementing the most optimal rehabilitation programs to achieve the best outcomes after arthroplasty. PROSPERO CRD42022355574.

Clinical Interpretability of Quadriceps Strength and Gait Speed Performance in Total Knee Arthroplasty: A Longitudinal Study.

After a total knee arthroplasty, physical assessments of quadriceps strength and gait speed performance are often undertaken during rehabilitation. Our study aimed to improve their clinical interpretability by examining trajectory curves across levels of self-reported walking and stair climbing function. A sample of 2624 patients with primary total knee arthroplasty participated in this retrospective longitudinal study. Monthly, for 4 mos after surgery, quadriceps strength and gait speed were quantified. At the month-6 time point, self-reported walking and stair climbing function was measured. All physical measures improved nonlinearly over time. In mixed-effects models, greater quadriceps strength and gait speed over time were associated with higher month-6 self-reported walking and stair climbing function ( P < 0.001). Steeper gains in quadriceps strength and gait speed were associated with higher levels of walking and stair-climbing function (interaction P < 0.001). Among female patients who had great difficulty with stair ascent and ambulation, quadriceps strength trajectory curves plateaued after 8 wks after total knee arthroplasty. By stratifying trajectory curves across clinically interpretable functional levels, our findings potentially provide patients and clinicians a means to better interpret the continuous-scaled quadriceps strength and gait speed values. This information may be valuable when engaging patients in shared decision making and expectation setting. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. Upon completion of this article, the reader should be able to: (1) Understand how self-reported walking and stair climbing abilities improved from baseline before total knee arthroplasty (total knee arthroplasty) to 6 mos postoperatively; (2) Describe the time course of the 2 performance-based measures of quadriceps strength and walking speed after a total knee arthroplasty; and (3) Relate the trajectories of post-total knee arthroplasty quadriceps strength and walking speed measurements across distinct levels of self-reported walking and stair climbing function. Advanced. The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Anosognosia in HD: Comparison of self-report and caregiver ratings with objective performance measures

IntroductionIndividuals with Huntington's disease (HD) commonly experience anosognosia, a lack of awareness of deficits. Thus, it is important to examine the accuracy of patient vs caregiver ratings on the basis of objective performance-based measures. MethodsThe Anosognosia Scale (AS) was given to 33 patients with manifest HD and their caregivers. The AS consists of 8 items in which individuals rate their global abilities relative to same-aged peers. Scores range from very impaired to excellent. Caregiver and patient ratings were then correlated with objective measures. ResultsCaregivers' evaluations of patients' cognitive and motoric abilities were more highly correlated with objective measures than patients' ratings. Specifically, caregivers’ AS item scores were highly correlated with objective measures of walking (Unified Huntington Disease Rating Scale (UHDRS) tandem walking score [r = 0.57, p = .001] vs. patient [r = 0.39, p = .031]); dexterity (UHDRS pronation supination score [r = 0.55, p = .011] vs. patient [r = 0.18, p = .393]); speech (UHDRS dysarthria score [r = 0.55, p = .004] vs. patient [r = 0.03, p = .854]); memory (MoCA score [r = -.45, p = .048] vs. patient [r = -.11, p = .963]); attention (Trails Making Test A score [r = 0.58, p = .004] vs. patient [r = 0.08, p = .686]); and word retrieval (category fluency ([r = -.58, p = .004] vs. patient [r = -.02, p = 1.00]). Moreover, both the UHDRS total motor score (TMS) (F(1,29) = 7.50, p = .010) and the Mini Mental Status Exam (MMSE) (F(1,31) = 5.40, p = .027) were significant predictors of patient levels of anosognosia. ConclusionsOur findings indicate that caregivers may be better able to rate HD patients’ cognitive and motor abilities than patients themselves. Both cognitive and motor severity are significant predictors of levels of anosognosia in HD.

Comparison of prosthetic mobility and balance in transfemoral amputees with bone-anchored prosthesis vs. socket prosthesis.

The literature comparing bone-anchored prosthesis (BAP) with socket prosthesis (SP) consistently reports improvement in physical health and quality of life using primarily patient-reported outcome measures (PROMs). To determine the differences in mobility and balance using performance-based outcome measures and PROMs in people with transfemoral amputations (TFAs) fitted with BAP vs. SP. Causal comparative. Two groups of people with TFAs were recruited: one using a BAP (N = 11; mean age ± standard deviation, 44 ± 14.9 years; mean residual limb length as a percentage of the intact femur, 68% ± 15.9) and another group using a SP (N = 11; mean age ± standard deviation, 49.6 ± 16.0 years; mean residual limb length as a percentage of the intact femur, 81% ± 13.9), and completed the 10-meter walk test, component timed-up-and-go, Prosthetic Limb Users Survey of Mobility™ 12-item, and Activities-specific Balance Confidence Scale. There were no statistically significant differences between the BAP and SP groups in temporal spatial gait parameters and prosthetic mobility as measured by the 10-meter walk test and component timed-up-and-go, yet large effect sizes were found for several variables. In addition, Activities-specific Balance Confidence Scale and Prosthetic Limb Users Survey of Mobility™ scores were not statistically different between the BAP and SP groups, yet a large effect sizes were found for both variables. This study found that people with TFA who use a BAP can demonstrate similar temporal spatial gait parameters and prosthetic mobility, as well as self-perceived balance confidence and prosthetic mobility as SP users. Therefore, suggesting that the osseointegration reconstruction surgical procedure provides an alternative option for a specific population with TFA who cannot wear nor have limitations with a SP. Future research with a larger sample and other performance-based outcome measures and PROMs of prosthetic mobility and balance would further determine the differences between the prosthetic options.

Adaptation and translation of a scalable measure for assessing health worker competence to deliver a brief psychological intervention: A case study from central India of its comparison to a performance-based measure.

Efforts to reduce the global burden of common mental disorders have focused on scaling up evidence-based training programs for non-specialist providers to deliver brief psychological interventions. To evaluate these provider training programs, appropriate and scalable assessments of competency need to be developed alongside them. We followed a systematic approach for the cultural adaptation and translation into Hindi of a valid, English, multiple-choice applied knowledge measure to assess non-specialists' competence to deliver a brief psychological intervention for depression in rural India. We then explored the relationship between the performance of 30 non-specialist providers on the same written measure compared with a structured performance-based measure consisting of two role-plays. The results of the multiple-choice assessment had an overall mean score of 37.40 (SD = 11.31) compared to the mean scores of role-play A (the easier role-play) of 43.25 (SD = 14.50) and role-play B (the more difficult role-play) of 43.25 (SD = 13.00). Role-play performance-based measures and written applied knowledge measures represent different approaches with unique strengths and challenges to measuring competence. Scaling up training programs requires the development of scalable methods for competency assessment. Exploring the relationship between these two measures, our team found no apparent differences between the two modes of assessment. Continued comparison of these approaches is needed to determine the consistency of outcomes across the two formats and to link the scores on these measures with clinical performance as reflected by the quality of care and patient outcomes.Trial Registration: ClinicalTrials.gov Identifier: NCT04157816; 8th November 2019.

AWARENESS OF AGE-RELATED GAINS AND LOSSES AND THEIR ASSOCIATIONS WITH PHYSICAL AND COGNITIVE FUNCTION

Abstract Awareness of age-related change (AARC) refers to people’s recognition of how aging has affected their performance, behavior, and ways of experiencing life. Sometimes these age-related changes are perceived as losses (AARC-Losses), such as when people notice declines in their health. However, other times these age-related changes are perceived as gains (AARC-Gains), such as when people notice they have developed a better sense of what is important to them. Past research has shown that higher AARC-Losses (and to a lesser extent lower AARC-Gains) are associated with poorer self-rated health. However, no research has yet examined whether AARC also relates to an objective performance-based measure of health. To address this, we examined the cross-sectional relationships between AARC-Losses and AARC-Gains with gait speed (i.e., a measure of physical function) in 164 community-dwelling older adults. Participants in this study also completed health-related questionnaires and the NIH Toolbox Cognition Battery. Results showed that AARC-Losses were most strongly predicted by depression levels, but higher AARC-Losses were also predicted by slower gait speeds. A different pattern emerged for AARC-Gains. After controlling for demographic factors, depression, and other self-reported measures of health, we found that higher AARC-Gains were predicted by poorer cognition and slower gait speed. The counterintuitive relationship between AARC-Gains and objective cognition has previously been reported in the literature. However, this study is the first to document that AARC-Gains are also associated with poorer performance on an objective measure of physical function. We discuss features of the AARC questionnaire that may lead to these paradoxical effects.

The Functional External Memory Aid Tool Version 2.0: A How-To Clinical Guide.

Although compensatory cognitive rehabilitation is a common treatment approach for adults with cognitive-communication disorders, there are few assessment tools available to support clinicians in developing person-centered treatment plans. In addition to understanding a client's cognitive and functional abilities, it is also important to understand how they compensate for their weaknesses, specifically with external aids (e.g., calendars, notes), in everyday life. The Functional External Memory Aid Tool (FEMAT) is a performance-based measure that quantifies and describes external aid use during task completion. The purpose of this clinical focus article is to educate and equip clinicians to administer and interpretate the FEMAT with adult clients with cognitive-communication disorders. This clinical focus article describes the theoretical motivation for the FEMAT as well as the administration, scoring, and interpretation procedures for Version 2.0 of the measure. A hypothetical case example is included to illustrate how to use the FEMAT to develop person-centered goals and treatment plans. The FEMAT is psychometrically sound, clinically relevant, free, easily accessible, and quick to administer and provides data that are complementary to data obtained from traditional performance-based and/or patient-reported measures. This clinical focus article describes new resources that are available to help clinicians administer and interpret Version 2.0 of the FEMAT when serving adults with cognitive-communication disorders. https://doi.org/10.23641/asha.21651311.

Psychological and functional impacts associated with restrictions in long-term care facilities (LTCF) due to the COVID-19 pandemic: A multicentre study

Objectives: To analyze the impacts of the restrictions implemented in LTCF during the COVID-19 pandemic on the psychological and functional status of older adults. Design: A retrospective multicentre study is designed. We hypothesize that the negative effects of the restrictions will lead to a higher rate of decline between the measures taken immediately before and after the lockdown than between the two measures taken before the lockdown. Setting and participants: 365 participants recruited in four Spanish LTCFs in Galicia and Valencia. Methods: Impacts of restrictions on cognitive (MMSE), affective (GDS) and functional status (Barthel index, Tinetti) were analyzed by Linear Mixed Models with random intercepts, random slopes, and personal and contextual factors as covariates. Results: Social measures covaried significantly with the cognitive and functional status but did not predict longitudinal change. MMSE, Barthel index and Tinetti scores decreased significantly across pre- and post-lockdown measurement times, but only the Tinetti scores showed a specific impact of the restrictions. Conclusions: Only performance-based functional measures showed the real impact of restrictions. The findings highlight the importance of having data from several pre-lockdown measurements to enable identification of changes that can be causally attributed to the restrictions. The findings also support the resilience of older adults in mitigating the effect of the restrictions.

Self-reported cognitive decline among middle and older age autistic adults.

Very little is known about autistic adults as they age. Early evidence suggests a potentially high risk for dementia and atypical cognitive decline in autistic middle and older age adults. Research in the general population indicates that self-reported cognitive decline may predict future dementia earlier than performance-based measures. Nevertheless, self-report dementia screeners have not been used to date in autism research. In a sample of middle and older age autistic adults (N=210), participants completed a self-rated dementia screener, the AD8, to describe the rate of cognitive decline, examine associations of cognitive decline with age, educational level, sex designated at birth, and autistic traits, and document the psychometrics of a dementia screener in autistic adults. We found high rates of cognitive decline with 30% of the sample screening positive. The most common symptoms were declining interest in leisure activities, and increases in everyday problems with thinking, memory, and judgment. There was evidence that autistic individuals designated female at birth may be more vulnerable to cognitive decline than autistic individuals designated male at birth. Notably, reports of cognitive decline did not vary by age or educational level. Modestly elevated autistic traits were found in those screening positive versus negative for cognitive decline. Finally, the dementia screener showed good psychometrics, including convergent validity with an independent measure of current memory problems. These results could signal an emerging public health crisis in autistic adults as they age, and support the potential utility of self-report measures for early screening for cognitive decline in this population.

Coping Strategies and Social Skills of School-Aged Children: Association with Performance-Based Measures and Behavioral Ratings of Executive Function

The aim of the present study was to analyze the association of executive function (EF) based on performance-based measures and behavioral ratings (Behavior Rating Inventory of Executive Function-2 [BRIEF-2]) with coping and social skills in children. To this end, we first examined the structure of EF based on performance-based measures in a Chilean sample of 275 girls and boys aged 8–12 years. Confirmatory factor analysis showed the best fit for the three-factor solution, with (1) working memory, (2) cognitive flexibility, and (3) inhibition as separate but related components. Selective associations were found between EF and coping and social skills, with differences according to the assessment method for EF. Specifically, only inhibitory control was related to the constructs when EF was assessed based on the performance-based measures. Meanwhile, EF assessed based on the behavioral ratings, including all dimensions of the BRIEF-2, were selectively associated with coping and social skills, mainly when the evaluation was performed by the teachers. Finally, structural equation models (SEM) showed that inhibitory control had direct effects on coping and social skills. However, when EF was assessed based on ratings, differences were observed between the teachers' and parents' reports. These results reveal the varying effects of EF on coping and social skills depending not only on the modality of assessment but also on the informant, emphasizing the relevance of comprehensive EF evaluation; they also provide relevant information regarding the relationship between EF and coping and social skills in children.

Construct validity of the Single Arm Military Press (SAMP) test for upper limb function in patients with neck pain

BackgroundNeck pain (NP) is often associated with upper limb disability (ULD). A clinically feasible measure to evaluate ULD in NP patients is necessary. The Single Arm Military Press (SAMP) is a ULD performance-based measure, specifically for NP patients. The validity of the SAMP in patients is still unknown. ObjectiveTo explore the construct validity (hypotheses testing) of the SAMP in NP patients. MethodsA total of 210 NP patients and 81 controls were recruited. The SAMP; Disability of the Arm, Shoulder, and Hand (DASH); and Neck Disability Index (NDI) were completed at baseline and 4–7 days later. The Visual Analogue Scale (VAS) was used to measure NP and ULD severity pre-testing in both occasions. Patients were divided into 4-subgroups based on their NDI score. Convergent validity was examined using Pearson correlation. The t-test and analysis of variance (ANOVA) were used to evaluate discriminant and known groups’ validity. To determine SAMP cut-off scores, the sensitivity and specificity were explored. ResultsA negative correlation between the SAMP and DASH/NDI scores was found in the patient group (r = −0.91 and −0.87, p < 0.01). The t-test revealed substantial differences (t = −23.96) in score between patients and controls. Also, ANOVA revealed substantial differences (f = 20.86) between the patients’ subgroups. The area under the curve (AUC) for patients and controls exceeded 0.90 when sensitivity and specificity were at equal importance. ConclusionThe SAMP can distinguish between NP patients and controls, and between different NP disability levels. The responsiveness of the SAMP needs to be investigated.

Utility of performance-based outcome measures (PBOMs) used in fall risk assessment tools for older adults.

This study investigated the diagnostic accuracy of different clusters of performance based outcome measures (PBOMs) recommended by two consensus-based guidelines: Stopping Elderly Accidents, Deaths, and Injuries (STEADI), and those recommended by a systematic review completed by the American Physical Therapy Association and Academy of Geriatric Physical Therapy (APTA-SR, APTA-SR3). 33 community-dwelling older adults (25 females, 8 males) aged mean 79.45 ± 7.64 years participated in this study. Participants completed a fall history questionnaire and were evaluated via a battery of PBOMs for comparative analysis. The diagnostic accuracy of each PBOM cluster was analyzed retrospectively (previous 1 year fall history) and prospectively (6 month follow up). Retrospective analysis revealed the APTA-SR3 had the highest clinical utility and diagnostic accuracy: Sp 88.24% (63.56-98.54), Sn 62.5% (35.43-84.8), LR+ 2.35 (1.22-4.53), LR- 0.19 (0.05-0.73), accuracy 70.22% (51.83-84.81). Prospective analysis revealed the cluster of the APTA-SR and APTA-SR3 had identical diagnostic accuracy: Sn 100% (39.76-100), Sp 43.75% (19.75-70.12), LR+ 1.78 (1.15-2.74), LR- 0 (0), accuracy 60.62% (36.63-81.36). The APTA-SR 3 cluster demonstrated the highest diagnostic accuracy and in this study was the most effective and efficient group of PBOMs to identify fall risk in community dwelling older adults.

Targeted Box and Blocks Test: Evidence of Convergent Validity in Upper Limb Prosthesis User Population

<h3>Research Objectives</h3> To conduct an initial psychometric evaluation in the upper limb prosthesis user population of a novel performance-based measure called the targeted Box and Blocks Test (tBBT) requiring controlled grasping, transport, and release of objects that can be used to evaluate upper limb functional ability. <h3>Design</h3> Nonrandomized controlled trial. <h3>Setting</h3> Academic research lab. <h3>Participants</h3> A convenience sample of n = 8 transradial myoelectric prosthesis users (3F/5M; mean age 46.3 ± 14.3 years). Nearly all prosthesis users used their myoelectric prosthetic device >8 hours/day and >5 days/week. Time since amputation for all but two prosthesis users was less than 6 years. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Participants were timed as they performed two trials each of the tBBT (in both a standing and seated position); the fork, reach overhead, and door knob tasks from the Activities Measure for Upper Limb Amputees (AM-ULA); and the picture frame, bottle squeeze, and pick up dice tasks from the Capacity Assessment of Prosthesis Performance for the Upper Limb (CAPPFUL). Average time of trials was used to calculate the Pearson correlation coefficients between tBBT and each task performed from the CAPPFUL and AM-ULA. <h3>Results</h3> Nearly all correlations between the tBBT (standing and seated) and select tasks from the AM-ULA and CAPPFUL were moderate to strong, ranging from 0.48 to 0.90. The correlation between tBBT in a seated position and the reach overhead AM-ULA task was weaker (R = 0.38). Interestingly, there was a significant strong negative correlation between tBBT score and the CAPPFUL task of squeezing water from a bottle (R = -0.89 for tBBT standing and R = -.76 for tBBT seated). <h3>Conclusions</h3> Preliminary results demonstrate the tBBT in both seated and standing positions has acceptable convergent validity in the upper limb prosthesis user population. Additional psychometric properties (e.g., known-group validity, test-retest reliability) should be determined to fully characterize this novel measure. <h3>Author(s) Disclosures</h3> None.

The Influence of Emotional Intelligence in the Workplace Environment: A Literature Review

This study examines the influence of emotional intelligence in the working environment that will affect both employee and company performance. This area of study involves people, the environment in which they live and work, how they affect their environment, and the effect that environment has upon them. Emotional intelligence is tied to adaptation, which is the process by which a person adjusts to external conditions to diminish disruption and maximize benefits. It is a favorable human trait associated with several beneficial life outcomes. Many research models are utilized to measure and capture the ability to conceptualize emotional intelligence as potential performance, and they use performance-based measures of emotional intelligence to achieve good performance. The aim of this research is to reflect the comprehensive studies within this realm regarding the utility of emotional intelligence in an organizational context.

Walking asymmetry and its relation to patient-reported and performance-based outcome measures in individuals with unilateral lower limb loss

ABSTRACT Gait asymmetry persists for most people after lower limb amputation and is associated with slower walking speeds. However, the relationship between gait asymmetry and patient-reported function remains unclear because they are not commonly assessed together. The purpose of this study was to determine relationships between gait asymmetries in people with lower limb loss and (1) patient-reported outcomes and (2) performance-based prosthetic functional measures. This cross-sectional analysis included nine people with unilateral limb loss aged 48.2 ± 13.1 years of mixed amputation etiology. Patient-reported outcomes included the Prosthetic Evaluation Questionnaire mobility subscale and Activities-specific Balance Confidence scale. Performance outcomes included the Berg Balance Scale and the 30-second sit-to-stand test. Walking performance measures included the 2-Minute Walk Test, during which APDM Opal sensors recorded spatiotemporal gait parameters, and daily step-counts from StepWatch4 activity monitors. The study found that the most asymmetric gait symmetry ratios (prosthetic-limb divided by intact-limb) could be attributed to prosthetic foot dorsiflexion-plantarflexion and rotation motion limitations: prosthetic-limb trailing double support (0.789 ± 0.052), toe-off (0.760 ± 0.068) and toe-out angle (0.653 ± 0.256). Single limb stance, and stance and swing phase durations were most strongly associated with balance and walking performance measures. Notably, no symmetry ratio was significantly associated with patient-reported prosthetic function (unadjusted Pearson correlation coefficients r < 0.50, P > 0.05). More gait symmetry was associated with better balance and walking performance but had no significant relationship with patient-reported function. Although achieving gait symmetry after lower limb loss is a common walking goal, symmetry was unrelated to the perception of functional mobility for people with lower limb loss.

Assessment of 'Cool' and 'Hot' Executive Skills in Children with ADHD: The Role of Performance Measures and Behavioral Ratings.

Executive dysfunction is an underlying characteristic of Attention Deficit/Hyperactivity Disorder (ADHD). Therefore, this study explored which measures of executive functions (EF) may lead to a better diagnostic prediction and evaluated whether participants were adequately assigned to the ADHD group based on the identified predictors. Seventeen 6- to 10-year-old children with ADHD were matched with 17 typically developing peers (TD) by age, gender, and non-verbal intelligence. Performance-based measures and behavior ratings of 'cool' and 'hot' EF were used. As expected, there was a significant group effect on the linear combination of measures, indicating that children with ADHD showed significant difficulties with EF compared to the TD group. In fact, significant differences were found in measures of short-term and working memory, planning, delay aversion, and EF-related behaviors, as reported by parents and teachers. However, the discriminant function analysis only revealed three significant predictors: the General Executive Composite of the Behavior Rating Inventory of Executive Function (Parent and Teacher Forms) and the Delay of Gratification Task, with 97.1% correct classifications. These findings highlight the importance and contribution of both behavioral ratings and 'hot' measures of EF for the characterization of ADHD in children.

Implementing ASH Guidelines: Clinical Utility of a Signaling Question for Detecting Cognitive Deficits in Pediatric Sickle Cell Disease

Introduction: Disease-related cognitive deficits are common in sickle cell disease (SCD). ASH 2020 guidelines recommend that clinicians conduct surveillance using simplified signaling questions for concerns about neurodevelopmental disorders. More formal screening is recommended for patients with abnormal surveillance results. While the guidelines suggest possible signaling questions that could be used, there is a lack of empirical research into which questions yield reliable estimates of cognitive impairment. We examined the clinical utility of a caregiver-directed signaling question for identifying cognitive deficits as assessed by a performance-based measure of intelligence (IQ). Methods: Primary caregivers of children with SCD aged 7-16 years were asked to rate their child's academic performance as below grade level, on grade level, or above grade level relative to their peers. Children completed the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V), a standardized assessment of IQ. The WISC-V produces standard score (Mean = 100, SD = 15) estimates of global intelligence (Full Scale IQ), verbal abilities (Verbal Comprehension Index or VCI), working memory (Working Memory Index or WMI), and processing speed (Processing Speed Index or PSI). One-way ANOVA was used to examine the degree to which WISC-V scores varied by caregiver-rated academic performance. Analyses were repeated separately for younger children (ages 7-11) and older children (ages 12-16). To determine the clinical utility of caregiver ratings of academic performance, academic performance was dichotomized (below grade level vs. at/above grade level) and WISC-V scores were dichotomized into low functioning (>1 SD below the mean) or normal functioning; sensitivity, specificity, positive predictive value, and negative predictive value estimates were subsequently calculated. Results: Eighty-nine caregivers of children with SCD (Mean age = 10.42, SD = 2.92; 58% female; 75% HbSS or HbS-beta0 thalassemia) reported on their child's academic performance, with the majority described as on grade level (67%), followed by below grade level (21%) and above grade level (11%). Children had a mean IQ of 91.61 (SD = 14.09), VCI of 95.65 (SD = 14.02), WMI of 95.18 (SD = 13.93), and PSI of 87.70 (SD = 14.42). Thirty-four percent of children had a low IQ, 25% had a low VCI, 26% had a low WMI, and 37% had a low PSI. Caregiver-rated academic performance was associated with variance in IQ (F(2,86) = 11.75, p < .001), VCI (F(2,85) = 9.28, p < .001), WMI (F(2,86) = 10.74, p < .001), and PSI (F(2,86) = 10.07, p < .001), with those rated as below grade level reliably scoring lower than those rated as at or above grade level. Differences in median cognitive functioning relative to caregiver ratings of academic performance are depicted in Figure 1. When examining differences by age group (ages 7-11: 65%, n = 58; ages 12-16: 35%, n = 31), results indicated that ratings of academic performance were significantly associated with variance in IQ (F(2,55) = 11.91, p < .001), VCI (F(2,54) = 7.38, p = .001), WMI (F(2,55) = 13.17, p < .001), and PSI (F(2,55) = 8.90, p < .001) for younger children but not older children (all p's > .08). Sensitivity, specificity, and positive and negative predictive value results are presented in Table I. Conclusions: Cognitive functioning in children with SCD significantly varies by caregiver ratings of academic performance. Children classified by their caregiver as being "below grade level” had lower IQ, verbal abilities, working memory, and processing speed relative to those described as "on grade level” and "above grade level.” Ratings of being below grade level demonstrated good specificity for detecting cognitive impairment but low sensitivity. Asking caregivers of children with SCD to estimate their child's academic performance relative to peers is a simple way to conduct surveillance for cognitive deficits but will result in high rates of false negatives so additional screening tools are needed to identify all children with SCD who have cognitive deficits. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

The neuropsychological profile of children with Diffuse Intrinsic Pontine Glioma (DIPG) before and after radiation therapy: A prospective longitudinal study

ABSTRACT Children with Diffuse Intrinsic Pontine Gliomas (DIPG), a malignant brainstem tumor, experience poor prognosis. Because of the disease’s rarity and highly aggressive course, there is a dearth of research on cognitive and psychosocial outcomes in this underserved, vulnerable population. However, evaluating effects of the disease and treatment on the cognitive and daily functioning of these patients is important to better understand their specific needs and improve their quality of life. The current longitudinal study administered prospective neuropsychological assessments to children diagnosed with CNS malignancies, including the largest sample of children with DIPG to date (n = 21, mean age = 7.86 years, range = 3–16) in neurocognitive, behavioral, social-emotional, and adaptive functioning at baseline, two weeks post-radiation, and six months later. The results describe population-based, cross-sectional characteristics and within-patient longitudinal changes. Prior to radiation, children with DIPG exhibited significant weaknesses compared to normative samples in both parent-report and performance-based measures of attention, and tests of processing speed and verbal learning/memory. Younger children demonstrated poorer inhibitory control on performance tests and worse parent-reported behavioral regulation, depression, and social withdrawal compared to older children. Six-months post-radiation, older children exhibited poorer socialization than younger children. Longitudinally, children with DIPG exhibited short-term improvements immediately post-radiation in performance-based attention tests and parent-reported behavior, including attention, hyperactivity, behavioral regulation, and executive function. However, these improvements did not persist and significant decline was documented on tests of attention by six months. Clinical implications for professionals working with children with DIPG and recommendations for cognitive remediation and quality of life interventions are provided.