Selective Control Assessment Of The Lower Extremity Research Articles

Are tactile function and body awareness of the foot related to motor outcomes in children with upper motor neuron lesions?

Somatosensory function can be reduced in children with Upper Motor Neuron (UMN) lesions. Therefore, we investigated relationships between somatosensory functions of the foot and motor outcomes in children with UMN lesions. In this cross-sectional study, we assessed the Tactile Threshold (TT) with monofilaments and body awareness with Tactile Localisation Tasks for spatial-related action (TLTaction) and structural-related perception (TLTperception) body representation at the foot sole. Furthermore, we assessed four motor outcomes: the Selective Control Assessment of the Lower Extremity (SCALE), the modified Timed Up and Go test (mTUG), the Gillette Functional Assessment Questionnaire (FAQ), and the Functional Mobility Scale (FMS). Spearman's correlations (ρ) were applied to assess relationships between the somatosensory function of the foot sole and the applied motor outcomes. Thirty-five children with UMN lesions, on average 11.7 ± 3.4 years old, participated. TLTperception correlated significantly with all lower limb motor outcomes (|ρ|=0.36-0.57; p < 0.05), but TLTaction (|ρ|=0.00-0.27; p = 0.15-0.97, and TT did not (|ρ|=0.01-0.83; p = 0.73-0.94). TLTperception correlated strongly with the Gross Motor Function Classification System (|ρ|=0.62; p = 0.001) in children with cerebral palsy (n = 24). Assessing structural body representation of the foot sole should be considered when addressing lower limb motor impairments, including gait, in children with upper motor neuron lesions. Our results suggest that the assessment of tactile function and spatial body representation may be less related to lower limb motor function.

Selective motor control correlates with gross motor ability, functional balance and gait performance in ambulant children with bilateral spastic cerebral palsy

BackgroundSelective motor control (SMC) is a fundamental component of typical human motion. As a result of brain damage, impaired SMC often leads to difficulties with coordination, balance, gait efficiency and symmetry. Research questionWhat is the association between impaired SMC and lower limb motor ability, functional balance and gait performance in children with bilateral spastic cerebral palsy (CP)? MethodsThirty-six children (aged 5–16 years) with spastic bilateral CP in Gross Motor Function Classification System (GMFCS) level I to II were included in this study. SMC was assessed using Selective Control Assessment of the Lower Extremity (SCALE). Gross motor function was assessed using Gross Motor Function Measure-88 items D and E dimension (GMFM-88 D&E). Functional balance was assessed using Pediatric Balance Scale (PBS) and Timed Up and Go Test (TUG). Gait quality was assessed using Edinburg Visual Gait Score (EVGS) and 10-Meter Walk Test (10MWT). Spearman's rank correlation analyses were used to determine the association between SMC and other factors. ResultsCorrelation analyses showed that SCALE was strongly positively correlated with GMFM-88 (D&E) (rs=0.756, p < 0.001), PBS (rs=0.769, p < 0.001), and height-normalized fast walking speed (rs=0.632, p < 0.001), and strongly negatively correlated with TUG (rs=−0.766, p < 0.001) and EVGS (rs=−0.893, p < 0.001). SignificanceLower extremity SMC deficits are associated with poor gross motor function and balance control, more severe overall gait deviations and decreased fast walking speed in children with bilateral spastic CP. Physical therapy should include interventions that promote selective motor control in order to improve overall functional ability.

Characteristics of sit-to-stand movement are associated with trunk and lower extremity selective control in children with cerebral palsy: a cross-sectional study.

Even though the effect of several factors on sit-to-stand (STS) performance of children with CP has been previously explored, the potential role of lower extremity selective control, trunk control and sitting function on the performance of STS has not been examined. This study aimed to investigate the association of trunk control and lower extremity selective motor control with STS performance in children with CP. We recruited 28 children with CP aged between 4 and 10 years whose Gross Motor Function Classification System levels were I and II and 32 age-matched typically developing (TP) children. Trunk control, sitting function, selective control of the lower extremities and STS were evaluated with Trunk Control Measurement Scale (TCMS), sitting section of Gross Motor Function Measure-88 (GMFM-88), Selective Control Assessment of the Lower Extremity (SCALE) and the STS outcomes of a force platform [weight transfer time, rising index, and center of gravity (COG) sway velocity], respectively. In all evaluations, children with CP demonstrated lower scores than TD children. A moderate correlation was found between total scores of TCMS, GMFM-88 sitting section scores and COG sway velocity during STS and a fair correlation between SCALE total scores and COG sway velocity in the CP group ( r = -0.51, r = -0.52, r = -0.39, respectively). A fair correlation was found between SCALE total scores and the weight transfer time during STS in children with CP ( r = -0.39). Based on these results, improving trunk and lower extremity selective control may enhance STS performance in children with CP.

Reliability and validity of the Turkish version of the Selective Control Assessment of the Lower Extremity (SCALE) in children with spastic cerebral palsy

Purpose This study aims to translate the Selective Control Assessment of the Lower Extremity (SCALE) into Turkish language, assess its reliability and validity in children with spastic cerebral palsy. Materials and methods Fifty-two children with CP (mean age 9 years 8 months, range 4–18 years) included in this cross-sectional study. Intra- and interrater reliability was assessed by intraclass correlation coefficient (ICC). The SCALE was correlated with the Gross Motor Function Classification System (GMFCS), the Physician’s Rating Scale (PRS), and Gross Motor Function Measurement (GMFM) to assess validity. Results Intra- and interrater reliability of the SCALE were excellent (ICC > 0.75). SCALE and GMFCS (r = −0.786, p < 0.001), SCALE and PRS (r = 0.761, p < 0.001), SCALE and GMFM (r = 0.863, p < 0.001) were highly correlated. SCALE scores differed significantly between GMFCS levels and between types of spastic CP. Conclusions The Turkish version of the SCALE appears to be a valid and reliable tool to assess selective voluntary motor control of the lower limbs in children with spastic CP. IMPLICATIONS FOR REHABILITATION The Turkish version of the Selective Control Assessment of the Lower Extremity is a valid and reliable assessment for children with spastic CP. The SCALE scores differed significantly between Gross Motor Function Classification System levels I versus II and levels II versus III as well as between types of spastic CP. The current study suggests that the SCALE is a quick and easy outcome measure to assess selective motor control in patients with spastic CP.

Determining the relationship between the impairment of selective voluntary motor control and gait deviations in children with cerebral palsy using simple video-based analyses.

The impairment of selective voluntary motor control (SVMC) in children with cerebral palsy (CP) has been shown to correlate with their gait characteristics using complex 3D gait analysis systems (3DGA); however, this relationship has not been investigated using simple video-based observational gait analysis (VBOGA). The aim of this study was to determine the relationship between VBOGA and SVMC of the lower extremities in children with CP. Forty-two CP children 10.9 ± 5.7 years old with Gross Motor Function Classification System (GMFCS) levels I-III participated in the study. Their gait characteristics were assessed using the Edinburgh Visual Gait Score (EVGS), and selective voluntary motor control was tested using the Selective Control Assessment of the Lower Extremity (SCALE). Spearman's rho correlation test with Cohen's classification were used in the statistical analyses. The GMFCS levels (r = 0.604, p < 0.001), foot clearance (r = -0.584. p < 0.001), and maximum ankle dorsiflexion (r =-0.567, p < 0.001) during the swing phase had strong correlations with total SCALE scores. There was also a moderate correlation between total SCALE scores and total EVGS (r =-0.494, p < 0.001), knee extension in the terminal swing phase (r = -0.353, p < 0.001), peak sagittal trunk position (r = -0.316, p < 0.005), and maximum lateral shift (r = -0.37, p < 0.001). Impaired lower extremity SVMC was noticeably related to the foot and ankle movements in the swing phase and initial stance during walking as well as the total EVGS scores and sagittal and frontal trunk movements. The SCALE correlations with VBOGA were similar those observed in the complex 3DGA in the literature; therefore, we suggest that SVMC impairment of gait could be evaluated using simple VBOGA. These findings may help to tailor physical therapy programs for CP children to increase their motor control and walking quality.

Selective Motor Control is a Clinical Correlate of Brain Motor Tract Impairment in Children with Spastic Bilateral Cerebral Palsy.

Selective voluntary motor control is an important factor influencing gross motor function, interjoint coordination, and the outcome of hamstring-lengthening surgery in spastic cerebral palsy. Using DTI, we investigated whether selective voluntary motor control would show strong correlations with WM motor tract microstructure and whether selective voluntary motor control is more sensitive to global WM impairment than gross motor function. Children with spastic bilateral cerebral palsy born preterm and typically developing children were recruited. The Selective Control Assessment of the Lower Extremity (SCALE) and Gross Motor Function Measure (GMFM) were assessed in participants with cerebral palsy. Participants underwent brain MR imaging to collect DWI data. Tract-Based Spatial Statistics was used to analyze the WM for between-group differences and correlations with SCALE and GMFM. ROI analyses compared motor regions. Twelve children with cerebral palsy (mean age, 11.5 years) and 12 typically developing children (mean age, 10.3 years) participated. Altered DTI outcomes were found throughout the whole brain for the cerebral palsy group. SCALE, developed to evaluate selective voluntary motor control in cerebral palsy, showed significant positive correlations with fractional anisotropy in more WM voxels throughout the whole brain and for motor regions, including the corticospinal tract and corpus callosum, compared with GMFM. A significant negative correlation between radial diffusivity and SCALE, but not GMFM, was found within the corpus callosum. SCALE was a more sensitive clinical correlate of motor and whole-brain WM tract impairment in children with spastic bilateral cerebral palsy, suggesting greater anisotropy and myelination in these regions for those with higher selective voluntary motor control.

Correlation between the Korean Version of the Trunk Control Measurement Scale and the Selective Control Assessment of the Lower Extremity Scores in Children with Cerebral Palsy.

Background and Objectives: The purpose of this study was to investigate the correlation between the Korean version of the trunk control measurement scale (K-TCMS) and the selective control assessment of the lower extremity (SCALE). Through this, we tried to find out the effect of proximal stabilization on distal motor development. Materials and Methods: Fifty-one children with gross motor function classification system level I–III, diagnosed with cerebral palsy (CP), were studied. The K-TCMS was used to evaluate the body control ability of the children. SCALE was used to quantify selective voluntary motor control (SVMC). Results: Analysis of SCALE and K-TCMS showed a significant positive correlation in all items. Multiple regression analysis showed that the SCALE score decreased as age increased, and that it increased as the static sitting balance ability score and the dynamic sitting balance ability score of the K-TCMS increased significantly (p < 0.05). Conclusions: In children with cerebral palsy, there was a close correlation between trunk control and selective voluntary motor control of the lower extremities. Therefore, when trying to improve the lower extremity function of a child with cerebral palsy, a trunk control intervention should be considered.

Quantifying age-related differences in selective voluntary motor control in children and adolescents with three assessments.

Neurophysiological development of selective voluntary motor control (SVMC) is assumed but has not been quantified objectively. We assessed SVMC with (i) clinical assessments, (ii) a combination of these assessments with surface electromyography (sEMG) and, (iii) a playful computer game. The aim of this study was to describe and compare age-related differences in SVMC, quantified with these tools, in neurologically intact children, adolescents, and adults. We measured upper and lower extremity SVMC with three assessments in 31 children and adolescents. A sample of 33 and 31 adults provided reference values for the upper and lower extremity assessments, respectively. The Selective Control of the Upper Extremity Scale (SCUES) or the Selective Control Assessment of the Lower Extremity (SCALE) were combined with simultaneous sEMG recordings. We quantified SVMC by a similarity index that compared an individual's muscle activation pattern with those of an adult reference group. The SVMC Assessgame required isolated joint movements to steer an avatar and quantified the accuracy of the selective movement and the extent of involuntary movements occurring in not involved joints. Results from the conventional clinical assessments correlated low to moderately with age (SCUES: r=0.55, p=0.013; SCALE: r=0.44, p=0.001), while the correlation between the sEMG based similarity index and age was negligible (r≤0.25). The outcomes of the Assessgame correlated highly with age (r≥0.80, p≤0.001). Older children and adolescents performed movements more accurately and with fewer involuntary movements compared to younger participants. The tools assess and quantify SVMC differently, affecting the way they capture age-related differences in SVMC. Some assessments require reference values from neurologically intact children and adolescents to correctly classify impairments of SVMC in patients with neuromotor disorders.

Cluster analysis of impairment measures to inform an evidence-based classification structure in RaceRunning, a new World Para Athletics event for athletes with hypertonia, ataxia or athetosis

ABSTRACT RaceRunning enables athletes with limited or no walking ability to propel themselves independently using a three-wheeled frame that has a saddle, handle bars and a chest plate. For RaceRunning to be included as a para athletics event, an evidence-based classification system is required. This study assessed the impact of trunk control and lower limb impairment measures on RaceRunning performance and evaluated whether cluster analysis of these impairment measures produces a valid classification structure for RaceRunning. The Trunk Control Measurement Scale (TCMS), Selective Control Assessment of the Lower Extremity (SCALE), the Australian Spasticity Assessment Scale (ASAS), and knee extension were recorded for 26 RaceRunning athletes. Thirteen male and 13 female athletes aged 24 (SD = 7) years participated. All impairment measures were significantly correlated with performance (rho = 0.55–0.74). Using ASAS, SCALE, TCMS and knee extension as cluster variables in a two-step cluster analysis resulted in two clusters of athletes. Race speed and the impairment measures were significantly different between the clusters (p < 0.001). The findings of this study provide evidence for the utility of the selected impairment measures in an evidence-based classification system for RaceRunning athletes.

Effects of Kinect Video Game Training on Lower Extremity Motor Function, Balance, and Gait in Adolescents with Spastic Diplegia Cerebral Palsy: A Pilot Randomized Controlled Trial

ABSTRACT The Kinect video game (KVG) has received attention as an intervention method for cerebral palsy (CP). However, evidence remains limited. Purpose To investigate the effects of training using Xbox Kinect on lower extremity motor function, balance, and gait in adolescents with spastic diplegia CP. Methods This study was a pilot randomized controlled trial. Ten participants were randomly allocated to either the KVG training group (n = 5) or the conventional training (CT) group (n = 5). The Selective Control Assessment of the Lower Extremity (SCALE) tool, Pediatric Balance Scale (PBS), and GAITRite were used for the outcome measurements. Results In the comparison between the groups, the KVG group showed significant improvements in all the items in the SCALE (except for right hip abduction) and PBS score as compared with the CT group. Conclusions KVG training might be an effective intervention for the rehabilitation of adolescents with spastic diplegia CP.

Brain Metabolism During A Lower Extremity Voluntary Movement Task in Children With Spastic Cerebral Palsy.

Reduced selective voluntary motor control (SVMC) is a primary impairment due to corticospinal tract (CST) injury in spastic cerebral palsy (CP). There are few studies of brain metabolism in CP and none have examined brain metabolism during a motor task. Nine children with bilateral spastic CP [Age: 6-11 years, Gross Motor Function Classification System (GMFCS) Levels II–V] completed this study. SVMC was evaluated using Selective Control Assessment of the Lower Extremity (SCALE) ranging from 0 (absent) to 10 (normal). Brain metabolism was measured using positron emission tomography (PET) scanning in association with a selective ankle motor task. Whole brain activation maps as well as ROI averaged metabolic activity were correlated with SCALE scores. The contralateral sensorimotor and superior parietal cortex were positively correlated with SCALE scores (p < 0.0005). In contrast, a negative correlation of metabolic activity with SCALE was found in the cerebellum (p < 0.0005). Subsequent ROI analysis showed that both ipsilateral and contralateral cerebellar metabolism correlated with SCALE but the relationship for the ipsilateral cerebellum was stronger (R2 = 0.80, p < 0.001 vs. R2 = 0.46, p = 0.045). Decreased cortical and increased cerebellar activation in children with less SVMC may be related to task difficulty, activation of new motor learning paradigms in the cerebellum and potential engagement of alternative motor systems when CSTs are focally damaged. These results support SCALE as a clinical correlate of neurological impairment.

FAMILY-CENTRED, GOAL-DIRECTED MULTIDISCIPLINARY APPROACH FOR LOWER EXTREMITY BOTULINUM TOXIN WITH PHYSICAL THERAPY AND REHABILITATION IN CEREBRAL PALSY

Purpose: This study aimed to investigate lower extremity botulinum toxin (BT) and physical therapy and rehabilitation (PTR) application scoping “family-centered, goal-directed multidisciplinary approach (FGMA)” in the children with cerebral palsy (CP) and to assess the satisfaction of parents and children from this approach. Methods: A physician and physiotherapist evaluated 30 children (age=6.33±2.38 years) with ambulatory CP and their parents using the FGMA. Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS) were used to define the functionality of children. Selectivity was assessed using the Selective Control Assessment of the Lower Extremity (SCALE). Walking was evaluated using the Observational Gait Scale (OGS) and the Gillette Functional Assessment Questionnaire (FAQ). Satisfaction levels marked on the Visual Analogue Scale. Results: Nineteen (63%) children were GMFCS level III, 16 (53%) children were MACS level I, 19 (63.33%) children were CFCS level I. Half of children had visual problems. While the most preferred muscles were hamstring and gastrocnemius for BT, the most common device was ankle-foot orthosis. The median score of SCALE, OGS, and FAQ, and the satisfaction of parents and children were 8 (4-17), 12 (2-24), 2 (1-10), 9 (7-10), and 7 (6-10) points, respectively. The satisfaction level of parents with the new approach was higher than the previous traditional approach (p&amp;lt;0.001). Conclusions: Both the parents and children may be satisfied with the FGMA for BT with the PTR program. Clinicians should take into account lower extremity selectivity, walking performance, and satisfaction levels as much as muscle tone or range of motion. Key Words: Botulinum Toxin; Cerebral Palsy; Parent; Physical Therapy.

Characteristics of selective motor control of the lower extremity in adults with bilateral spastic cerebral palsy.

[Purpose] We aimed to examine the relationship between gross motor function, selective motor control (SMC), range of motion (ROM), and spasticity in the lower extremities of adults with cerebral palsy (CP), as well as the proximal to distal distribution of SMC impairment in lower extremity joints. [Participants and Methods] We recruited 11 adults with bilateral spastic CP, ranging from levels I to III according to the Gross Motor Function Classification System (GMFCS). We evaluated participants according to the Selective Control Assessment of the Lower Extremity (SCALE), ROM, and the Modified Ashworth Scale (MAS). We conducted the Friedman test to assess differences among the SCALE scores of each joint. The relationship between GMFCS level, SCALE scores, ROM, and MAS scores was assessed. [Results] The mean SCALE scores were lower for distal than for proximal joints. The SCALE scores of each leg showed significant inverse correlations with the GMFCS level. [Conclusion] SMC in adults with CP strongly influences gross motor function. SMC did not have a significant relationship with spasticity or ROM. SMC, ROM, and spasticity independently influenced gross motor function in adults with CP. SMC impairment in adults with CP was higher in distal than in proximal joints.

Influence of impaired selective motor control on gait in children with cerebral palsy.

PurposeSpastic cerebral palsy (CP) is characterized by four neuromuscular deficits: weakness, short muscle-tendon unit, muscle spasticity and impaired selective motor control (SMC). We examined the influence of impaired SMC on gait in children with bilateral spastic CP. Delineating the influence of neuromuscular deficits on gait abnormalities can guide surgical and therapeutic interventions to reduce long-term debilitating effects of CP.MethodsThe relationship between impaired SMC and gait was assessed using multivariate linear regression analysis of Selective Control Assessment of the Lower Extremity (SCALE) in relation to stance phase knee flexion and temporal-spatial gait parameters calculated using 3D kinematics for 57 children with bilateral spastic CP, ages seven to 11 years.ResultsMean SCALE values were 5.8 (0 to 10, sd 3.0) and 5.7 (0 to 10, sd 2.9) for right and left legs, respectively. Multivariate linear regression models, including right and left SCALE and height, significantly predicted right and left knee flexion at initial contact (R = 0.479, p = 0.003; R = 0.452, p = 0.007, respectively) and right and left knee flexion in midstance (R = 0.428, p = 0.013; R = 0.407, p = 0.022, respectively). The model significantly predicted right and left step length (R = 0.645, p = 0.000; R = 0.523, p = 0.001, respectively) and predicted gait velocity (R = 0.444, p = 0.008). The model including SCALE did not predict step width.ConclusionResults indicate impaired SMC predicts increased knee flexion at initial contact, and reduces step length and velocity. Understanding the influence of impaired SMC on gait can inform decisions regarding therapy and surgery, such as hamstring lengthening.Level of evidenceLevel II Retrospective Study

Selective control assessment of the lower extremity (SCALE) score correlates with joint‐specific gait deviations in children with bilateral cerebral palsy

Selective control assessment of the lower extremity (SCALE) score correlates with joint‐specific gait deviations in children with bilateral cerebral palsy

Selective motor control and gross motor function in bilateral spastic cerebral palsy

To investigate the relationship between selective motor control (SMC), muscle volume, and spasticity with gross motor function in adolescents and young adults with bilateral spastic cerebral palsy (CP). Eleven male participants with CP (mean age 15y 7mo, standard deviation 3y 6mo, range 12y 1mo-23y 1mo) in Gross Motor Function Classification System (GMFCS) levels I to IV took part in this cross-sectional study. Magnetic resonance imaging (MRI) of both lower limbs of all participants were acquired, from which 18 muscles were manually segmented and muscle volume calculated by a single assessor. Muscle volumes were normalized to body mass and averaged between limbs for each individual. SMC was assessed using Selective Control Assessment of the Lower Extremity (SCALE). Spasticity was assessed using the Modified Ashworth Scale (MAS), and gross motor functional ability was assessed using the Gross Motor Function Measure (GMFM-66). GMFM-66 was strongly positively correlated to SCALE (r=0.901, p≤0.001) and lower limb muscle volume normalized to body mass (r=0.750, p=0.008). MAS was significantly correlated with GMFM-66 (r=-0.691, p=0.018). SMC is a major factor influencing gross motor function in individuals with CP. Lower limb muscle volume and spasticity also influence gross motor function. Selective motor control is a major factor of gross motor function in adolescents and young adults with bilateral cerebral palsy (CP). Gross motor function is related to muscle size and level of spasticity in adolescents and young adults with bilateral CP.

The influence of lower limb impairments on RaceRunning performance in athletes with hypertonia, ataxia or athetosis

ObjectivesRaceRunning enables athletes with limited or no walking ability to propel themselves independently using a three-wheeled running bike that has a saddle and a chest plate for support but no pedals. For RaceRunning to be included as a Para athletics event, an evidence-based classification system is required. Therefore, the aim of this study was to assess the association between a range of impairment measures and RaceRunning performance. MethodsThe following impairment measures were recorded: lower limb muscle strength assessed using Manual Muscle Testing (MMT), selective voluntary motor control assessed using the Selective Control Assessment of the Lower Extremity (SCALE), spasticity recorded using both the Australian Spasticity Assessment Score (ASAS) and Modified Ashworth Scale (MAS), passive range of motion (ROM) of the lower extremities and the maximum static step length achieved on a stationary bike (MSSL). Associations between impairment measures and 100-meter race speed were assessed using Spearman’s correlation coefficients. ResultsSixteen male and fifteen female athletes (27 with cerebral palsy), aged 23 (SD = 7) years, Gross Motor Function Classification System levels ranging from II to V, participated. The MSSL averaged over both legs and the ASAS, MAS, SCALE, and MMT summed over all joints and both legs, significantly correlated with 100 m race performance (rho: 0.40-0.54). Passive knee extension was the only ROM measure that was significantly associated with race speed (rho = 0.48). ConclusionThese results suggest that lower limb spasticity, isometric leg strength, selective voluntary motor control and passive knee extension impact performance in RaceRunning athletes. This supports the potential use of these measures in a future evidence-based classification system.

Selective voluntary motor control measures of the lower extremity in children with upper motor neuron lesions: a systematic review.

Recovery and trainability of impaired selective voluntary motor control (SVMC) of the lower extremity in children with upper motor neuron lesions has received little attention. To facilitate an evidence-based debate about this topic, this review evaluates the evidence level of the psychometric properties of SVMC measures. MEDLINE, Embase, CINAHL, PsycINFO, Scopus, Cochrane and PEDro databases were systematically searched up to July 2016. Two independent raters scored the methodological quality in accordance to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. The overall level of evidence was scored according to Cochrane criteria. We identified 3590 studies, of which 17 were included. COSMIN scores ranged from 'poor' to 'excellent' for studies investigating measurement properties of the Selective Motor Control test, modified Trost test, Gillette's Selective Motor Control test, Selective Control Assessment of the Lower Extremity (SCALE), kinematic measures, electromyography, and torque steadiness. Studies assessing the SCALE scored highest on COSMIN items. Evidence levels for SCALE's validity and reliability properties were moderate, while for the other SVMC measures these ranged from unknown to moderate. Responsiveness was not assessed. Further psychometric studies of SVMC measures are needed to provide a scientific contribution to the ongoing debate of SVMC trainability.

Reliability and validity of the Japanese version of the selective control assessment of the lower extremity tool among patients with spastic cerebral palsy.

[Purpose] The aim of this study was to translate the Selective Control Assessment of the Lower Extremity (SCALE) tool from English to Japanese and to assess the reliability and validity of the Japanese version of the SCALE (SCALE-J) tool in Japanese patients with spastic cerebral palsy. [Subjects and Methods] The SCALE tool was translated into Japanese in accordance with the published guidelines. In total, 55 patients with spastic cerebral palsy were enrolled in the present study. Reliability by internal consistency (Cronbach’s α), intrarater reliability, inter-rater reliability, and convergent validity by comparing Gross Motor Function Classification System (GMFCS) scores were examined. [Results] The Cronbach’s α value of the SCALE-J tool was 0.97–0.98, whereas that of the intrarater and inter-rater reliability ranged from 0.93 to 0.96. The Spearman correlation coefficient revealed a good relationship between the SCALE tool and the GMFCS. [Conclusion] The SCALE-J tool was found to be reliable and valid; therefore, the SCALE tool may be useful for evaluation in clinical practice.

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

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