Sitting Assessment Scale Research Articles

Validity and reliability of the Sitting Assessment Scale in cerebral palsy.

The aim of this study was to examine the validity and reliability of the Sitting Assessment Scale (SAS) in individuals with cerebral palsy (CP). The study included 34 individuals with a diagnosis of spastic CP. Individuals were evaluated with the Gross Motor Function Classification System and the Manual Ability Classification System. SAS and Trunk Control Measurement Scale (TCMS) were applied to the participants. The intraclass correlation coefficient (ICC) was calculated to determine the intraobserver and interobserver reliability of the scale scored by three different physiotherapists at two different time intervals. Internal consistency was calculated with Cronbach's ⍺ coefficient. The fit between SAS and TCMS for criterion-dependent validity was evaluated using Pearson Correlation Analysis. According to the GMFCS level, 79.41% of the children were mildly (Level I-II), 14.71% were moderately affected (level III), and 5.88% were severely affected (level IV). Intra > observer and interobserver reliability values of SAS were extremely high (ICCinterrater > 0.923, ICCintrarater > 0.930). It was observed that the internal consistency of SAS had high values (Cronbach ⍺test > 0.822, Cronbach ⍺retest > 0.804). For the criterion-dependent reliability; positive medium correlations found between SAS with Total TCMS Static Sitting Balance (r = 0.579, p < 0.001), with TCMS Selective Movement Control (r = 0.597, p < 0.001), with TCMS Dynamic Reaching (r = 0.609, p < 0.001), and with TCMS Total (r = 0.619, p < 0.001). SAS was found to have high validity and reliability in children with CP. In addition, the test-retest reliability of the scale was also high. SAS is a practical tool that can be used to assess sitting balance in children with CP.

Evaluation of the functional outcome and mobility of patients after stroke depending on their cognitive state

The study aimed to analyze the functional outcome and mobility in stroke patients depending on their cognitive state. 180 patients after first stroke were divided into four groups: 48 patients without symptoms of cognitive impairment (G1); 38 with mild cognitive impairment without dementia (G2); 47 with mild dementia (G3); 47 with moderate dementia (G4). The Mini Mental State Examination (MMSE), Barthel Index (BI), Sitting Assessment Scale (SAS), Berg Balance Scale, Trunk Control Test and Test Up & Go were used. The tests were carried out at the time of admission to the ward (T1) and at the time of discharge (T2). A statistically significant improvement was demonstrated in all parameters in almost all groups. No significant difference was observed only in groups G1 and G4 in SAS head. Statistically significant differences in BI results in T2 between groups G1 and G4 were noted. The lowest change in BI was observed in the G4. Regression analysis showed that MMSE and BI at T1 and MMSE score at T2 explained the functional status at T2. Cognitive dysfunction at the time of admission to the ward and discharge may determining the patient's functional status at the time of discharge from the ward.

A Comparative Analysis of Functional Status and Mobility in Stroke Patients with and without Aphasia.

All researchers agree that aphasia is a serious consequence of a stroke, but they also report contradictory data regarding the functional outcome. The aim of this study was, therefore, to assess the functional outcomes of stroke patients with and without aphasia, who were undertaking a regular rehabilitation programme. Materials and Methods: The study group consisted of 116 post-stroke patients, including 54 patients without aphasia (G1) and 62 patients with aphasia (G2). The following tests were used before (T1) and after (T2) rehabilitation measurement points: Barthel Index (BI), Sitting Assessment Scale (SAS), Berg Balance Scale (BBS), Trunk Control Test (TCT), Test Up & Go (TUG) and the Timed Walk Test (TWT). Results: The group of post-stroke patients with aphasia had a significantly longer time since a stroke on admission, a significantly longer length of stay in the ward and significantly worse SAS and TCT scores at T2, compared to patients without aphasia. Both groups achieved significant improvement in all studied parameters (SAS, TCT, BI, BBS, TUG and TWT). Aphasia was a predictor of functional status in the stroke patients group, but only at the time of admission to the ward. Conclusions: Patients with and without aphasia have an equal likelihood of improving their functional status and returning to independence. Aphasia should not be an absolute factor that excludes stroke patients from research studies on their functional status.

Seating system for scoliosis in nonambulatory children with cerebral palsy: a randomized controlled trial.

This study aimed to investigate the effect of an adaptive seating system on pelvic obliquity and spinal coronal/sagittal balance in children with nonambulatory cerebral palsy and scoliosis. This was a single-blind, prospective, randomized interventional study. Nonambulatory children aged 6-15 years with cerebral palsy and scoliosis were included. The seating system was used for 4 h/day, and exercises were performed 3 days/week for 12 weeks. The Cobb angle, spinopelvic parameters, pelvic obliquity, Reimer's migration index, and Sitting Assessment Scale were measured before and after treatments. A total of 29 participants were randomized into two groups, namely, the seating system+exercise group (SSE-group; n=15) and the exercise group (E-group; n=14). There was no significant change in Cobb angle and Reimer's migration index for both hips in SSE-group, but there was a significant increase in E-group (p=0.002, 0.049, and 0.003, respectively). The sagittal vertical axis, pelvic incidence, and pelvic obliquity decreased in SSE-group. However, there was no difference in the other sagittal parameters and Sitting Assessment Scale-total scores among groups. The adaptive seating system was found to be superior in reducing the progression of Cobb angle and hip subluxation/dislocation, decreasing pelvic obliquity, and improving the sagittal balance of the spine/pelvis compared with exercise therapy.

The Influence of Hippotherapy on the Body Posture in a Sitting Position among Children with Cerebral Palsy.

The purpose of this study was to assess the influence of hippotherapy (therapy with horses) on posture and body function among children with cerebral palsy. A case–control study included forty-five children aged 6–12 years, classified as Gross Motor Function Classification System (GMFCS) level I or II, with spastic diplegia or hemiplegia. The participants were randomly divided into three groups: study I (n = 15), study II (n = 15) and control (n = 15). The children from the study groups attended 30min hippotherapy sessions for 12 consecutive weeks, twice (study group I) or once (study group II) a week. The Sitting Assessment Scale (SAS) was used. A comparison of SAS showed an improvement in almost all the assessed categories among the children who participated in hippotherapy. In study group I, statistically significant differences were noted in the assessment of head position control, arm function (in both cases, p = 0.012) and trunk control (p = 0.005) and in study group II in the assessment of trunk control (p = 0.028). Hippotherapy has a positive influence on the body posture and function of individual body parts in a sitting position among children with cerebral palsy.

The Relationship between Trunk Control and Upper Extremity Function in Children with Obstetric Brachial Plexus Palsy

ABSTRACT Purpose This study aimed to assess sitting skills and trunk control in children with obstetric brachial plexus palsy (OBPP) and investigate the effect of these skills on upper extremity function. Methods A total of 106 children with OBPP aged 10–18 months were included in this study. Injury severity was determined with Narakas Classification. The Gross Motor Function Measurement Sitting Sub-scale was used to assess sitting skills, while the Sitting Assessment Scale was used to evaluate the trunk control. The upper extremity functions were assessed with using the Active Movement Scale and the Modified Mallet Score. Results As the severity of injury increased, sitting skills and trunk control values decreased (p = .0001). In addition, upper extremity function decreased with the decreasing sitting skills and trunk control (p = .0001). Conclusion Rehabilitation approaches should involve approaches that aim to increase trunk control in addition to programs targeting the extremity function in children with OBPP.

The effects of vest type dynamic elastomeric fabric orthosis on sitting balance and gross manual dexterity in children with cerebral palsy: a single-blinded randomised controlled study*

Purpose: To evaluate the effects of vest type dynamic elastomeric fabric orthosis on posture and balance during sitting and gross manual dexterity and to compare the efficacy of daily wearing time of 2 h versus 6 h.Method: Twenty-four children with cerebral palsy (CP) aged 3–9 years with GMFCS levels III and IV were randomised to either of three groups: (i) a control group who received only conventional exercise therapy, (ii) dynamic elastomeric fabric orthosis 2 h group who wore the orthosis for 2 h during therapy and dynamic elastomeric fabric orthosis 6 h group who wore the orthosis for 4 h in addition to the 2 h of wear along with therapy during hospital inpatient stay for 2 weeks. Children continued to use dynamic elastomeric fabric orthosis during the post-discharge period. The primary outcome measure was the Sitting Assessment Scale. The secondary outcome measurements were the sitting dimension of Gross Motor Function Measure, Box and Block Test and Parent Satisfaction Survey. Assessments were made before treatment, at post-treatment, at 1-month post-treatment, and at 3-months post-treatment. Sitting Assessment Scale and Box and Block Test were also assessed when immediately after wearing the orthosis. This trial is registered with Clinicaltrials.gov, under number NCT03191552.Results: All groups showed similar improvements except the control group which showed less improvement in Sitting Assessment Scale scores compared to the dynamic elastomeric fabric orthosis groups. Dynamic elastomeric fabric orthosis groups showed greater improvements compared to the control group in the Sitting Assessment Scale but not in the sitting dimension of Gross Motor Function Measure and Box and Block Test at post-treatment, at 1-month post-treatment and at 3-months post-treatment. When the dynamic elastomeric fabric orthosis groups (2 h versus 6 h) were compared, there were no significant differences in any of the assessments. The Sitting Assessment Scale and Box and Block Test scores also improved immediately after the patients put on the orthosis. At 1-month post-treatment, parents of children in the control group reported less satisfaction than parents of the children in dynamic elastomeric fabric orthosis groups.Conclusions: Dynamic elastomeric fabric orthosis vest has an immediate effect on the sitting balance and gross manual dexterity. It also provides improvements in posture and balance during sitting. Wearing dynamic elastomeric fabric orthosis vest for 2 h during therapy is as much effective as wearing it for 6 h in children with CP in addition to therapy to improve sitting balance.Implications for rehabilitationDynamic elastomeric fabric orthosis vest provides improvements in sitting balance when used in addition to conventional therapy in children with cerebral palsy.Wearing dynamic elastomeric fabric orthosis for 2 h and wearing dynamic elastomeric fabric orthosis vest for 6 h resulted in similar clinical outcomes.Dynamic elastomeric fabric orthosis vest has an immediate effect on sitting balance and gross manual dexterity in children with cerebral palsy.

The effect of dynamic elastomeric fabric orthosis (DEFO) on sitting balance and gross manual dexterity in children with cerebral palsy: A single-blinded randomized controlled study

The aim of this study was to investigate if the use of a vest type dynamic elastomeric fabric orthosis (DEFO) will lead to improvement in sitting balance, hip lateralization and gross manual dexterity. Twenty-four children with CP between the ages of 3–7 with impaired trunk control were allocated to either of three groups: Control group who received only conventional exercise therapy, DEFO 2 hours group who wore DEFO 2 hours during therapy and DEFO 6 hours group who wore DEFO 4 hours in addition to 2 hours of wear during therapy. Children were evaluated with sitting domain of Gross Motor Function Measure (GMFM), Sitting Assessment Scale (SAS), Box and Block Test (BBT) and Parent Satisfaction Questionnaire before treatment (BT), at posttreatment, at 1 month posttreatment (MPT) and at 3 MPT. SAS and BBT were also assessed when immediately after wearing the orthosis. To measure trunk asymmetry and effect of orthosis in hip lateralization, changes in Cobb (CA) and kyphotic angles (KA) and Migration index (MI) between BT and 6 MPT were determined. All groups showed similar improvements except the control group showing less improvement in SAS scores than DEFO groups. SAS and BBT scores also improved immediately after wearing the orthosis. While CA and KA decreased significantly at 6 MPT, MI did not show statistically significant difference. Changes in radiographic assessments were similar between groups except kyphotic angle values. KA values showed less change in control group. When DEFO groups compared with each other, there were no significant differences in any of the assessments. DEFO vest has an immediate effect on sitting balance and gross manual dexterity. DEFO provides improvements in posture and balance during sitting. Using DEFO vest for 2 hours and 6 hours yielded similar outcomes. Wearing DEFO vest improves kyphotic posture but not scoliosis and hip lateralization.

Does stabilizing input pressure orthosis vest, lycra-based compression orthosis, improve trunk posture and prevent hip lateralization in children with cerebral palsy?

This study aims to investigate whether the use of a lycra-based compression orthosis known as stabilizing input pressure orthosis (SPIO) vest improves trunk posture and hip lateralization in children with cerebral palsy (CP) and to compare the effects of two- and six-hours daily wear of the orthosis. Between December 2013 and July 2015, a total of 24 children with CP (5 boys, 19 girls; mean age 61.1 months; range 35 to 105 months) with impaired trunk control were included in this single-blind, randomized-controlled study. All were randomized to either of the three groups as the control group (received only conventional exercise therapy), the SPIO 2-hour group (worn orthosis two hours during therapy), and the SPIO 6-hour group (worn orthosis four hours in addition to two hours of wear during therapy). The Sitting Assessment Scale (SAS), Cobb angle, kyphotic angle, and Migration Index were used to evaluate the trunk posture and hip lateralization before treatment and at six months after treatment. The SAS scores improved compared to baseline in all groups. The Cobb angle and kyphotic angle showed a significant decrease at six months after treatment only in the SPIO groups, while intra-group analysis of the Migration Index did not show a statistically significant difference. Changes in the radiographic assessments were similar among the groups, except for the kyphotic angles. The kyphotic angle showed less change in the control group. Comparison of the SPIO groups showed no significant differences in terms of the variables assessed. The SPIO vest improves the kyphotic posture, but not scoliosis and hip lateralization in children with CP with impaired trunk control when used in combination with the conventional therapy. Using the SPIO vest for two and six hours also yields similar outcomes.

Effects of different seating equipment on postural control and upper extremity function in children with cerebral palsy.

Adaptive seating supports for cerebral palsy are recommended to develop and maintain optimum posture, and functional use of upper extremities. To compare the effectiveness of different seating adaptations regarding postural alignment and related functions and to investigate the effects of these seating adaptations on different motor levels. Prospective study. A total of 20 children with spastic cerebral palsy (Gross Motor Function Classification System 3-5) were included. Postural control and function (Seated Postural Control Measure, Sitting Assessment Scale) were measured in three different systems: standard chair, adjustable seating system and custom-made orthosis. In results of all participants ungrouped, there was a significant difference in most parameters of both measurement tools in favor of custom-made orthosis and adjustable seating system when compared to standard chair ( p < 0.0017). There was a difference among interventions in most of the Seated Postural Control Measure results in Level 4 when subjects were grouped according to Gross Motor Function Classification System levels. A difference was observed between standard chair and adjustable seating system in foot control, arm control, and total Sitting Assessment Scale scores; and between standard chair and custom-made orthosis in trunk control, arm control, and total Sitting Assessment Scale score in Level 4. There was no difference in adjustable seating system and custom-made orthosis in Sitting Assessment Scale in this group of children ( p < 0.017). Although custom-made orthosis fabrication is time consuming, it is still recommended since it is custom made, easy to use, and low-cost. On the other hand, the adjustable seating system can be modified according to a patient's height and weight. Clinical relevance It was found that Gross Motor Function Classification System Level 4 children benefitted most from the seating support systems. It was presented that standard chair is sufficient in providing postural alignment. Both custom-made orthosis and adjustable seating system have pros and cons and the best solution for each will be dependent on a number of factors.

PO-0843 Effect Of Cerebral Palsied Childrens’ Sitting Posture On Mothers’ Quality Of Life

The aim of this study was to investigate the relation between sitting posture of diplegic spastic cerebral palsied children and the quality of life of their mothers. Twenty two children with the diagnosis of diplegic spastic cerebral palsy and their mothers were included in the study. The functional level of children were classified according to the Gross Motor Function Classification System (GMFMCs). Sitting Assessment Scale (SAS) was used to evaluate sitting posture. Nottingham Health Profile (NHP) was used to assess the quality of life of mothers. Spearman correlation analysis was used to investigate the relation between sitting posture of children and quality of life of mothers. The mean age of children and mothers were 6.3 ± 4.6 years, 35.7 ± 8.6 years, respectively. The median GMFMCs level was 4. The mean SAS score was 13.2 ± 3.4 in children and, mean NHP score was 164.2 ± 106.7 in mothers. There was a significant correlation between SAS score and NHP score (rho=-0,622, p

Study of the therapeutic effects of a hippotherapy simulator in children with cerebral palsy: a stratified single-blind randomized controlled trial

Objective: To investigate whether hippotherapy (when applied by a simulator) improves postural control and balance in children with cerebral palsy. Design: Stratified single-blind randomized controlled trial with an independent assessor. Stratification was made by gross motor function classification system levels, and allocation was concealed. Subjects: Children between 4 and 18 years old with cerebral palsy. Interventions: Participants were randomized to an intervention (simulator ON) or control (simulator OFF) group after getting informed consent. Treatment was provided once a week (15 minutes) for 10 weeks. Main measures: Gross Motor Function Measure (dimension B for balance and the Total Score) and Sitting Assessment Scale were carried out at baseline (prior to randomization), end of intervention and 12 weeks after completing the intervention. Results: Thirty-eight children participated. The groups were balanced at baseline. Sitting balance (measured by dimension B of the Gross Motor Function Measure) improved significantly in the treatment group (effect size = 0.36; 95% CI 0.01–0.71) and the effect size was greater in the severely disabled group (effect size = 0.80; 95% CI 0.13–1.47). The improvements in sitting balance were not maintained over the follow-up period. Changes in the total score of the Gross Motor Function Measure and the Sitting Assessment Scale were not significant. Conclusion: Hippotherapy with a simulator can improve sitting balance in cerebral palsy children who have higher levels of disability. However, this did not lead to a change in the overall function of these children (Gross Motor Function Classification System level V).

The effects of Kinesio® taping on sitting posture, functional independence and gross motor function in children with cerebral palsy

Purpose: The aim of this study was to investigate the effects of Kinesio® tape (KT) application on sitting posture, gross motor function and the level of functional independence.Method: The study included 31 cerebral palsied children scored as level III, IV or V according to gross motor functional classification system (GMFCS). Children were randomly separated into two groups as study (n == 15, receiving KT and physiotherapy) and control (n == 15, receiving only physiotherapy). KT application was carried out for 12 weeks. Gross motor function measure (GMFM), functional independence measure for children (WeeFIM) and Sitting Assessment Scale (SAS) were used to evaluate gross motor function, independency in the activities of daily living and sitting posture, respectively.Results: Compared to initial assessments, both groups showed a significant difference in parameters of GMFCS sitting subscale, GMFCS total score and SAS scores (p < 0.05). At the end of 12 weeks, only SAS scores were significantly different in favour of the study group when the groups were compared (p < 0.05). Also, post-intervention WeeFIM scores of the study group were significantly higher compared to initial assessment (p < 0.05), however, no difference was detected in the control group (p > 0.05).Conclusions: No direct effects of KT were observed on gross motor function and functional independence, though sitting posture (head, neck, foot position and arm, hand function) was affected positively. These results may imply that in clinical settings KT may be a beneficial assistive treatment approach when combined with physiotherapy.

The Effect of Hippotherapy on Postural Control in Sitting for Children with Cerebral Palsy

The purpose of this single subject research study was to examine the effects of a once weekly, 10-week hippotherapy program for three children, ages 27–54 months, with cerebral palsy. Participants were rated as Level V on the Gross Motor Function Classification System. The Sitting Dimension of the Gross Motor Function Measure was used to establish a baseline of sitting abilities, and was administered every 2 weeks during intervention. The Sitting Assessment Scale and the Gross Motor Function Measure were administered before, after, and 4 weeks post-intervention. Parental perceptions of the hippotherapy intervention were assessed using questionnaires. None of the children made gains on any of the standardized outcome measures. Parental perceptions were very positive, with reported improvements in range of motion and head control.

Effects of the hip abduction orthosis on muscle activity in children with Cerebral Palsy

Hip abduction orthoses are commonly used as adjuncts to create a symmetrical and stable sitting position for children with spastic diplegia. This study investigated how activity in m. Adductor longus, m. Rectus femoris, m. Gastrocnemius and m. Erector spinae was affected while sitting in a ''functional sitting position'' (FSP) performing five upper extremity tasks under four test conditions, one without hip orthosis and three with the orthosis set at three different spring lengths. The experimental group consisted of four children with spastic diplegia (mean age 4 years), while five healthy children (mean age 7 years) served as controls. The initial hip abduction angle adopted spontaneously by each child was measured by a goniometer. Muscle activity was measured by surface electromyography (EMG) during three minutes under each test condition. The children in the experimental group were also assessed from videofilms with the Sitting Assessment Scale (SAS) and the SAS scores were compared to the EMG results. The results of the study failed to demonstrate significant difference in EMG voltage under different sitting conditions, without or with hip abduction orthosis adjusted to varying hip abduction positions. This may imply that if a functional sitting position is assured, further addition of an orthosis is not needed. Follow-up study on a larger group of children with CP may be advisable.

FIVE‐YEAR FOLLOW‐UP OF FUNCTIONAL SITTING POSITION IN CHILDREN WITH CEREBRAL PALSY

Ten children with cerebral palsy (CP) were videotaped and photographed after the introduction to a functional sitting position (FSP--defined as a position in which children with CP could gain head-, trunk- and foot-control and the maximum degree of independent function when performing arm and hand movements during tasks) and again five years later. Head-, trunk- and foot-control, and arm- and hand-function were assessed from video-tapes by the Sitting Assessment Scale. The eight children who had been using the FSP throughout this period showed slight but significant improvement; the remaining two had deteriorated. Since all 10 children had undergone similar rehabilitation programmes, it is concluded that sitting in an FSP contributed to their improvement in the ability to use the hand and arm.