Static standing balance is commonly measured with research laboratory systems (LabSys) or clinical systems (ClinSys). The purposes of this study were to (1) assess the reliability of two systems designed to measure static standing balance in nondisabled children, (2) compare the findings derived from the two systems of measurement, and (3) examine the relationship between anthropometric measures and postural sway. Twenty-five nondisabled children (12 male, 13 female) ages 1 year 11 months to 12 years 2 months (mean = 6 years 4 months; SD = 4 years 3 months) participated in the study. Each child stood on the LabSys and the ClinSys for three consecutive 10 second measurement periods. Intraclass correlation coefficients (ICC (2, 1)) for the three trials on each system were 0.62 (LabSys) and 0.63 (ClinSys). The level of agreement between the two systems was 0.61 (ICC (2, 1)). Younger children exhibited more variability and less agreement between measurement trials using the ClinSys. However, older children demonstrated more similar sway indices when comparing the two systems of measurement. Two-way analysis of variance indicated that there were significant differences between sway indices measured by the two systems (p < 0.01) and between the youngest children (aged 2-4 years) and all other children (p < 0.01). In addition, agreement among trials for the two systems was different depending on the age group measured. Correlation coefficients for sway index and age, height, weight, and foot length ranged from -0.52 to -0.64 for the LabSys (p < 0.01) and -0.62 to -0.73 for the Clin-Sys (p < 0.01). Stepwise multiple regression analysis indicated that height was the most significant predictor of sway when measured by the ClinSys (R2 = 0.536, p < 0.01) whereas age was the most significant predictor when sway was measured using the LabSys (R2 = 0.403, p < 0.01). The results suggest that the degree of postural sway and the reliability of the measurement itself are influenced by the age of the child and the measurement system employed.
Improvements in surgical and rehabilitation care are critical to lessen the burden of cerebral palsy (CP), the most common cause of severe physical disability in childhood. The selective percutaneous myofascial lengthening (SPML) surgical procedure is a minimally invasive method designed to improve ambulation by lengthening contracted musculoskeletal tissues. Information on surgical procedures, efficacy, and safety of SPML for children with CP is lacking. Phase 1 of our research is a “proof-of-principle” study for multisite SPML to improve functional mobility of children with CP, and Phase 2 assesses safety, reoperation rates, and efficacy over time in subsequent patient series. Phase 1 was a repeated measurement case series study of 17 children (mean age 7.6 years). One physical therapist, blinded to the surgeon’s measurements, measured bilateral knee and ankle motion before and after SPML procedures, using video recordings of a standardized gait path. Functional Mobility Scale (FMS) 5, 50, and 500 outcomes were taken pre- and postoperatively and via telephone follow-up. In Phase 2, multisite SPLM surgeries were implemented in larger successive cohorts from 2006 to 2017. Complications, reoperation rates, and efficacy were retrospectively analyzed. Phase 1 results showed improvement in the children’s knee and ankle motion while ambulating and improved FMS 5, 50, and 500 outcomes postoperatively (mean, 6.3 months). At second follow-up (mean 33.3 months), FMS 500 scores continued improvement, while FMS 5 and FMS 50 scores maintained. During Phase 2, the complication rate was 2.4%, and reoperation rates (including reoperations due to maturation) were between 8% and 13%. Improvements to correct ankle equinus were recorded in 498 cases. In conclusion, in a specialized center, single-event, multilevel SPML surgeries of children with CP safely improved ambulatory knee and ankle angle motion and daily mobility outcomes. Future educational studies of training needs for surgeons new to the approach are needed.
The purpose of the study reported here was to determine the validity of the Blind Learning Aptitude Test (BLAT). The findings revealed significant correlations between scores on the BLAT and braille oral reading speed, comprehension, age, grade, years of blindness, intelligence, and achievement. The relationship between the BLAT scores and comprehension was stronger than the relationship between BLAT scores and braille reading speed.
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