BackgroundClinicians and researchers require sound neurological tests to measure changes in neurological impairments necessary for clinical decision-making. Little evidence-based guidance exists for selecting and interpreting an appropriate, paediatric-specific lower limb neurological test aimed at the impairment level.ObjectiveTo determine the clinimetric evidence underpinning neurological impairment tests currently used in paediatric rehabilitation to evaluate muscle strength, tactile sensitivity, and deep tendon reflexes of the lower limb in children and young people with a neurological condition.MethodsThirteen databases were systematically searched in two phases, from the date of database inception to 16 February 2017. Lower limb neurological impairment tests were first identified which evaluated muscle strength, tactile sensitivity or deep tendon reflexes in children or young people under 18 years of age with a neurological condition. Papers containing clinimetric evidence of these tests were then identified. The methodological quality of each paper was critically appraised using standardised tools and clinimetric evidence synthesised for each test.ResultsThirteen papers were identified, which provided clinimetric evidence on six neurological tests. Muscle strength tests had the greatest volume of clinimetric evidence, however this evidence focused on reliability. Studies were variable in quality with inconsistent results. Clinimetric evidence for tactile sensitivity impairment tests was conflicting and difficult to extrapolate. No clinimetric evidence was found for impairment tests of deep tendon reflexes.ConclusionsLimited high-quality clinimetric evidence exists for lower limb neurological impairment tests in children and young people with a neurological condition. Results of currently used neurological tests, therefore, should be interpreted with caution. Robust clinimetric evidence on these tests is required for clinicians and researchers to effectively select and evaluate rehabilitation interventions.

AIM This study aimed to identify paediatric terminology used in the Australian health and health-education context, propose a standardized framework for Australian use, and compare it with a US-based framework.METHOD Australian health and health-education websites were systematically searched using a novel hierarchical domain-specific search strategy to identify grey literature containing paediatric terminology. Webpages published from 2009 to February 2014, with a '.gov.au' or '.edu.au' domain and no advertising, were included. Paediatric terms were analysed with power-law distributions. Age definitions were grouped using a chi-squared test automatic interaction detection analysis (p<0.05). RESULTSIn total, 34 paediatric terms and 197 unique age definitions were identified in 613 webpages. Terms displayed a language distribution, although definitions had semantic and lexical ambiguity. Age definitions were divided into four statistically different groups (F=245.3, p<0.001). Four paediatric terms with distinct age definitions were proposed based on Australian data: 'infant: 0 to <1 year', 'early childhood: 1 year to <5 years', 'child: 5 years to <13 years', and 'young person: 13 years to <22 years'. These recommendations were broader than the US-based comparison.INTERPRETATION This is a starting point for standardizing Australian paediatric terminology, and a method for exploring paediatric terminology in other countries.Paediatric terms with overlapping age ranges from birth to adulthood are used interchangeably throughout the world, with variability both within and between nations. [1][2][3][4] In Australia, there are no universally accepted paediatric definitions within health and health-education contexts. 1,4,5 Australia's Macquarie Dictionary Online defines 'paediatrics' as the study and treatment of children, 6 but does not define the term 'child'. The definition of the term 'child' may include the relationship to their parents or the transitional age range before adulthood. 5,6 This may add to confusion. 'Child' is defined as 'a baby or infant' or as a young person determined by statute to be 'less than 17' or 'under 18 or 21 years' in Australian law.6 Age of consent, and health care access and eligibility may differ in children and young people owing to biological, developmental, or psychosocial differences, 2 and by geographical location. 7 A consenting young person, parent, or carer may access universal child health services provided in Australia within a primary health care model. 8 These services can be accessed directly or by referral, often by a general practitioner.8 Consent refers to a young person having adequate maturity and mental capacity with a legal recognition of competence with no set age. 7,9 Age of legal consent often ranges from 14 to 18 years, depending on Australian federal, state, and territory jurisdictions, 7,9,10 and may be defined using different paediatric terms. Current paediatric term variability has thus created confusion throughout the health care setting. 7,9,11,12 Consis...

Objectives: Accurate, clinically meaningful outcome measures that are responsive to change are essential for selecting interventions and assessing their effects. Little guidance exists on the selection and administration of neurological impairment tests in children with a neurological condition. Clinicians, therefore, frequently modify adult assessments for use in children, yet the literature is inconsistent. This study aims to establish consensus on neurological conditions most likely to require neurological impairment test in pediatrics and the barriers, enablers and modifications perceived to enhance test reliability. Methods: Over a 2-round modified Delphi study, a panel of experts (n = 24) identified neurological conditions perceived to typically require pediatric neurological testing and the modifications to address barriers/enablers to testing. Experts comprised of physical therapists with evidence of advanced training or research in pediatrics. Using a 6-point Likert scale, (6 = strongly agree, 5 = agree, 4 = somewhat agree, 3 = somewhat disagree, 2 = disagree, 1 = strongly disagree), experts rated statements from existing literature. Thematic analyses were conducted on responses to open-ended questions. A-priori consensus was pre-set at 65% agreement/disagreement. Median, mode and interquartile ranges estimated perceived importance. Cessation was pre-determined by non-consensus items &lt; 10% and panel fatigue. Results: Experts reached consensus on 107/112 (96%) items, including identifying 25/26 (96%) neurological conditions they perceived to require routine neurological testing. Experts strongly agreed with high importance that appropriately trained, experienced therapists are less variable when testing children. Communication modifications were perceived most important. Conclusions: High levels of consensus support the use of lower limb neurological testing in a range of pediatric neurological conditions. Trained clinicians should document modifications such as visual aid use. Using recommended modifications could encourage consistency amongst clinicians. Impact: This is the first study to identify the barriers and enablers to pediatric neurological testing. Barriers and enablers were partially addressed through suggested modifications. Further rigorous examination of these modifications is required to support their use.

Many people reach the end of their lives needing to forgive themselves or others. The resolution of personal and family conflicts can contribute to a peaceful death and a more healthy grieving period for those who remain. There are phases in the forgiveness process that need to be worked through if resolution is to be achieved. By being aware of these phases and by establishing a trusting relationship with patients and their families, hospice staff can facilitate forgiveness.

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