Objectives: Children diagnosed with acute lymphoblastic leukemia (ALL) in their early childhood are more susceptible to neuromuscular and musculoskeletal impairments. This cross-sectional study was designed to address different types of fine motor impairments in Egyptian children diagnosed with ALL.Methods: Fifty-four children treated for ALL in maintenance phase aged from four to seven years were compared with an age-and sex-matched control group. Fine motor performance was assessed using the total fine motor form of the Bruininks-Oseretsky Test of Motor Proficiencysecond edition (BOT-2). Sex-and age-specific norms of BOT-2 were used to calculate scale and standard scores in both groups.Results: Children with ALL had significantly impaired fine motor skills in all subtests and composites of BOT-2 compared with the typically developing group (P < 0.00001). Cumulative doses of vincristine, methotrexate, and dexamethasone revealed no significant correlation with any BOT-2 measure. Males performed significantly better than females in all BOT-2 scores except for the fine motor integration subtest and the total fine motor control composite as no significant differences were observed. The protocol risk stratum, duration of maintenance treatment, and the age at assessment did not significantly affect the BOT-2 measures.Conclusion: About 67% of children with ALL on maintenance treatment experienced fine motor difficulties. Periodic evaluation along the course of chemotherapy could identify specific impaired fine motor domains providing the base for a successful rehabilitation program. K E Y W O R D Sacute lymphoblastic leukemia, BOT-2, chemotherapy, children, fine motor skills

Background The timed up and down stairs (TUDS) test is widely used to assess the time required by a patient to climb up and down stairs as a measure of functional mobility. Aim This cross-sectional study was conducted to examine test-retest, intra-rater, and inter-rater reliability of TUDS test in children with cerebral palsy (CP). Subjects Forty children (22 boys and 18 girls) with unilateral and bilateral spastic CP were selected from the Cairo University Hospitals to participate in this study. The age range was 3–9 years. Subjects classified according to Gross Motor Function Classification System-Expanded and Revised (GMFCS-E&R) in categories 1 or 2 only were included. All subjects with muscle tone above normal (spasticity) were included. Methods The TUDS test was performed at two testing sessions on the same day to determine test-retest reliability; the main investigator scored all children at real time using a stopwatch and then rescored them later from video recording to determine intra-rater reliability. Another research team member scored all children from video recording to determine inter-rater reliability. Scoring was carried out at real time and from video recordings of the trials. Reliability was estimated using intra-class correlation coefficients (ICC). Results The TUDS test showed excellent reliability for all measured types of reliability. ICC score for test-retest reliability was 0.978, ICC score for intra-rater reliability was 0.999, while ICC score for inter-rater reliability was 0.998 and 0.999. Conclusion The TUDS test is a reliable outcome measure for children with spastic CP. It can be measured at real time or later from video recording of the performance trials. The TUDS test is an important tool in the re-evaluation process of children with CP.

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