Measuring and training of walking abilities in pediatric neurorehabilitation

AIM To review outcome measures used to evaluate hand function, with emphasis on manual capacity and performance, in children with bilateral cerebral palsy (CP), to describe the content and measurement properties of such measures, and to investigate the quality of the studies that have examined these properties.METHOD Embase, MEDLINE, PubMed, and CINAHL were searched. The COSMIN-criteria (COnsensus-based Standards for the selection of health Measurement INstruments) were used to assess the quality of studies and the Terwee criteria were used to assess the result of the studies.RESULTS Five hand function measures were identified from 16 papers. The strongest level of evidence for aspects of validity and reliability was found for the Melbourne Assessment 2, assessing unimanual capacity, and for the questionnaire ABILHAND-Kids, assessing perceived manual ability in daily activities. However, evidence for the responsiveness of these measures is missing. INTERPRETATIONFurther high-quality studies providing evidence for responsiveness, as well as for additional aspects of validity and reliability of the Melbourne Assessment 2 and the ABILHAND-Kids, are needed. Furthermore, there is a need to develop appropriate outcome measures evaluating how children with bilateral CP use their hands when handling objects in bimanual tasks.Outcome measures with sound measurement properties are crucial for appropriate planning and evaluation of interventions, as well as for the assessment of the development of children with chronic health conditions such as cerebral palsy (CP). The assessment of a child's development can be used to counsel families regarding prognostic factors, as well as informing about the child's strengths and limitations in the attribute measured and expected treatment outcomes. In addition, changes over time associated with service provision can be documented, to allow enhanced clinical decision-making and appropriate allocation of resources. 1The selection of appropriate outcome measures can be facilitated by systematic appraisal of the content and measurement properties of the instruments in question.2 An outcome measure used for evaluation should address the domain of concern, be valid and reliable in the population of interest, be responsive to change, and have good clinical utility.3 Recent reviews have confirmed that valid and reliable outcome measures exist to evaluate hand function in children with unilateral CP 4-8 and a few systematic reviews have summarized evidence on parent-reported measures of functional hand use, 9 assessment tools, and classification systems of the upper extremity in children with CP in general.10,11 For children with bilateral CP, however, there is little evidence on efficacy of interventions targeting their upper extremity function, 12 and this may in part be because of a lack of appropriate outcome measures. This is of concern because more than 60% of children with bilateral CP have decreased hand function.13 Thus, it is of the upmost importance to identify and appraise outcome ...

Section: Data Extraction and Quality Assessmentmentioning

confidence: 99%

“…To account for sample size, the level of evidence was rated as 'strong' when the total sample size of included studies was 100 or greater, 'moderate' for a total sample size between 50 and 99, 'limited' for a total sample size between 30 and 49, and 'unknown' when sample size was less than 30. [20][21][22]…”

Section: Online Supporting Information)mentioning

confidence: 99%

Outcome measures evaluating hand function in children with bilateral cerebral palsy: a systematic review

Elvrum

Sæther

Riphagen

et al. 2016

“…However, they fail to elaborate on other important MLS used within these interventions, including how the physiotherapist communicates with the child, promotes problem solving, or links the tasks within the Lokomat to daily activities. [11][12][13] Additionally, without a common language to specify the type of MLS used, it is difficult to elucidate an intervention's 'active ingredients' to understand which components contribute to its success. 7 Documenting the motor learning content of physiotherapy interventions using standardized terminology would allow comparisons and create an opportunity to understand the relationship between MLS use and each child's needs.…”

mentioning

confidence: 99%

Reliability of the Motor Learning Strategies Rating Instrument in physiotherapy intervention for children with cerebral palsy

Ryan

Levac

Wright

2019

AIM To evaluate the reliability of the Motor Learning Strategies Rating Instrument (MLSRI-20) in gait-based, video-recorded physiotherapy interventions for children with cerebral palsy (CP). METHOD Thirty videos of 18 children with CP, aged 6 to 17 years, participating in either traditional or Lokomat-based physiotherapy interventions were rated using the MLSRI-20. Physiotherapist raters provided general and item-specific feedback after rating each video, which was used when interpreting reliability results. RESULTS Both interrater and intrarater reliability of the MLSRI-20 total score was good. The interrater reliability intraclass correlation coefficient (ICC) was 0.78 with a 95% confidence interval (CI) of 0.53–0.89 and a coefficient of variation (CV) of 11.8%. The intrarater reliability ICC was 0.89 with a 95% CI of 0.76–0.95 and CV of 7.8%. Rater feedback identified task delineation and interpretation of therapist verbalizations as sources of interrater reliability-related scoring challenges. INTERPRETATION The MLSRI-20 is a reliable tool for measuring the extent to which a physiotherapist uses motor learning strategies during a video-recorded intervention. These results have clinical and research implications for documenting and analyzing the motor learning content of physiotherapy interventions for children with CP.

“…5 Although achieving a child's independence in daily life activities may be a major goal of rehabilitation, there is a paucity of reliable, valid, and responsive outcome measures that evaluate gait performance in children with neuromotor disorders in daily life and across different settings. 6 As direct observation of a child's usual mobility methods is often not feasible, the few existing tools usually rely on parent reports, which are a realistic and valid way to gather data reflecting gait performance of a child. 7 The Functional Mobility Scale (FMS) and the Gillette Functional Assessment Questionnairewalking scale (FAQ) are examples of such tools.…”

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confidence: 99%

Interrater reliability of two gait performance measures in children with neuromotor disorders across two different settings

Ammann-Reiffer

Bastiaenen

Bie

et al. 2017

The Functional Mobility Scale and Gillette Functional Assessment Questionnaire - walking scale measure gait performance reliably at home and in an inpatient setting. Physiotherapists, nurses, and parents reliably score gait performance. Inpatient gait performance scores correspond well to children's performance at home. Physiotherapists and nurses in an inpatient setting can reliably estimate gait performance at home.