A. Vermeer

Functional motor abilities of children with cerebral palsy: a systematic literature review of assessment measures

Objective: To provide an overview of functional assessment measures for children with cerebral palsy, supporting the selection of measures and the interpretation of results from measures. Methods: Instruments were selected on the basis of a literature search of the Medline, Sportdisk and PsychLIT databases. Issues reviewed: Instruments were reviewed with respect to target group, purpose, nature, type and psychometric properties. Results: In the literature 17 instruments that are used in paediatric rehabilitation and paediatric physical therapy to assess the functional motor abilities of children with cerebral palsy were found. While there is an urgent need for measures that can evaluate change in functional abilities, it was found that most measures are developed and validated for discriminative purposes. Conclusions: Although instruments developed within the lastdecade meet psychometric criteria more adequately than those developed previously, it is concluded that only two evaluative assessment measures, the Gross Motor Function Measure (GMFM) and the Pediatric Evaluation of Disability Inventory (PEDI), fulfil the criteria of reliability and validity with respect to responsiveness to change.

Qualitative analysis of therapeutic motor intervention programmes for children with cerebral palsy: an update

This study presents a comprehensive evaluation of therapeutic motor interventions for children with or at risk for cerebral palsy (CP), examining 50 studies covering the period from 1990 to 2001. The purpose was to review noticeable changes in the scientific quality of the studies and to highlight trends and changes in the nature of the evaluated programmes. Our results were compared with those of Vermeer and Bakx (1990) who reviewed the period from 1980 to 1989. It was concluded that fundamental research with adequate methodology was applied more often in the study period than in the period reviewed by Vermeer and Bakx. However, these developments did not lead to a substantial improvement in the scientific foundation of the interventions under study. Single case studies, combined with efforts to develop measures specifically for children with CP and with high sensitivity, might make more valuable contributions to the scientific justification of therapeutic interventions.

Children with asthma and physical exercise: effects of an exercise programme

Objective: To evaluate the effects of a physical exercise programme for children with asthma on an outpatient basis. Design: Intervention study: a randomized pretest–post-test control group design. Setting and subjects: Forty-seven children with clinically diagnosed asthma participated in the intervention study, including 34 boys and 13 girls, from 8 to 13 years of age (mean age 10.6). Interventions: The physical exercise programme consisted of regular group exercises and home exercises for a period of three months. It was based on a theoretical model describing the relationships between physical competence (condition), perceived physical competence, self-esteem and coping behaviour. Main outcome measures: Maximum incremental exercise test, endurance test, the Self-Perception Profile for Children (CBSK), the Asthma Coping Test (ACBT), lung function and exercise-induced bronchoconstriction. Results: The results showed significant effects of the intervention programme on physical condition. There was a significant improvement of 15 W on the maximal workload (Wmax) (p < 0.001), of 7% on VO 2max (oxygen uptake) (p = 0.002) and a significant decrease on heart rate submaximal of 6% (p = 0.001). There was also a significant improvement of 50% in running time measured with the endurance test (p = 0.021). Furthermore, a significant effect of the intervention was seen on coping with asthma (p = 0.003). Conclusion: It was concluded that participation in the physical exercise programme not only enhanced physical fitness, but also improved coping behaviour with asthma.

Reliability of the Dutch Pediatric Evaluation of Disability Inventory (PEDI)

Objective: To evaluate the reliability of the Dutch version of the Pediatric Evaluation of Disability Inventory (PEDI), an instrument for measuring functional status (capability and performance in self-care, mobility and social function) of young children using parent interviews. Design: Inter-interviewer reliability was studied after scoring audiotaped interviews by a second researcher. For test–retest reliability the same parent was interviewed twice within three weeks; in inter-respondent reliability both parents of a child were interviewed independently within a few days. On item level, percentage identical scores were computed, and on scale level intraclass correlation coefficients (ICC) and Cronbachs alphas were calculated. Subjects: Parents of 63 nondisabled and 53 disabled (various diagnosis) children aged between 7 and 88 months were interviewed. Results: On scale level, all ICCs were above 0.90 and Cronbachs alpha was 0.89 for the self-care domain, 0.74 for the mobility domain and 0.87 for the social function domain. On item level for the Functional Skills Scale, the mean percentage identical scores varied from 89 to 99, and for the Caregiver Assistance Scale from 54 to 90. Different scores between interviewers resulted partially from ambiguous interpretation of the item and/or the explanation. Conclusions: Although small adaptations have to be made, the psychometric properties of the Dutch PEDI are found to be good.

Effect of task context on reaching performance in children with spastic hemiparesis

Objective: To investigate the effect of task context on the quality of reaching movements in children with spastic hemiparesis. Design: Randomized controlled experimental trial. Setting: Institute for the Study of Education and Human Development (ISED). Subjects: Twelve children (8–14 years of age) with spastic hemiplegic cerebral palsy. Interventions: Subjects made fast reaching movements with the affected or nonaffected arm on a digitizer in three context conditions: (a) reach to press a light switch to turn on a red light (functional), (b) reach to press the light switch; no light (semi-functional), and (c) reach to a marker (nonfunctional). Main outcome measures: Kinematics of reaching movements of affected and nonaffected arms: movement time (MT), peak velocity (PV), time to PV, percentage of MT where peak velocity occurred (PPV), and smoothness (i.e. number of movement units (MU)). Results: The functional condition elicited better quality of reaching for the nonaffected, but particularly the affected arm. Reaching of the affected arm was faster (larger MT; F = 10.21, p < 0.01), smoother (fewer MU; F = 19.95, p < 0.001), and better-controlled (right shift of PPV; F = 16.03, p < 0.001) compared with the semi and nonfunctional condition. Reaching of the nonaffected arm was also faster (longer MT, F = 4.81, p < 0.05), and more smooth (fewer MU, F = 7.23, p < 0.05). Conclusions: These findings suggest that providing a functional context to perform a task may enhance the quality of reaching movements of the affected arm in children with spastic hemiparesis.

Effects of aquatic interventions in children with neuromotor impairments: a systematic review of the literature

Objective: To determine the effectiveness of aquatic interventions in children with neuromotor impairments. Design: A search of electronic databases that included MEDLINE, PubMed, ERIC, PsychLit, PEDro, Sport Discus, CINAHL and Cochrane between 1966 and January 2005 was conducted using the following keywords: ‘hydrotherapy’, ‘aquatic therapy’, ‘water exercise’, ‘aquatics’, ‘adapted aquatics’, ‘aquatic exercise’ and ‘swimming’. An additional resource, the Aquatic Therapy Research Bibliography until 1999, was explored manually. Titles and abstracts were assessed manually according to the following inclusion criteria: (1) population (children with neuromotor or neuromuscular impairments), (2) intervention (aquatic programme). Articles were reviewed according to merit of design, population participants and outcome measures with respect to International Classification of Function and Disability terminology (changes in body function, activity level and participation). Results: Eleven of the 173 articles that were retrieved met the inclusion criteria: one randomized control trial, two quasi-experimental studies, one cohort study, two case control studies and five case reports. Seven articles reported improvement in body functions, and seven articles reported improvement in activity level. Two of the four articles that investigated outcome measures regarding participation described positive effects while the findings of the other two revealed no change. None of the articles reported negative effects due to aquatic interventions. Conclusion: According to this review, there is a substantial lack of evidence-based research evaluating the specific effects of aquatic interventions in this population.

Detecting individual change in children with mild to moderate motor impairment: the standard error of measurement of the Movement ABC

Objective: To assess whether the Movement ABC can be used to monitor individual change in motor performance. Design: Motor-impaired children were tested three times in succession with the Movement ABC without any intervention. Setting: Two schools for special education and one school for children who are chronically ill. Subjects: Three girls and 20 boys aged 6–8 years. Main outcome measures: Scores were measured per item (0→5), added to cluster scores (0→10 or 15), added to form the total scores (0→40). Mean scores, standard errors of measurement (SEMs) and least detectable differences (LDDs) were calculated per item, per cluster and for the total scores. A repeated measures analysis of variance was performed to test for the effects of time. Results: The total scores improved significantly from the first session (mean: 15.4 points) to the second (mean: 13.3), but not from the second to the third (mean: 13.2). Average item scores ranged from 0.6 to 2.7 points with SEMs of 0.79→1.54 and LDDs of 2.20→4.27. Average cluster scores ranged from 3.4 to 5.3 with SEMs of 1.51→1.84 and LDDs of 4.18→5.11. The SEM of the total scores equalled 3.13 with an LDD of 8.68. Conclusions: The total score of the Movement ABC is sufficiently sensitive to monitor individual change; the cluster scores have moderate sensitivity and individual items are inappropriate to monitor individual change. The significant effect of time is interpreted as an effect of learning.

Self-worth, perceived competence, and behaviour problems in children with cerebral palsy

Purpose. To examine the relevance of physical disabilities for self-worth and perceived competence in children with cerebral palsy (CP), and to examine associations between behaviour problems and self-worth and perceived competence. Methods. The Harter scales for self-worth and perceived competence and a new scale for perceived motor competence were used in a sample of 80 children with CP. Their motor functioning was assessed with the Gross Motor Functioning Measure (GMFM) and behaviour problems with the Child Behaviour Check List administered to parents. Results. Self-worth and perceived competence for children with CP were comparable to the Dutch norm sample, except for perceived athletic competence. Within the CP sample, the GMFM showed a domain-specific effect on perceived motor competence. In the multivariate analysis, internalizing problems were associated negatively with all perceived competence scales and self-worth, whereas aggression was positively associated with perceived motor competence, physical appearance, and self-worth. Conclusions. Children with CP appear resilient against challenges posed to their self-worth caused by their disabilities. The relevance of the physical disability appears to be domain specific. For internalizing problems and aggression, different theoretical models are needed to account for their associations with self-worth and perceived competence.

Disturbances in the Motor Behaviour of Children with Down's Syndrome: The need for a theoretical framework

Summary A theoretical framework has been developed concerning the specific motor problems of Downs syndrome children on the basis of a review of disturbances in the system of postural control which occur in the various phases of their motor development. The reduced postural tone, manifest in each child, plays a key role by adversely influencing co-contraction and balance reactions. The lack of postural control is further exacerbated by inadequate proprioceptive feedback on posture and movement and by an increased mobility of the joints. This leads to problems in adopting and maintaining positions and for movement. Consequently, qualitative aspects of motor skills are insufficiently developed, thereby reducing the goal-directedness of posture and movement. Characteristic features of children with Downs syndrome are static and symmetrical movement patterns, compensatory strategies of movements, and a lack of variability of movement patterns.

Bimanual circle drawing in children with spastic hemiparesis: effect of coupling modes on the performance of the impaired and unimpaired arms

The present study examined the effect of interlimb coupling on the performance of the impaired and unimpaired arm in children with spastic hemiparesis during bimanual circle drawing. The following questions were addressed: (1) does coupling positively influence the performance of the impaired arm compared to single-hand performance and (2) is such an effect dependent on mode of coordination (i.e., symmetric versus asymmetric). Twelve children with spastic hemiparesis produced circle drawings on a digitizer under different task conditions. Spatiotemporal characteristics and quality of movement of pen trajectories of the individual limbs as well as interlimb relative phase were analysed. Coupling in a symmetric coordination mode resulted in a decrease of temporal variability and an increase of smoothness of circle drawing movements in the impaired arm compared to single-handed performance. Coupling in an asymmetric coordination mode resulted in an increase of spatial and temporal variability in the unimpaired arm. It is concluded that coupling may enhance the performance of the impaired arm in children with spastic hemiparesis, but only during symmetric bimanual coordination. A possible underlying neural mechanism that might explain these findings is discussed.