Beth Provost

Endurance and gait in children with cerebral palsy after intensive body weight-supported treadmill training.

Purpose: This study was designed to investigate changes in endurance, functional gait, and balance after intensive body weight-supported treadmill training in children with CP who were ambulatory. Methods: Six school-aged children with CP (four boys, two girls; age range: six to 14 years) participated in an intensive program of body weight-supported treadmill training 30 minutes twice daily for two weeks. Results: Statistically significant improvement in walking velocity and energy expenditure were observed. Variability of individual outcomes was observed with some children showing positive changes, and others no change or a decline in performance. Four children showed minimal detectable changes in a positive direction on both an endurance measure and a functional gait measure. Each endurance and functional gait measure included at least one child with a positive minimal detectable change. Conclusion: Intensive body weight-supported treadmill training may be an effective intervention for some children with CP who are ambulatory.

Levels of Gross and Fine Motor Development in Young Children with Autism Spectrum Disorder

The purpose of this study was to compare levels of gross motor (GM) and fine motor (FM) development in young children with autism spectrum disorder (ASD), and to compare their levels of GM and FM development with children with developmental delay (DD) without ASD. Thirty-eight children (ASD group: n = 19; DD group: n = 19) between 21 and 41 months of age were assessed using the Peabody Developmental Motor Scales, Second Edition (PDMS-2). Using PDMS-2 classifications as well as differences between standard scores, each child was placed in one of three motor profiles based on the childs relative levels of GM and FM skills (GM = FM, GM > FM, and GM < FM). The results showed that most of the children with ASD had generally similar levels of GM and FM development. The motor profiles of children with ASD were analogous to those of children with DD.

Concurrent validity of the Bayley Scales of Infant Development II Motor Scale and the Peabody Developmental Motor Scales-2 in children with developmental delays.

Purpose: The purpose of this study was to explore concurrent validity of the age equivalent and standard scores of the Bayley Scales of Infant Development II (BSID II) Motor Scale and the Peabody Developmental Motor Scales-2 (PDMS-2), including correlations and clinical agreement between the scores of the two tests. Methods: One hundred ten children aged three to 41 months who were referred to an early childhood evaluation program because of concerns about their development were administered both the BSID II Motor Scale and the PDMS-2 as part of their developmental evaluations. Results: The correlation coefficients were high to very high for age-equivalent scores, and the Locomotion Subscale had the closest agreement with the BSID II Motor Scale age equivalent. The correlation coefficients were moderate to high for standard scores, and there was only slight agreement between the tests for standard score categories. More than 75% of the 70 children in this study whose scores on the BSID II supported eligibility for services based on scores at least two SD below the mean of the test would not have qualified for services if the PDMS-2 standard scores alone were used to assess their eligibility. Approximately half the children who showed appropriate total motor performance on the PDMS-2 were classified as delayed on the BSID II Motor Scale. Conclusions: The study supports concurrent validity of the tests only for certain subscale age-equivalent scores, particularly the BSID II Motor Scale with the PDMS-2 Locomotion Subscale. The current findings suggest that the standard scores show poor agreement and have low concurrent validity. There are marked differences in the standard scores of the two tests that may affect a childs eligibility for services in some states, and therapists should be cautious when making clinical decisions based solely on standard scores of one test.

Mealtime behaviors of preschool children: comparison of children with autism spectrum disorder and children with typical development.

ABSTRACT This study identified mealtime behaviors of young children (3–6 years old) with autism spectrum disorder (ASD) and compared these behaviors to children with typical development matched for age, gender, and ethnicity. The parents of children with ASD (n = 24) and children with typical development (n = 24) completed a mealtime survey to assess early mealtime history, mealtime location and behaviors, food preferences and behaviors, and eating problems. Parental concerns increased significantly after age 1 year in the children with ASD. Matched analysis results showed significant differences between the pairs of children in specific mealtime behaviors. More children with ASD were picky eaters, mouthed nonfood items, resisted new foods, limited foods based on textures, had problems with gagging, had difficulty eating at regular restaurants or at school, resisted sitting at the table, and threw or dumped food. Knowledge of these early differences can help pediatric therapists to assess feeding issues and plan interventions.

Ankle dorsiflexion fMRI in children with cerebral palsy undergoing intensive body‐weight‐supported treadmill training: a pilot study

This pilot study investigated the feasibility of using functional magnetic resonance imaging (fMRI) as a physiological marker of brain plasticity before and after an intensive body‐weight‐supported treadmill training (BWSTT) program in children with cerebral palsy (CP). Six ambulatory children (four males, two females; mean age 10y 6mo, age range 6–14y) with spastic CP (four hemiplegia, two asymmetric diplegia, all Gross Motor Function Classification System Level I) received BWSTT twice daily for 2 weeks. All children tolerated therapy; only one therapy session was aborted due to fatigue. With training, over ground mean walking speed increased from 1.47 to 1.66m/s (p=0.035). There was no change in distance walked for 6 minutes (pre‐: 451m; post‐: 458m;p 0.851). In three children, reliable fMRIs were taken of cortical activation pre‐ and post‐intervention. Post‐intervention increases in cortical activation during ankle dorsiflexion were observed in all three children. This study demonstrates that children with CP between 6 and 14 years of age can tolerate intensive locomotor training and, with appropriate modifications, can complete an fMRI series. This study supports further studies designed to investigate training‐dependent plasticity in children with CP.

Concurrent Validity of the Bayley Scales of Infant Development II Motor Scale and the Peabody Developmental Motor Scales in Two-Year-Old Children

Concurrent validity of the Bayley Scales of Infant Development, Second Edition (BSID II) Motor Scale and the Peabody Developmental Motor Scales (PDMS) was examined by administering both tests to 38 two-year-old Native American children. A correlation analysis of age equivalent scores indicated very good to high correlation for the BSID II Motor Scale with the PDMS Fine Motor Scale (PDFMS) (r = .87) and the PDMS Gross Motor Scale (PDGMS) (r = .83). A correlation analysis of standard scores showed poor to unacceptable correlation between the BSID II Motor Scale with the PDFMS (r = .64) and the PDGMS (r = .49); further, there was poor agreement between the classifications of significantly delayed, mildly delayed, and within normal limits performance on each test. The PDFMS tended to classify children lower than the BSID II Motor Scale. The scores of the relatively younger children within each of the PDMS 6-month age categories agreed less between the tests than did the scores of the relatively older children. In conclusion, this study provides evidence for the concurrent validity of the BSID II Motor Scale and the PDMS for age equivalent scores, but not for standard scores of 2-year-old children. Professionals must be aware of the strengths and limitations of the BSID II and the PDMS, and choose appropriately to avoid denial of or over-referral for services for young children.

A pilot study of quality of life in children with cerebral palsy after intensive body weight-supported treadmill training.

Purpose: This pilot study was designed to examine the effects of a 2-week program of intensive body weight-supported treadmill training (BWSTT) on clinical measures of perceived health-related quality of life and fatigue in children with cerebral palsy. Methods: Six children with spastic cerebral palsy (aged 6–14 years; all classified as Gross Motor Function Classification System Level I) received two 30-minute sessions of BWSTT daily for 2 weeks, and completed questionnaires preintervention and postintervention. Results: Ratings by children and their parents who completed the Pediatric Quality of Life Inventory™ and Multidisciplinary Fatigue module resulted in nonsignificant higher mean postscores. However, of the children with complete data, 4 showed minimal clinically important differences by child and parent-proxy report. Conclusions: Results suggest that positive health-related quality of life changes can be identified after an intensive intervention of BWSTT, and should include ratings from both children and parents.

Motor Development of Two-Year-Old Typically Developing Native American Children on the Bayley Scales of Infant Development II Motor Scale

This study was designed to investigate motor development of two-year-old children of Native American background using the Psychomotor Development Index scores (PDI) of the Bayley Scales of Infant Development, 2nd ed (BSID-II) Motor Scales and assess the cultural relevancy of this test. Thirty-nine children typically developing, who were two years old and of Native American background participated in this study. The children were divided into two age groups, 24 to 29 months, (n = 21) and 30 to 35 months(n = 18). The BSID-II was administered to all subjects. The PDIs for both age groups were significantly lower than the normative data (p < 0.001) with the younger group scoring lower than the older group. More than one third of the total sample, and more than one half of the younger group, scored at least one standard deviation (SD) below the mean of the test. All children were felt to be developing typically and using a predictive formula, children in this sample would be predicted to have a PDI of 100 by 38.9 months. Results of our study suggest that professionals must recognize the variability in the rate of motor development in some Native American cultures, especially in younger two-year-old children, and should be cautious in interpreting test results.