Birgit Rösblad

The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability

The Manual Ability Classification System (MACS) has been developed to classify how children with cerebral palsy (CP) use their hands when handling objects in daily activities. The classification is designed to reflect the childs typical manual performance, not the childs maximal capacity. It classifies the collaborative use of both hands together. Validation was based on the experience within an expert group, a review of the literature, and thorough analysis of children across a spectrum of function. Discussions continued until consensus was reached, first about the constructs, then about the content of the five levels. Parents and therapists were interviewed about the content and the description of levels. Reliability was tested between pairs of therapists for 168 children (70 females, 98 males; with hemiplegia [n=52], diplegia [n=70], tetraplegia [n=19], ataxia [n=6], dyskinesia [n=19], and unspecified CP [n=2]) between 4 and 18 years and between 25 parents and their childrens therapists. The results demonstrated that MACS has good validity and reliability. The intraclass correlation coefficient between therapists was 0.97 (95% confidence interval 0.96-0.98), and between parents and therapist was 0.96 (0.89-0.98), indicating excellent agreement.

THE INTEGRATION OF SENSORY INFORMATION IN THE DEVELOPMENT OF PRECISE MANUAL POINTING

The development of manual pointing was studied in 270 children from 4 yr of age to 12 yr of age. Fifteen boys and 15 girls were included in each age group. The task was to place pins underneath a table-top at positions seen or felt on the table-top. Each child was tested in four different conditions: both visual and proprioceptive information about the position of the dot to be pointed at could be provided, just one of these two sources of information could be provided, or none of them. Errors were analysed in terms of systematic and random error. The results show that in all age groups, performance was superior when visual information about the position of the dot was provided. The ability to utilize visual information was found to be rather good already at the youngest ages. In the visual conditions the random error decreased with age in a gradual and linear fashion but the systematic error did not, it decreased and increased and decreased again. Errors were substantially smaller at 7 and 11 yr of age. The ability to use information from the proprioceptors improved remarkably during the youngest ages. All the improvement of the random error between 4 and 5 yr of age could be attributed to this factor. The systematic error in all conditions was found to be displaced towards the contralateral side of the body, but this effect was strongest in the proprioceptive condition. A strong interaction between sex and hand used in pointing was found in the systematic errors but none in the random errors. The interaction could be described as a nondominant hand disadvantage of the girls.

Disturbances in programming goal-directed arm movements in children with ADHD

We investigated in children with attention‐deficit‐hyperactivity disorder (ADHD) the ability to programme and execute goal‐directed arm movements. The sample consisted of 25 males with ADHD (mean age 11 years 6 months, SD1 year 11 months, range 8 to 15 years) and 25 age‐matched typically developing males. The children moved a cursor on a screen by moving a hand‐held indicator on a horizontal digitizing tablet. Start and target positions on the screen were always visible during the movement. The screen cursor, however, could either be visible throughout the movement (visual feedback) or blanked at movement initiation (without visual feedback). Analysis showed that movement control was impaired in children with ADHD and that their problems were especially pronounced during the without‐visual‐feedback condition. In this condition, the children with ADHD exhibited large end‐point errors and prolonged movement durations. As there can be no visual corrections of the movement during this condition, results indicate poorer motor programming in children with ADHD. Moreover, children with ADHD performed jerky movements and showed a reduced capacity to select a movement speed that met with the accuracy demands of the movement.

The assessment of children with Developmental Coordination Disorders in Sweden: A preliminary investigation of the suitability of the Movement ABC

Abstract The Movement ABC is now widely used in Sweden by physio and occupational therapists. The manual was translated into Swedish in 1996. It is generally assumed that the published norms for the test are valid for use with Swedish children but no systematic investigation of their suitability has been undertaken. The aim of this study was to begin this process by comparing the performance of a group of six-year-old Swedish children with that of American children from the original standardisation sample. Two matched groups of 60 children were compared. Out of 10 cross-cultural comparisons, only one revealed a significant difference between the groups. Swedish children were better on one of the ball skills tasks. Although the restricted age range and small sample size make it difficult to generalise our results beyond Age Band One of the test, the data so far suggest that the norms for the test may need little adjustment for use with Swedish children. PsycINFO Classification: 2221; 2330

Impairment Severity Selectively Affects the Control of Proximal and Distal Components of Reaching Movements in Children with Hemiplegic Cerebral Palsy.

This study explored proximal‐to‐distal components during goal‐directed reaching movements in children with mild or moderate hemiplegic cerebral palsy (HCP); [seven females, four males; mean age 8y 6mo; SD 27mo], compared with age‐matched, typically developing children (seven females, five males; mean age 8y 3mo [SD 25mo]. Severity of HCP was assessed following the approach of Claeys et al. Optoelectronic registrations were made during unimanual reaching‐to‐grasp and reaching‐to‐hit movements with both the affected/non‐preferred and unaffected/preferred side. Regardless of task, the children with HCP, particularly those with moderate impairment, displayed less optimal spatiotemporal organization of movements performed with the affected arm. Compared with the goal to hit, and increasingly with more severe impairment, children with HCP adapted to the goal to grasp by recruiting augmented shoulder movements when reaching with the affected side. A resulting impact on distal kinematics was found in shorter, straighter, and less segmented movement paths. Thus, depending on severity of hemispheric lesions and task complexity, unilateral brain injuries in HCP may selectively affect neural pathways underlying both proximal and distal arm movement control. Levels of both ipsi‐ and contralateral activation in relation to side and lesion severity should be considered in future studies on prehension movements in HCP.

Roles of Visual Information for Control of Reaching Movements in Children.

What visual information do children normally require for the control of reaching movements? How is performance affected when children do not have access to the preferred mode of perceptual information? These questions were studied in 28 children who were tested on 3 occasions: at 6, 7, and 8 years of age. The task was to pick beads, 1 at a time, from 1 cup and carry them to another cup. With the aid of a mirror arrangement and a curtain, the amount of visual information was manipulated with regard to both the target and the performing hand. The movements were monitored with an optoelectronic device (SELSPOT II) and analyzed in terms of transport and object-handling phases. Results showed that object handling required visual information on both hand and target. For the transport phase of the movement, visual information on the spatial location of the target was sufficient, and sight of the hand did not improve performance. In contrast to adult subjects, when children did not have access to the required visual information, their performances deteriorated markedly. These results indicate that from the age of 6, children use visual information for control of arm movements in a manner like that of adults, although with less accuracy and speed. However, even 8-year-old children are limited in their ability to use alternative perceptual strategies for movement control, and they therefore become less flexible and more dependent on visual information.

Using the MACS to facilitate comunication about manual abilities of children with cerebral palsy.

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Perceptual Control of Manual Pointing in Children with Motor Impairments

Accuracy in manual pointing was studied in 29 children between 5 and 13 years of age with motor impairments including cerebral palsy, developmental co-ordination disorders and spina bifida. The task was to place pins underneath a table-top at positions seen or felt on the table-top. Vision of the pointing hand was always excluded. The results were evaluated with reference to Hofsten and Rosblad (1988), who collected corresponding data from 270 normal children between 4 and 12 years of age. Children with motor impairments, like normal children, were more accurate when the target was visible than when it was felt or remembered. However, the dependency on vision was found to be much more pronounced in the group of children with motor impairments. The wide variation within the three diagnostic groups is discussed and the results of individual children are presented.

Effects of botulinum toxin type A and a programme of functional activity to improve manual ability in children and adolescents with cerebral palsy.

We aimed to evaluate the effectiveness of a clinical programme that combined botulinum toxin injections with a functional activity programme to improve manual ability in children and adolescents with cerebral palsy. A total of 25 young people age range 2 to 19 years participated. They were given injections of botulinum toxin type A into spastic muscles in the upper extremities and participated in a functional activity training programme. Standardised clinical assessments were made before injections, one to two months after, and six months after, the final injections. To assess if the treatment had changed their ability to use the treated hand in activities of everyday life a questionnaire was given to the parents. The families thought that the ability had improved, and that the improvements took place both during the first three months after treatment and after more than six months after the final injections. The ability to extend wrist and fingers actively and the position of the thumb had improved significantly both in the short and long term. This study supports the assumption that a programme combining botulinum toxin A injections with training in functional activity improves manual ability in young people with cerebral palsy.

Control of reaching movements in children and young adults with myelomeningocele

The aim of the present study was to analyze the ability to programme and execute reaching movements in individuals with myelomeningocele (MMC) and in a control group. Thirty‐one participants (18 males, 13 females; mean age 12 years 11 months, SD 2 years 7 months, range 9 to 19 years) with MMC and 31 participants (matched for age and sex) without disabilities were investigated. Reaching was performed with and without visual feedback toward three targets displayed on a computer screen and data were collected using a digitizing tablet linked to a computer. The kinematics of reaching were analyzed and analysis of variance was used for statistical analysis. Results showed that both groups were able to programme reaching movements under both visual conditions. Although the execution of reaching was poor in the MMC group compared with the control individuals, as indicated by larger end‐point errors (p=0.002), less straight movements (p=0.018), and shorter deceleration phases (p=0.004), movement time was not prolonged in the MMC group. Those with shunt treatment (n=21) had more difficulties when visual feedback was provided. Those with symptoms of early brainstem dysfunction (n=5) had shorter deceleration phases under both visual conditions.