Deborah Kartin

Ambulatory Physical Activity Performance in Youth With Cerebral Palsy and Youth Who Are Developing Typically

Background and Purpose Assessment of walking activity in youth with cerebral palsy (CP) has traditionally been “capacity-based.” The purpose of this study was to describe the day-to-day ambulatory activity “performance” of youth with CP compared with youth who were developing typically. Subjects Eighty-one youth with CP, aged 10 to 13 years, who were categorized as being in Gross Motor Function Classification System (GMFCS) levels I to III and 30 age-matched youth who were developing typically were recruited. Methods Using a cross-sectional design, participants wore the StepWatch monitor for 7 days while documenting average daily total step counts, percentage of time they were active, ratio of medium to low activity levels, and percentage of time at high activity levels. Results The youth with CP demonstrated significantly lower levels of all outcomes than the comparison group. Discussion and Conclusion Daily walking activity and variability decreased as functional walking level (GMFCS level) decreased. Ambulatory activity performance within the context of the daily life for youth with CP appears valid and feasible as an outcome for mobility interventions in CP.

Effect of balance training on recovery of stability in children with cerebral palsy

This study examined the effect of massed practice in balance recovery of stability in six children (four males, two females; mean age 9 years 2 months, SD 2 years, range 7 years 5 months to 12 years 11 months) with cerebral palsy (CP). Four children were diagnosed with spastic diplegia (Gross Motor Function Classification System [GMFCS] level II) and two with spastic hemiplegia (GMFCS level I). A single-subject, multiple-baseline experimental design involving three pairs of children matched for diagnosis was used. A moveable forceplate system was used to test and train reactive balance control. Area per second (i.e. area covered by the center of pressure over a one second period) and time to stabilization from center of pressure measures were calculated following perturbations. The intervention phase consisted of massed practice on the moving platform (100 perturbations/day for 5 days). Analysis included hierarchical linear modeling and a repeated measures ANOVA. All children demonstrated a significant improvement in their ability to recover stability as demonstrated by reduced center of pressure area and time to stabilization following training. These improvements were still present 30 days following completion of training. Results suggest that postural control mechanisms in school-age children (7 to 13 years) with CP are modifiable.

Review of the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2)

The Bruininks-Oseretsky Test of Motor Proficiency (Bruininks, 1978) is a standardized, norm-referenced measure used by physical therapists and occupational therapists in clinic and school practice settings. This test recently was revised and published as the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2; Bruininks & Bruininks, 2005). The BOT-2 is an individually administered measure of fine and gross motor skills of children and youth, 4 through 21 years of age. It is intended for use by practitioners and researchers as a discriminative and evaluative measure to characterize motor performance, specifically in the areas of fine manual control, manual coordination, body coordination, and strength and agility. The BOT-2 has both a Complete Form and a Short Form. This review of the BOT-2 describes its development and psychometric properties; appraises strengths and limitations; and discusses implications for use by physical therapists and occupational therapists.

Understanding Falls in Multiple Sclerosis: Association of Mobility Status, Concerns About Falling, and Accumulated Impairments

Background Falls in people with multiple sclerosis (MS) are a serious health concern, and the percentage of people who restrict their activity because of concerns about falling (CAF) is not known. Mobility function and accumulated impairments are associated with fall risk in older adults but not in people with stroke and have not been studied in people with MS. Objective The purposes of this study were: (1) to estimate the percentage of people who have MS and report falling, CAF, and activity restrictions related to CAF; (2) to examine associations of these factors with fall status; and (3) to explore associations of fall status with mobility function and number of accumulated impairments. Design A cross-sectional survey was conducted. Methods A total of 575 community-dwelling people with MS provided information about sociodemographics, falls, CAF, activity restrictions related to CAF, mobility function, and accumulated impairments. Chi-square statistics were used to explore associations among these factors. Results In all participants, about 62% reported CAF and about 67% reported activity restrictions related to CAF. In participants who did not experience falls, 25.9% reported CAF and 27.7% reported activity restrictions related to CAF. Mobility function was associated with fall status; participants reporting moderate mobility restrictions reported the highest percentage of falls, and participants who were nonwalkers (ie, had severely limited self-mobility) reported the lowest percentage. Falls were associated with accumulated impairments; the participants who reported the highest percentage of 2 or more falls were those with 10 impairments. Limitations This cross-sectional study relied on self-reported falls, mobility, and impairment status, which were not objectively verified. Conclusions Both CAF and activity restrictions related to CAF were common in people with MS and were reported by people who experienced falls and those who did not. The association of fall status with mobility function did not appear to be linear. Fall risk increased with declining mobility function; however, at a certain threshold, further declines in mobility function were associated with fewer falls, possibly because of reduced fall risk exposure.

Effect of balance training on muscle activity used in recovery of stability in children with cerebral palsy: a pilot study

This study explored possible neural mechanisms that contribute to improvements in balance control produced by reactive balance training in children with cerebral palsy (CP). Six children with CP (four males, two females; mean age 9y 4mo), two with spastic hemiplegia (Gross Motor Function Classification System [GMFCS] level I) and four with spastic diplegia (GMFCS level II,) were given 5 days of intensive training in reactive balance control (100 perturbations per day on a moveable force platform). Surface electromyography was used to characterize changes in neuromuscular responses pretraining, immediately posttraining, and 1 month posttraining. Training in reactive balance control resulted in improvements in directional specificity of responses (a basic level of response organization) and other spatial/temporal characteristics including: (1) faster activation of muscle contraction after training, allowing children to recover stability faster; (2) emergence of a distal-proximal muscle sequence; and (3) improved ability to modulate the amplitude of muscle activity (increased amplitude of agonist and decreased amplitude of antagonist, reducing coactivation). Each child with spastic hemiplegia or diplegia showed a different combination of factors that contributed to improved performance; the level of change in neural factors depended on the severity of involvement of the child: hemiplegia vs diplegia, and level of involvement within each diagnostic category.

Pain in Persons With Cerebral Palsy: Extension and Cross Validation

OBJECTIVE To cross-validate and extend the assessment of pain in persons with cerebral palsy (CP). DESIGN Standardized in-person interviews. SETTING University medical clinics and local residential and community housing for persons with developmental disabilities. PARTICIPANTS One hundred adults with CP. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Measures of pain intensity, pain interference in daily activities, psychologic function, significance of pain problem, and satisfaction with pain treatment. RESULTS Sixty-seven (67%) subjects reported 1 or more chronic pain problem(s). Low back, hip, and leg pain were most common. Twenty-four percent reported constant pain; 19% reported that pain occurred daily. Mean pain intensity +/- standard deviation over the previous week on an 11-point scale (0, no pain; 10, pain as bad as could be) was 4.08+/-2.25. Minor interference (2.55+/-3.03; scale range, 0-10) from pain with routine daily activities was reported. Responses to the Satisfaction with Life Scale (n=63) indicated only moderate life satisfaction (18.44+/-8.34; scale range, 5-35) among those with 1 or more pain problem(s). Responses to the Rand Mental Health Inventory (n=65; mean score, 60.65+/-20.36) revealed relatively high levels of psychologic distress in those with chronic pain. Consumer satisfaction with pain management care varied, with 32.8% of the subjects reporting dissatisfaction. CONCLUSIONS The study findings are consistent with earlier findings concerning pain problems in adults with CP and provide further evidence that pain problems may be overlooked and undertreated in this population.

Responding to the Challenge of Early Intervention for Fetal Alcohol Spectrum Disorders

Prenatal alcohol exposure can lead to significant neurodevelopmental disabilities, now recognized as fetal alcohol spectrum disorders (FASD). This includes both fetal alcohol syndrome, a lifelong birth defect, and a wider range of enduring learning and behavior deficits often called alcohol-related neurodevelopmental disorder (ARND). Diagnostic classification systems have been developed to identify children with FASD, and early interventionists from multiple disciplines can be central in identification and referral for diagnosis, and in providing the known protective influence of intervention early in life. With the recent federal mandates to better address needs of children born prenatally affected by substances, or those impacted by abuse and/or neglect, by referring them for screening and possible early intervention services, there is heightened need for providers to understand FASD. There is a growing body of research data describing the teratogenic effects of alcohol on central nervous system function and physical development, the diversity of children with prenatal alcohol exposure and their families, and the developmental and behavioral characteristics of this clinical population. This article reviews the latest research evidence, bearing in mind what is important to early intervention. This article also gives practical guidance on FASD prevention, methods for early screening, and referral of young children for diagnosis of FASD (and referral for needed services once diagnosed), and how to provide education, support, advocacy assistance, and anticipatory guidance for families raising children with FASD.

Sensory Processing, School Performance, and Adaptive Behavior of Young School-Age Children with Fetal Alcohol Spectrum Disorders

This study described sensory processing behaviors and sensory-motor abilities in children with fetal alcohol spectrum disorders (FASD) and explored their relationship to home and school function. A clinic-referred sample of 25 children with FASD, ages 5 to 8 years, was compared with 26 children with typical development, balanced for age, gender, and race/ethnicity, on standardized tests examining sensory processing, sensory-motor performance, school performance, and adaptive behavior. Children with FASD scored significantly more poorly on sensory processing, sensory-motor, adaptive, and academic achievement measures, and demonstrated more problem behaviors at home and school. Correlations were significant between measures of sensory processing and sensory-motor performance, adaptive behavior, and some aspects of academic performance. Sensory processing and related foundational sensory-motor impairments should be considered when determining the developmental needs of children with FASD. These impairments may co-occur with and contribute, at least in part, to decreased adaptive and school function.

Pain treatment in persons with cerebral palsy: frequency and helpfulness.

Engel JM, Kartin D, Jensen MP: Pain treatment in persons with cerebral palsy: Frequency and helpfulness. Am J Phys Med Rehabil 2002;81:291–296. Objectives To identify the interventions currently being used by adults with cerebral palsy (CP) for pain management, examine the perceived helpfulness of these interventions, and determine the extent to which these individuals with cerebral palsy–related pain were accessing the services of healthcare providers for the explicit purpose of addressing pain. Design Retrospective, descriptive study of 64 adults with cerebral palsy–related chronic pain. Subjects ranged in age from 18 to 76 yr and included 35 women and 29 men. Subjects were evaluated by using a protocol-based interview. Results The study sample sought and used a variety of pain treatments and healthcare providers and rated many of the interventions as being at least moderately helpful. Despite the reported helpfulness of the pain interventions, however, most are only being used by a small subset of the sample. Conclusion The majority of the sample with chronic pain did not access healthcare providers for help in managing their pain. Cerebral palsy–related pain is undertreated in the adult population with cerebral palsy.

The relationship of physical activity to health status and quality of life in cerebral palsy

Purpose: To compare the influence of functional level, ambulatory, and physical activity performance on self-reported health status and quality of life (QOL) of youth with cerebral palsy (CP) and with typical development. Methods: A cross-sectional comparison cohort design was used in 81 youth with CP, ages 10 to 13 years and 30 youth with typical development. Participants wore the StepWatch™ monitor for 7 days and completed the Activity Scale for Kids, Child Health Questionnaire-Child Form, and Youth Quality of Life Questionnaire. Multiple regression analysis was used. Results: Self-reported activity performance influenced self-reported physical (β = 0.36), behavioral (β = 0.32), and emotional (β = 0.29) health. Functional level and performance did not influence QOL. Conclusions: Measures of ambulatory and physical activity and youth-reported health status separated from the measure of QOL seem helpful in defining the specific health issues of ambulatory youth with CP and have implications for physical activity intervention.