Helene M. Dumas

Social participation of children and youth with acquired brain injuries discharged from inpatient rehabilitation: a follow-up study

Primary objective: To determine the nature and extent of participation in home, school and community life in children and youth with acquired brain injuries (ABI) and identify factors associated with their participation. Research design: Cross-sectional survey. Methods and procedures: Measures of participation, environment and child factors were completed by family caregivers. Data were obtained on 60 children and youth with acquired brain injuries up to 6.7 years post-discharge from one inpatient rehabilitation programme in the USA. Descriptive, correlation and regression analyses were conducted. Main outcomes and results: Children were most restricted in peer social-play, structured community activities and managing daily routines. Eighty-two per cent of the variance accounted for in participation scores was explained by discharge self-care and post-discharge child and environmental factor scores. Conclusions: Results suggest that greater efforts are needed to address social participation in children and youth with ABI. Information about functional activity at discharge and child and environmental factors may provide insight into post-discharge levels of participation and service needs.

Accuracy and Precision of the Pediatric Evaluation of Disability Inventory Computer-Adaptive Tests (PEDI-CAT)

Aim  The aims of the study were to: (1) build new item banks for a revised version of the Pediatric Evaluation of Disability Inventory (PEDI) with four content domains: daily activities, mobility, social/cognitive, and responsibility; and (2) use post‐hoc simulations based on the combined normative and disability calibration samples to assess the accuracy and precision of the PEDI computer‐adaptive tests (PEDI‐CAT) compared with the administration of all items.

Lessons from use of the Pediatric Evaluation of Disability Inventory: where do we go from here?

Purpose: The purpose of this article is to review the innovations, applications, and effect of the original Pediatric Evaluation of Disability Inventory (PEDI) published in 1992 and to describe planned revisions. Summary of Key Points: During the past decade, the PEDI has helped to shift thinking from a developmental to a functional focus. Using the PEDI, researchers and clinicians worldwide have highlighted variations in functional skill acquisition in clinical populations, the importance of recognizing cultural differences, and the value of documenting functional progress in relation to interventions. Conclusions: The PEDI has had a rich tradition in helping to document functional development. New methods are proposed for the next generation of the PEDI by using item banks and computer adaptive testing. Recommendations for Clinical Practice: The computer adaptive testing feature and the revised and expanded content of the new PEDI will enable therapists to more efficiently assess childrens functioning to a broader age group of children.

Computer adaptive test performance in children with and without disabilities: prospective field study of the PEDI-CAT.

Purpose: To examine the discriminant validity, test–retest reliability, administration time and acceptability of the pediatric evaluation of disability inventory computer adaptive test (PEDI-CAT). Methods: A sample of 102 parents of children 3 through 20 years of age with (n = 50) and without (n = 52) disabilities was recruited for this prospective field study. A sub-sample (n = 25) also completed the PEDI-CAT a second time within one month. Parents completed 15 items in each of the four PEDI-CAT domains (daily activities, mobility, social/cognitive, responsibility) using a laptop computer. Following completion, parents answered a four-question user evaluation survey. Results: PEDI-CAT scores based on parent responses differentiated between groups of children with and without disabilities in all four domains. Test–retest reliability estimates were high (ICC = 0.96–0.99) for all four domains. The mean time to complete 60 items for the full sample (n = 102) was 12.66 minutes (SD = 4.47). Parents reported favorable reactions to the PEDI-CAT. Conclusions: The PEDI-CAT offers a valid and reliable assessment acceptable to parents. Implications for rehabilitation The pediatric evaluation of disability inventory computer adaptive test (PEDI-CAT) is a new measure for infants, children and youth from birth through 20 years of age in the functional areas of daily activities, mobility, social/cognitive and responsibility. PEDI-CAT scores based on parent responses differentiated functional skills between groups of children with and without disabilities in all four domains. The PEDI-CAT has high test–retest reliability and could be completed in about 12 minutes. Parent respondents indicated they provided meaningful information about their child with the PEDI-CAT.

Evaluation of an Item Bank for a Computerized Adaptive Test of Activity in Children With Cerebral Palsy

Background: Contemporary clinical assessments of activity are needed across the age span for children with cerebral palsy (CP). Computerized adaptive testing (CAT) has the potential to efficiently administer items for children across wide age spans and functional levels. Objective: The objective of this study was to examine the psychometric properties of a new item bank and simulated computerized adaptive test to assess activity level abilities in children with CP. Design: This was a cross-sectional item calibration study. Methods: The convenience sample consisted of 308 children and youth with CP, aged 2 to 20 years (X=10.7, SD=4.0), recruited from 4 pediatric hospitals. We collected parent-report data on an initial set of 45 activity items. Using an Item Response Theory (IRT) approach, we compared estimated scores from the activity item bank with concurrent instruments, examined discriminate validity, and developed computer simulations of a CAT algorithm with multiple stop rules to evaluate scale coverage, score agreement with CAT algorithms, and discriminant and concurrent validity. Results: Confirmatory factor analysis supported scale unidimensionality, local item dependence, and invariance. Scores from the computer simulations of the prototype CATs with varying stop rules were consistent with scores from the full item bank (r=.93–.98). The activity summary scores discriminated across levels of upper-extremity and gross motor severity and were correlated with the Pediatric Outcomes Data Collection Instrument (PODCI) physical function and sports subscale (r=.86), the Functional Independence Measure for Children (Wee-FIM) (r=.79), and the Pediatric Quality of Life Inventory–Cerebral Palsy version (r=.74). Limitations: The sample size was small for such IRT item banks and CAT development studies. Another limitation was oversampling of children with CP at higher functioning levels. Conclusions: The new activity item bank appears to have promise for use in a CAT application for the assessment of activity abilities in children with CP across a wide age range and different levels of motor severity.

Self-Care Recovery of Children with Brain Injury

The purpose of this study was to describe self-care recovery of children and adolescents with acquired brain injury using six newly derived self-care functional classification levels, to examine the responsiveness of the levels, and to compare level changes with scaled score changes. Upon admission and discharge to inpatient rehabilitation, the Pediatric Evaluation of Disability Inventory (PEDI) Functional Skills Self-Care domain was administered by occupational therapy staff to 152 children and adolescents with brain injury (mean age = 9.3 years; SD = 6 5.2). Scaled scores were converted to self-care classification levels. Using the Wilcoxon matched pairs signed rank test, a difference between admission and discharge level was found for the entire group. Children with traumatic brain injury and stroke demonstrated the most change. When compared with scaled score changes, minimal sensitivity was lost when using classification levels. The PEDI self-care levels provide a responsive analysis of recovery and offer an alternative to the reporting of change scores.

Classifying mobility recovery in children and youth with brain injury during hospital-based rehabilitation

Primary objective: This article describes mobility recovery for children and youth with traumatic and non-traumatic brain injury during hospital-based rehabilitation. Research design: A retrospective, descriptive pre-test/post-test design was used. Methods and procedures: One hundred and fifty-seven individuals with brain injury who were admitted for rehabilitation over a 5-year period were enrolled in this study. The Paediatric Evaluation of Disability Inventory (PEDI) was used to document functional mobility at admission and discharge from the rehabilitation programme. The PEDI mobility classification system consisting of seven discrete levels of mobility was developed to provide clinically relevant and succinct outcome information. Main outcomes and results: The majority of children with brain injury (69%) improved one or more mobility classification levels. Children in the traumatic brain injury group made greater changes ( p = 0.001) in mobility recovery than children in the non-traumatic group. Conclusions: Information about recovery using a well-defined functional classification system may assist with programme evaluation and facilitate optimal service delivery.

Item Bank Development for a Revised Pediatric Evaluation of Disability Inventory (PEDI)

ABSTRACT The Pediatric Evaluation of Disability Inventory (PEDI) is a useful clinical and research assessment, but it has limitations in content, age range, and efficiency. The purpose of this article is to describe the development of the item bank for a new computer adaptive testing version of the PEDI (PEDI-CAT). An expanded item set and response options were reviewed by clinician experts and examined at parent and clinician focus groups. Eleven parents participated in 32 cognitive interviews to examine content, format, and comprehension of items and responses. A set of 76 self-care, 78 mobility, and 64 social function items with pictures and a four-point “Difficulty” scale were developed. The PEDIs Caregiver Assistance scale was replaced by a “Responsibility Scale” with 53 items. Content validity was established incorporating input from clinicians and parents. The new item bank covers a broad range of functional activities for children of all ages and abilities.

An Aquatic Physical Therapy Program at a Pediatric Rehabilitation Hospital: A Case Series

Purpose: The purpose of this case series is to describe the implementation of an aquatic physical therapy (PT) program at a pediatric hospital and to document improvements in participants’ abilities after PT intervention. Methods: Four patients with cerebral palsy, juvenile idiopathic arthritis, or Prader-Willi syndrome participated in aquatic and land-based PT intervention. Three of the patients had orthopedic conditions which required limited weight-bearing or low-joint impact during motor activities. A wide range of outcomes were used to assess changes in participation, activity, and body function. When available, minimal detectable change and minimal important difference values were used to interpret data. Results: Clinically significant improvements were documented in functional mobility, walking endurance, range of motion, muscle strength, and/or pain reduction for all 4 patients. Conclusions: Aquatic PT used as an adjunct to land-based PT interventions may be effective in improving outcomes in patients with physical disabilities.

Assessing Self-Care and Social Function Using a Computer Adaptive Testing Version of the Pediatric Evaluation of Disability Inventory

OBJECTIVE To examine score agreement, validity, precision, and response burden of a prototype computer adaptive testing (CAT) version of the self-care and social function scales of the Pediatric Evaluation of Disability Inventory compared with the full-length version of these scales. DESIGN Computer simulation analysis of cross-sectional and longitudinal retrospective data; cross-sectional prospective study. SETTING Pediatric rehabilitation hospital, including inpatient acute rehabilitation, day school program, outpatient clinics; community-based day care, preschool, and childrens homes. PARTICIPANTS Children with disabilities (n=469) and 412 children with no disabilities (analytic sample); 38 children with disabilities and 35 children without disabilities (cross-validation sample). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Summary scores from prototype CAT applications of each scale using 15-, 10-, and 5-item stopping rules; scores from the full-length self-care and social function scales; time (in seconds) to complete assessments and respondent ratings of burden. RESULTS Scores from both computer simulations and field administration of the prototype CATs were highly consistent with scores from full-length administration (r range, .94-.99). Using computer simulation of retrospective data, discriminant validity, and sensitivity to change of the CATs closely approximated that of the full-length scales, especially when the 15- and 10-item stopping rules were applied. In the cross-validation study the time to administer both CATs was 4 minutes, compared with over 16 minutes to complete the full-length scales. CONCLUSIONS Self-care and social function score estimates from CAT administration are highly comparable with those obtained from full-length scale administration, with small losses in validity and precision and substantial decreases in administration time.