Johanna Darrah

Effects of neurodevelopmental treatment (NDT) for cerebral palsy: an AACPDM evidence report.

The objective of the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) evidence reports is to provide the biomedical research and clinical practice communities with the current state of evidence about various interventions for the management of developmental disabilities. AACPDM evidence reports aggregate all that has been published about outcomes of an intervention for a medical condition, gauge the credibility (i.e. strength of the internal validity) of that evidence, and identify gaps in our scientific knowledge. The original version of this report was published in the ‘AACPDM Database of Evidence Reports’ on the internet (www.aacpdm.org) where evidence reports are regularly updated to include new research.

Focus on function: a cluster, randomized controlled trial comparing child‐ versus context‐focused intervention for young children with cerebral palsy

Aim  This study evaluated the efficacy of a child‐focused versus context‐focused intervention in improving performance of functional tasks and mobility in young children with cerebral palsy.

Evaluation of a Community Fitness Program for Adolescents with Cerebral Palsy

A community fitness program for adolescents with cerebral palsy was evaluated. Twenty-three subjects (mean age, 14.2 yr) completed a program of aerobics, strength training, and stretching three times a week for 10 weeks. They were tested three times before training, once at the end of the training,

Aquatic exercise for children with cerebral palsy.

Exercise for children with cerebral palsy (CP) is gaining popularity among pediatric physical therapists as an intervention choice. Exercise in water appeals to children with CP because of the unique quality of buoyancy of water that reduces joint loading and impact, and decreases the negative influences of poor balance and poor postural control. In this paper, research of land-based exercise and aquatic exercise for children with CP is reviewed. Clinically relevant considerations for aquatic exercise programming for children with CP are discussed.

Stability of serial assessments of motor and communication abilities in typically developing infants-implications for screening

BACKGROUND Neuromaturational theory and dynamic systems theory make different assumptions about the rate of development of motor and communication skills. AIMS The stability of fine motor, gross motor, and communication scores of infants was evaluated to test these assumptions. STUDY DESIGN This longitudinal descriptive study evaluated infants in their homes at 9, 11, 13, 16, and 21 months of age. PARTICIPANTS One hundred and two Canadian children of English-speaking parents classified as typically developing at 23 months of age using the Diagnostic Inventory for Screening Children Preschool Screen were included. OUTCOME MEASURES The Peabody Developmental Motor Scales and the Communication Symbolic Behavior Scales-Developmental Profile were used to assess development at each time. Scores were stable if the 95% confidence intervals around the scores overlapped across all assessments. Correlations evaluated the relationship of scores in a domain over time (normative stability) as well as the relationship of scores between domains (ipsative stability). RESULTS There was large variability in scores within an infant, among infants and across developmental domains. Typical development is nonlinear rather than occurring at a constant rate. Fine motor, gross motor, and communication skills appear to develop independently. CONCLUSIONS These results have implications both for developmental screening policies and for early intervention programs. Screening should include multiple domains and multiple time points before referrals are made to early intervention programs.

Context therapy: a new intervention approach for children with cerebral palsy

Aim  To describe the development of context therapy, a new intervention approach designed for a randomized controlled trial.

Are families with adolescents and young adults with cerebral palsy the same as other families

This study compared adolescents with cerebral palsy (CP) and their families to adolescents without physical disabilities and their families as the child enters and leaves adolescence (age ranges 13 to 15 years and 19 to 23 years). Families of 90 individuals with CP (42 females, 48 males) and 75 individuals without physical disabilities (34 females, 41 males) participated. They completed the Family Assessment Device, Life Situation Survey, Multidimensional Scale of Perceived Social Support, and Future Questionnaire. There were few differences in family functioning, life satisfaction, or perceived social support between the groups. Expectations of young adults with CP and parents of both adolescents and young adults regarding future independence and success were lower than the expectations of the control group. While the group results emphasize similarities between families during the two stages of adolescence, individual families and individual family members report specific challenges.

Using the berg balance scale to distinguish balance abilities in children with cerebral palsy.

Purpose: This study was designed to evaluate the use of the Berg Balance Scale (BBS) to assess the balance abilities of children with cerebral palsy. Methods: Thirty‐six ambulatory children with cerebral palsy and 14 children with no motor impairment (ages eight to 12 years) were assessed on the BBS and the Gross Motor Function Measure (GMFM). Participants with cerebral palsy comprised three groups based on diagnosis (spastic hemiplegia, spastic diplegia who ambulated without aids, and spastic diplegia who ambulated with aids). A fourth group consisted of control subjects with no motor impairment. It was hypothesized that these four groups demonstrated a hierarchy of balance abilities. A one‐way ANOVA was used to detect significant differences in test scores among the four groups. The analysis was repeated categorizing children on the Gross Motor Function Classification System (GMFCS) instead of diagnosis. Results: The ability to use scores on the GMFM was slightly better than using BBS scores to distinguish among the groups when children were classified using diagnosis. Significant pair‐wise differences among the groups were present on both the BBS and the GMFM when the children were grouped on the GMFCS. Conclusions: The results suggest that the BBS can be considered as a clinical measure of balance for children with cerebral palsy, and a functional classification system can be used to group children more homogeneously than traditional classification by diagnosis. (Pediatr Phys Ther 2002;14:92‐99)

Evaluating research in developmental disabilities: a conceptual framework for reviewing treatment outcomes

The study of developmental disabilities, not being confined to one medical field, poses a challenge in evaluating outcomes research. It is a multidisciplinary area of study which encompasses health-care, rehabilitation, psychosocial, educational, and biotechnology specialties and involves biological, social, and behavioral effects of intervention. Consequently, there is a lack of consistency in what has been studied, how the outcomes have been measured, and where these results have been recorded. Naturally, these disparate outcomes data need to be consolidated in such a way that comparison of treatments can be made, within and across professional disciplines. In an attempt to facilitate this, the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) is committed to providing critical and useful appraisal of the scientific literature to help clinicians keep abreast in their own as well as other relevant disciplines1. The Academy has explored several classification systems to consolidate and interpret data, and has established a two-part conceptual framework (1) to aggregate treatment outcomes and construct evidence tables based on a model of disablement which classifies treatment outcomes by the dimension in which they have an effect; and (2) to determine the degree of confidence that can be placed in the scientific evidence available in support of an intervention.

Review of four tests of gross motor development.

In 1937, Orton1 described children with motor coordination difficulties as ‘clumsy’, a term still used today. Other terms used to describe these difficulties include developmental dyspraxia, awkwardness, motor learning problems, and most recently, developmental coordination disorder (DCD). DCD is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as a ‘marked impairment in the development of motor coordination [that]... interferes with academic achievement or activities of daily living’.2 The impaired coordination is present in the absence of a known medical condition such as cerebral palsy or muscular dystrophy. The heterogeneity of the motor and cognitive abilities of children included in this classification, and the numerous terms employed to describe them, have hindered systematic accumulation of knowledge about DCD. Currently, children with motor coordination difficulties are identified early in order to receive timely and appropriate intervention. This is despite a lack of strong evidence to support early intervention strategies. Two recent reviews concluded that various interventions for DCD do not result in significant improvement of motor abilities.3, 4 In addition, symptoms of motor coordination problems appear to resolve in a large number of young children.5 However, Schoemaker and coworkers6 report that significant improvements in motor abilities were observed following three months of sensorimotor training and neurodevelopmental treatment. Evidence that clumsiness in early school years is strongly associated with subsequent identification of academic difficulties and psychological problems,7–9 supports current early screening and intervention philosophies. This paper reviews four tests of motor development frequently used to assess and evaluate children with movement difficulties: (1) the Bruininks–Oseretsky Test of Motor Proficiency (BOTMP);10 (2) the Movement Assessment Battery for Children (MABC);11 (3) the Peabody Developmental Motor Scales (PDMS);12 and (4) the Test of Gross Motor Development (TGMD).13 A brief review of general issues of test evaluation is presented, followed by individual reviews of the four tests. Finally, we discuss broader assessment issues and the relative merits and disadvantages of each test. The tests were selected based on the high frequency of use reported by professionals who work with school-aged children with motor coordination difficulties.14