Lynn Jeffries

Determinants of gross motor function of young children with cerebral palsy : A prospective cohort study

The aim of this study was to test a model of determinants of gross motor function of young children with cerebral palsy (CP).

Family ecology of young children with cerebral palsy

BACKGROUND Family ecology in early childhood may influence childrens activity and participation in daily life. The aim of this study was to describe family functioning, family expectations of their children, family support to their children, and supports for families of young children with cerebral palsy (CP) based on childrens gross motor function level. METHODS Participants were 398 children with CP (mean age = 44.9 months) and their parents residing in the USA and Canada. Parents completed four measures of family ecology, the Family Environment Scale (FES), Family Expectations of Child (FEC), Family Support to Child (FSC) and Family Support Scale (FSS). RESULTS The median scores on the FES indicated average to high family functioning and the median score on the FSS indicated that families had helpful family supports. On average, parents reported high expectations of their children on the FEC and strong support to their children on the FSC. On the FES, higher levels of achievement orientation were reported by parents of children in Gross Motor Function Classification System (GMFCS) level II than parents of children in level I, and higher levels of control were reported by parents of children in level I than parents of children in level IV. On the FEC, parents of children with limited gross motor function (level V) reported lower expectations than parents of children at all other levels. CONCLUSIONS Family ecology, including family strengths, expectations, interests, supports and resources, should be discussed when providing interventions and supports for young children with CP and their families.

Determinants of participation in family and recreational activities of young children with cerebral palsy

Abstract Purpose: To test a model of child, family and service determinants of participation in family and recreational activities for young children with cerebral palsy (CP). Methods: Participants were a convenience sample of 429 children (242 males) with CP, aged 18 to 60 months, representing all levels of the Gross Motor Function Classification System (GMFCS). Children were divided into two groups by GMFCS levels, levels I to II and levels III to V. Data on impairments and gross motor function were collected by therapists; parents provided information about children’s health conditions and adaptive behaviour. Seven months later, parents reported on family life and services received. One year after the beginning of the study, parents reported their children’s participation. Data from the two groups of children were analysed separately using structural equation modelling. Results: The model explained 35% and 40% of the variance of frequency of participation in family and recreation and 28% and 38% of enjoyment in participation, for the two groups of children, respectively. Children’s adaptive behaviour, family ecology, and number of community recreational programs were associated with the frequency of participation for both groups. Gross motor function was only associated with the frequency of participation for children in levels III–V. Adaptive behaviour was associated with enjoyment for both groups. The extent services met children’s needs was associated with enjoyment for children in levels I to II and family ecology was a determinant of enjoyment for children in levels III to V. Conclusion: Supporting children’s adaptive behaviour, family ecology, and access to community recreational programmes may foster participation in family and recreational activities for young children with CP. Implications for Rehabilitation Participation in family and recreational activities for young children with CP is complex and influenced by child, family and environmental factors. Practitioners are encouraged to support children’s adaptive behaviour and access to community programs and family relationships, involvement in community activities and expectations of their children. Optimizing gross motor function for children who have limitations in self-mobility may enhance their participation in family and recreational activities. For children with a good prognosis for walking, providing services perceived by parents to meet their children’s needs may enhance children’s enjoyment of participation.

Development and validity of the early clinical assessment of balance for young children with cerebral palsy.

Abstract Objectives: Validity of the Early Clinical Assessment of Balance (ECAB), to monitor postural stability in children with cerebral palsy (CP), was evaluated. Methods: 410 children with CP, 1.5 to 5 years old, participated. Physical therapists scored children on the Movement Assessment of Infants Automatic Reactions section and Pediatric Balance Scale. Through consensus, researchers selected items from both measures to create the ECAB. Content and construct validity were examined through item correlations, comparison of ECAB scores among motor ability, age and gender groups and correlations with the Gross Motor Function Measure 66 basal and ceiling (GMFM-66-B&C). Results: Internal consistency was high (Cronbach’s alpha = 0.92). ECAB differed significantly among motor ability, children <31 months old scored lower than older children, but there was no difference between boys and girls. ECAB and GMFM-66-B&C scores correlated strongly (r = 0.97). Conclusion: Validity of the ECAB was supported. Reliability and responsiveness need study.

Development of the early activity scale for endurance for children with cerebral palsy

Purpose: The Early Activity Scale for Endurance (EASE) was developed as a clinically feasible measure of endurance for physical activity in young children with cerebral palsy (CP). Validity and reliability were evaluated. Methods: Participants included 414 children with CP and 106 without CP. Parents completed the EASE, an 11-item self-report measure. For construct validity, EASE scores were compared by Gross Motor Function Classification System levels (0 assigned for children without CP), age, and gender. In subgroups, convergent validity with the 6-minute walk test and test-retest reliability with a second EASE were evaluated. Results: EASE scores differed significantly by Gross Motor Function Classification System, but not by age or gender. The EASE correlated moderately (rs = 0.57) with the 6-minute walk test. Test-retest reliability was high, intraclass correlation (2,1) = 0.95. Conclusion: The EASE has acceptable psychometrics for use in practice and research to estimate endurance for physical activity in young children with CP.

Determinants of self-care participation of young children with cerebral palsy

Abstract Objective: To test a model of child, family and service determinants of self-care participation of children with cerebral palsy (CP), grouped by Gross Motor Function Classification System levels (I–II and III–V). Methods: Participants were a convenience sample of 429 children (242 males) with CP, aged 18–60 months. Data on impairments and gross motor function were collected by reliable therapists; parents provided information about childrens health conditions and adaptive behaviour. Seven months later parents reported on family life and services received. One year after study onset, parents documented childrens self-care participation. Data from two groups of children were analysed using structural equation modelling. Results: The model explained a significant proportion of the variance of self-care participation, with higher motor function, fewer health conditions and higher levels of adaptive behaviour being associated with greater self-care participation. Conclusion: Supporting childrens gross motor function, health and adaptive behaviour may optimize self-care participation.

Description of Primary and Secondary Impairments in Young Children With Cerebral Palsy.

Purpose: We describe primary and secondary impairments in young children with cerebral palsy (CP); report differences in impairments on the basis of Gross Motor Function Classification System (GMFCS), age, and sex; and examine the extent that individual impairments account for the construct of primary and secondary impairments. Methods: Participants included 429 children with CP (242 [56%] male; 1½ to 5 years) representing all GMFCS levels. Reliable assessors collected primary and secondary impairment data using clinical measures. Analyses included descriptive statistics, comparisons among GMFCS, age, and sex, and factor analysis. Results: Young children with CP present with primary and secondary impairments. Significant differences in impairments occur among some GMFCS levels and age groups but not sex groups. Postural stability contributed most to primary impairments and strength to secondary impairments. Conclusion: Young children with CP across GMFCS levels may have already developed secondary impairments that should be addressed within therapy services.

Decreasing sound and vibration during ground transport of infants with very low birth weight

Objective:To measure the effectiveness of modifications to reduce sound and vibration during interhospital ground transport of a simulated infant with very low birth weight (VLBW) and a gestational age of 30 weeks, a period of high susceptibility to germinal matrix and intraventricular hemorrhage.Study Design:Researchers measured vibration and sound levels during infant transport, and compared levels after modifications to the transport incubator mattresses, addition of vibration isolators under incubator wheels, addition of mass to the incubator mattress and addition of incubator acoustic cover.Result:Modifications did not decrease sound levels inside the transport incubator during transport. The combination of a gel mattress over an air chambered mattress was effective in decreasing vibration levels for the 1368 g simulated infant.Conclusion:Transport mattress effectiveness in decreasing vibration is influenced by infant weight. Modifications that decrease vibration for infants weighing 2000 g are not effective for infants with VLBW. Sound levels are not affected by incubator covers, suggesting that sound is transmitted into the incubator as a low-frequency vibration through the incubator’s contact with the ambulance. Medical transportation can apply industrial methods of vibration and sound control to protect infants with VLBW from excessive physical strain of transport during vulnerable periods of development.

Exercise using the Wii Fit plus with a child with primary Raynaud's disease and obesity: a case report.

ABSTRACT The purpose of this case report was to describe the use of the Nintendo® Wii Fit Plus as an alternative exercise for an 11-year-old child with primary Raynauds disease (PRD) and obesity who was not involved in organized sports and had limited outdoor physical activity and exercise. The Wii Fit Plus exercise parameters are described as well as outcomes measured at baseline, 12 weeks, and 24 weeks. Specifically, we evaluated changes in body mass index (BMI), cardiorespiratory fitness, and health related quality of life (HRQL). Following the 24-week exercise program, the childs BMI decreased, cardiorespiratory fitness increased, and HRQL increased and were comparable to values in healthy children. These findings suggest that the Wii Fit Plus may have been an effective exercise strategy for this child.

Outcomes for Students Receiving School-Based Physical Therapy as Measured by the School Function Assessment.

Purpose: To describe School Function Assessment (SFA) outcomes after 6 months of school-based physical therapy and the effects of age and gross motor function on outcomes. Methods: Within 28 states, 109 physical therapists and 296 of their students with disabilities, ages 5 to 12 years, participated. After training, therapists completed 10 SFA scales on students near the beginning and end of the school year. Results: Criterion scores for many students remained stable (46%-59%) or improved (37%-51%) with the most students improving in Participation and Maintaining/Changing Positions. Students aged 5 to 7 years showed greater change than 8- to 12-year-olds on 5 scales. Students with higher gross motor function (Gross Motor Function Classification System levels I vs IV/V and II/III vs IV/V) showed greater change on 9 scales. Conclusions: Positive SFA change was recorded in students receiving school-based physical therapy; however, the SFA is less sensitive for older students and those with lower functional movement.