Maria A. Fragala-Pinkham

Group aquatic aerobic exercise for children with disabilities

The effectiveness and safety of a group aquatic aerobic exercise program on cardiorespiratory endurance for children with disabilities was examined using an A–B study design. Sixteen children (11 males, five females) age range 6 to 11 years (mean age 9y 7mo [SD 1y 4mo]) participated in this twice‐per‐week program lasting 14 weeks. The children’s diagnoses included autism spectrum disorder, myelomeningocele, cerebral palsy, or other developmental disability. More than half of the children ambulated independently without aids. Children swam laps and participated in relay races and games with a focus of maintaining a defined target heart rate zone. The strengthening component consisted of exercises using bar bells, aquatic noodles, and water resistance. The following outcomes were measured: half‐mile walk/run, isometric muscle strength, timed floor to stand 3‐meter test, and motor skills. Complaints of pain or injury were systematically collected. Significant improvements in the half‐mile walk/run were observed, but not for secondary outcomes of strength or motor skills. The mean program attendance was 80%, and no injury was reported. Children with disabilities may improve their cardiorespiratory endurance after a group aquatic aerobic exercise program with a high adult:child ratio and specific goals to maintain training heart rates.

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.

Evaluation of a community-based group fitness program for children with disabilities.

Purpose: This study examined the feasibility, safety, and effectiveness of a community-based group fitness program for children with disabilities. Methods: Twenty-eight children with neuromuscular and developmental disabilities, 6 to 14 years of age, participated. The 16-week community-based program, held twice weekly, consisted of strengthening, aerobic conditioning, and flexibility exercises. A pretest-posttest design was used, and the following outcomes were measured: isometric muscle strength of the knee extensors, hip abductors, and ankle plantarflexors, walking energy expenditure, functional mobility, and fitness. Falls and injury data also were collected. Results: Mean program attendance was 75.3%, and no injuries were reported. Improvements in all clinical outcomes were observed. The most clinically meaningful improvement was in functional mobility with a large effect size (0.87). Conclusions: Physical therapists partnering with community centers may feasibly and safely shift group fitness programs for school-aged children with disabilities from the medical setting to the community.

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.

Sensitivity of a computer adaptive assessment for measuring functional mobility changes in children enrolled in a community fitness programme

Objective: To examine the relative sensitivity to detect functional mobility changes with a full-length parent questionnaire compared with a computerized adaptive testing version of the questionnaire after a 16-week group fitness programme. Design: Prospective, pre- and posttest study with a 16-week group fitness intervention. Setting: Three community-based fitness centres. Subjects: Convenience sample of children (n = 28) with physical or developmental disabilities. Interventions: A 16-week group exercise programme held twice a week in a community setting. Main measures: A full-length (161 items) paper version of a mobility parent questionnaire based on the Pediatric Evaluation of Disability Inventory, but expanded to include expected skills of children up to 15 years old was compared with a 15-item computer adaptive testing version. Both measures were administered at pre- and posttest intervals. Results: Both the full-length Pediatric Evaluation of Disability Inventory and the 15- item computer adaptive testing version detected significant changes between pre and posttest scores, had large effect sizes, and standardized response means, with a modest decrease in the computer adaptive test as compared with the 161-item paper version. Correlations between the computer adaptive and paper formats across pre and posttest scores ranged from r = 0.76 to 0.86. Conclusions: Both functional mobility test versions were able to detect positive functional changes at the end of the intervention period. Greater variability in score estimates was generated by the computerized adaptive testing version, which led to a relative reduction in sensitivity as defined by the standardized response mean. Extreme scores were generally more difficult for the computer adaptive format to estimate with as much accuracy as scores in the mid-range of the scale. However, the reduction in accuracy and sensitivity, which did not influence the group effect results in this study, is counterbalanced by the large reduction in testing burden.

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.

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.

A computer adaptive testing approach for assessing physical functioning in children and adolescents

The purpose of this article is to demonstrate: (1) the accuracy and (2) the reduction in amount of time and effort in assessing physical functioning (self‐care and mobility domains) of children and adolescents using computer‐adaptive testing (CAT). A CAT algorithm selects questions directly tailored to the childs ability level, based on previous responses. Using a CAT algorithm, a simulation study was used to determine the number of items necessary to approximate the score of a full‐length assessment. We built simulated CAT (5‐, 10‐, 15‐, and 20‐item versions) for self‐care and mobility domains and tested their accuracy in a normative sample (n=373; 190 males, 183 females; mean age 6y 11mo [SD 4y 2m], range 4mo to 14y 11mo) and a sample of children and adolescents with Pompe disease (n=26; 21 males, 5 females; mean age 6y 1mo [SD 3y 10mo], range 5mo to 14y 10mo). Results indicated that comparable score estimates (based on computer simulations) to the full‐length tests can be achieved in a 20‐item CAT version for all age ranges and for normative and clinical samples. No more than 13 to 16% of the items in the full‐length tests were needed for any one administration. These results support further consideration of using CAT programs for accurate and efficient clinical assessments of physical functioning.

Effects of aquatic aerobic exercise for a child with cerebral palsy: single-subject design.

Purpose: The purpose of this study was to evaluate the effects of an aquatic aerobic exercise program for a child with cerebral palsy. Methods: A 5-year-old girl with spastic diplegia classified at level III on the Gross Motor Function Classification System participated in this single-subject A-B-A design study. The aquatic aerobic exercise intervention was carried out 3 times per week for 12 weeks at an intensity of 50% to 80% of heart rate reserve. The Canadian Occupational Performance Measure, Gross Motor Function Measure, and 6-minute walk test were used as outcomes. Results: Statistically significant improvements were found in the participation, activity, and body function components of the International Classification of Functioning, Disability, and Health model. Improvements in functional abilities and walking endurance and speed were recorded. Conclusion: These findings suggest that an aquatic aerobic exercise program was effective for this child with cerebral palsy and support the need for additional research in this area.