Rebecca Parks

Treatment late effects in long-term survivors of pediatric sarcoma

To assess health and musculoskeletal function in survivors of pediatric sarcomas.

Changes in Neurologic Function Tests May Predict Neurotoxicity Caused by Ixabepilone

PURPOSE To investigate baseline factors and neurologic function tests (NFTs) that may predict the development of grade 2 or higher peripheral neuropathy (PN) after treatment with ixabepilone, an epothilone microtubule-stabilizing agent with antitumor activity. PATIENTS AND METHODS Advanced breast cancer patients were treated with ixabepilone (6 mg/m2) for 5 consecutive days every 3 weeks in a phase II clinical trial. Physical examinations, questionnaires, nerve conduction studies, and NFTs, including the Jebsen Test of Hand Function (JTH) and the Grooved Pegboard Test (GPT), were performed at baseline and during subsequent cycles. RESULTS Forty-seven patients assessable for PN received a median of five cycles of therapy (range, one to 22 cycles). Nine of these patients developed grade 2 PN, and two developed grade 3 PN, with a median time to onset of 144 days (range, 6 to 189 days). Among these 11 patients, PN resolved in eight patients, with a median of 15 days (range, 6 to 346 days) after onset, but PN did not resolve in three patients during follow-ups at 76, 361, and 746 days after onset. GPT and changes of JTH scores at onset of PN were significantly different between patients with and without PN at comparable follow-up times (P = .006 and P = .002, respectively). Changes in GPT and JTH scores over the first two cycles were often associated with the development of PN by exploratory actuarial analysis. CONCLUSION Serious ixabepilone-induced neuropathy was relatively rare on the treatment schedule used. NFTs, such as JTH and GPT, may have utility for predicting PN, but further testing is needed.

Brief assessment of motor function: content validity and reliability of the oral motor scales.

Sonies BC, Cintas HL, Parks R, Miller J, Caggiano C, Gottshall SG, Gerber L: Brief assessment of motor function: Content validity and reliability of the oral motor scales. Objective:The Brief Assessment of Motor Function consists of five 0- to 10-point hierarchical scales designed for rapid assessment of gross, fine, and oral motor skills. We describe the development and evaluation of the two Brief Assessment of Motor Function Oral Motor Scales: Oral Motor Articulation and Oral Motor Deglutition. Design:This validation study employed an expert panel of 28 speech-language pathologists, who rated the Brief Assessment of Motor Function Oral Motor Scales items on a scale from 1 to 4 (disagree to agree) to establish content validity. For reliability, oral motor performances of 18 participants (6 mos–20 yrs) were videotaped to represent a wide range of articulation and deglutition capabilities. Four speech-language pathologists, and 1 undergraduate and 10 graduate speech-language pathology students rated the participants’ taped samples using the Brief Assessment of Motor Function Oral Motor Scales. Results:All items on the content validity questionnaire had average agreement scores that exceeded criteria, except two, which were not clearly worded; these were clarified. Interrater and intrarater reliability values were 0.997 and 0.986 for the Oral Motor Articulation Scale and 0.977 and 0.997 for the Oral Motor Deglutition Scale. Conclusions:Expert feedback and reliability procedures suggest that the Brief Assessment of Motor Function Oral Motor Articulation and Deglutition Scales represent the content that they are designed to assess and are reliable for rapid assessment of oral motor skills.

Brief assessment of motor function: content validity and reliability of the fine motor scale.

Purpose: The Brief Assessment of Motor Function Fine Motor Scale (FMS) allows rapid assessment, independent of age. This study was done to establish content validity of the FMS and to demonstrate FMS reliability. Methods: A standard questionnaire (“Disagree” to “Agree,” 1–4) was emailed to 28 expert panel members. Ten children with diagnoses including Proteus, Sheldon-Freeman, Smith-Lemli-Opitz, and Smith-Magenis syndromes were videotaped for reliability trials. Results: Expert panel members agreed that all 28 items should be included (means, 3.43–3.89); were functionally relevant (means, 2.93–3.82), were clearly worded (means, 2.71–3.61), and were easily discriminated (means, 3.32–4.0). Kappa values for interrater and intrarater reliability were 0.978 and 0.993, respectively. Conclusions: Feedback from an expert Panel supported content validity of the Brief Assessment of Motor Function FMS. Kappa values for interrater and intrarater reliability suggest this is a reliable instrument for rapid, objective fine motor assessment.

Motor Skill Development of Children with HIV Infection Measured with the Peabody Developmental Motor Scales.

Purpose: Improved health care for pregnant women who are HIV+ has minimized complications during delivery and resulted in a measurable cohort of children entering the health care system who are HIV+ with potential for motor disorders. This study was designed to determine how gross and fine motor skills were affected by HIV infection in children aged five years and younger using the Peabody Developmental Motor Scales, and to follow a subsample of these children for one and a half years to determine if their relative skill performances changed over time. Methods: A sample of 143 children who were HIV+ was evaluated using the Peabody Developmental Motor Scales for their gross and fine motor skills. Their performance scores were compared with the Peabody normative values for age‐matched healthy children. A subset of 22 children were reevaluated at six‐month intervals (six months; one year; one year six months) to determine if their gross and fine motor skills would change. Raw scores and Peabody Developmental Motor Quotients (DMQ, normalized to the reference population) were calculated. Results: The children who were HIV+ as a group performed below the 50th percentile of the normal reference population. During the one year six month study period, the children who were HIV+ improved in raw scores but did not improve in relative (DMQ) scores. The exceptions were the fine motor skill subcategories of “grasping” and “hand use,” for which the children who were HIV+ performed comparably with the reference population. Conclusions: Clinicians working with children who are HIV+ should emphasize intervention strategies generally designed to develop all gross motor skills and the specific fine motor skills of “eye‐hand coordination” and “manual dexterity.” (Pediatr Phys Ther 2002;14:74‐84)

Brief Assessment of Motor Function: Content Validity and Reliability of the Upper Extremity Gross Motor Scale.

ABSTRACT Content validity and reliability of the Brief Assessment of Motor Function (BAMF) Upper Extremity Gross Motor Scale (UEGMS) were evaluated in this prospective, descriptive study. The UEGMS is one of five BAMF ordinal scales designed for quick documentation of gross, fine, and oral motor skill levels. Designed to be independent of age and diagnosis, it is intended for use for infants through young adults. An expert panel of 17 physical therapists and 13 occupational therapists refined the content by responding to a standard questionnaire comprised of questions, which asked whether each item should be included, is clearly worded, should be reordered higher or lower, is functionally relevant, and is easily discriminated. Ratings of content validity exceeded the criterion except for two items, which may represent different perspectives of physical and occupational therapists. The UEGMS was modified using the quantitative and qualitative feedback from the questionnaires. For reliability, five raters scored videotaped motor performances of 10 children. Coefficients for inter-rater (0.94) and intra-rater (0.95) reliability were high. The results provide evidence of content validity and reliability of the UEGMS for the assessment of UEGM skill.

Psychosocial Characteristics of Women with a Delayed Diagnosis of Turner Syndrome

Objectives To characterize the psychosocial profiles of adult women diagnosed with Turner syndrome before (early diagnosis) and at or after (late diagnosis) 13 years of age. Study design Women with Turner syndrome ages 22 and older at evaluation (n = 110) participated in a cross‐sectional study at the National Institutes of Health. Researchers performed nonparametric and logistic regression analyses to assess early and late diagnosis cohorts on measures of depression, substance use, and perceptions of competence and identity. Results Of study participants, 47% received a Turner syndrome diagnosis at or after age 13 years. Median age at diagnosis was 12.0 years (range, 0‐43). Covariate‐adjusted models revealed that women with late diagnoses had an increased likelihood of developing mild to severe depressive symptoms (OR, 7.36) and a decreased likelihood of being perceived as competent (OR, 0.26). Women with a late diagnosis also exhibited more frequent substance use compared with women with early diagnoses. Conclusions These data suggest that Turner syndrome diagnoses received at or after age 13 years may contribute to adverse outcomes related to depression, substance use, and perceptions of competence. Delayed Turner syndrome diagnoses may place women and girls at risk for negative psychosocial development extending into adulthood. These findings indicate it is important for pediatricians to evaluate psychosocial domains in girls with Turner syndrome regularly, particularly among those diagnosed at age 13 years or older. Trial registration ClinicalTrials.gov: NCT00006334.