Tien Ni Wang

Functional performance of children with developmental coordination disorder at home and at school

This study investigated the functional performance of daily activities at home and at school in a population‐based sample of children with different degrees of motor coordination impairment and competence. Sixteen children (seven males, nine females; mean age 8y, SD 9mo) with developmental coordination disorder (DCD), 25 with suspected DCD ([sDCD] 17 males, eight females; mean age 7y 6mo, SD 8mo), and 63 children without motor problems (39 males, 24 females; mean age 7y 9mo, SD 7mo) were recruited from public schools (Grades 1–3, age 6y 4mo–9y 10mo) using the Chinese version of the Developmental Coordination Disorder Questionnaire, the Movement Assessment Battery for Children, and the Bruininks‐Oseretsky Test of Motor Proficiency. Functional performance was assessed using the Chinese versions of the Vineland Adaptive Behavior Scales and the School Function Assessment–Chinese version. The functional performance of children with DCD and sDCD was statistically significantly lower than those without DCD (p’s<0.05). χ2 and logistic regression analyses showed significant differences among all groups in the proportion of children scoring at the ‘inadequate’ adaptive level of home performance (p’s<0.05). There were also significant differences among the groups in the proportion of children scoring below the cut‐off in school performance (p’s<0.05). The findings show the pervasive impact of DCD on children’s functional performance in daily activities at home and at school.

Effects of home-based constraint-induced therapy versus dose-matched control intervention on functional outcomes and caregiver well-being in children with cerebral palsy.

This study compared home-based constraint-induced therapy (CIT) with a dose-matched home-based control intervention for children with cerebral palsy (CP). The differences in unilateral and bilateral motor performance, daily functions, and quality of parental well-being (i.e., the stress level of their parents) were evaluated. The study included 21 children with CP (age range, 48-119 months) who were randomly assigned to the CIT or control group. All participants received individualized home-based interventions, 3.5-4h a day, twice a week for 4weeks. Primary outcomes were measured by the Peabody Developmental Motor Scales II (PDMS-2) and the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) is the whole name of the assessment. All first letters of this instrument title should be in upper case. Secondary outcome measures were the Pediatric Motor Activity Log (PMAL), the Caregiver Functional Use Survey (CFUS), and the Parenting Stress Index-Short Form (PSI). Outcome measures were performed at baseline (pretreatment), 4weeks (posttreatment), and 6-month (follow-up). Compared with the control group, the CIT group exhibited significantly better performance in grasping control as measured by the PDMS-2, unilateral/bilateral motor efficacy as measured by the BOTMP, and unilateral hand function as measured by the PMAL immediately after the treatment. At the 6-month follow-up, CIT had beneficial effects on grasping control assessed by PDMS-2 and on unilateral/bilateral functional performance measured by the PMAL and CFUS. Parents in both groups reported comparable stress levels at the 6-month follow-up, although the parent-child dysfunctional interaction deteriorated more immediately after CIT than after the control intervention. The follow-up of this randomized controlled trial suggested beneficial effects of home-based CIT on unilateral grasping skills and unilateral/bilateral functional performance at 6 months. The higher stress level reported by the parents in the CIT group than in the control group at posttreatment is temporary and could be alleviated at a longer period of time. Home-based CIT is a feasible and effective alternative to the intervention administered at clinics.

Validity, Responsiveness, Minimal Detectable Change, and Minimal Clinically Important Change of the Pediatric Motor Activity Log in Children with Cerebral Palsy.

This study examined criterion-related validity and clinimetric properties of the Pediatric Motor Activity Log (PMAL) in children with cerebral palsy. Study participants were 41 children (age range: 28-113 months) and their parents. Criterion-related validity was evaluated by the associations between the PMAL and criterion measures at baseline and posttreatment, including the self-care, mobility, and cognition subscale, the total performance of the Functional Independence Measure in children (WeeFIM), and the grasping and visual-motor integration of the Peabody Developmental Motor Scales. Pearson correlation coefficients were calculated. Responsiveness was examined using the paired t test and the standardized response mean, the minimal detectable change was captured at the 90% confidence level, and the minimal clinically important change was estimated using anchor-based and distribution-based approaches. The PMAL-QOM showed fair concurrent validity at pretreatment and posttreatment and predictive validity, whereas the PMAL-AOU had fair concurrent validity at posttreatment only. The PMAL-AOU and PMAL-QOM were both markedly responsive to change after treatment. Improvement of at least 0.67 points on the PMAL-AOU and 0.66 points on the PMAL-QOM can be considered as a true change, not measurement error. A mean change has to exceed the range of 0.39-0.94 on the PMAL-AOU and the range of 0.38-0.74 on the PMAL-QOM to be regarded as clinically important change.

Systematic Review of Interventions Used in or Relevant to Occupational Therapy for Children With Feeding Difficulties Ages Birth–5 Years

Research articles on the effectiveness of feeding interventions for infants and young children were identified, appraised, and synthesized. Thirty-four studies met the inclusion criteria and were reviewed. Three broad intervention themes regarding feeding approaches were identified on the basis of their theoretical orientations. These three feeding approaches were (1) behavioral interventions, (2) parent-directed and educational interventions, and (3) physiological interventions. Synthesis of the evidence suggested that various feeding approaches may result in positive outcomes in the areas of feeding performance, feeding interaction, and feeding competence of parents and children. This synthesis of empirical evidence supporting interventions for feeding problems provides a foundation for future research to define the types of outcomes that can be expected for children with different diagnoses or functional impairments and to develop best practice guidelines.

Validity, Responsiveness, and Clinically Important Difference of the ABILHAND Questionnaire in Patients With Stroke

OBJECTIVE To investigate the criterion-related validity, responsiveness, and clinically important differences of the ABILHAND questionnaire in patients with stroke. DESIGN Validation and clinimetric study. SETTING Three medical centers. PARTICIPANTS Patients with stroke (N=51). INTERVENTIONS A total of 51 patients with stroke received 1 of 3 upper extremity rehabilitation programs for 4 weeks. MAIN OUTCOME MEASURES The ABILHAND and the criterion measures, including the Stroke Impact Scale (SIS), FIM, Nottingham Extended Activities of Daily Living (NEADL), and accelerometers, were administered at pretreatment and posttreatment. The score of the ABILHAND, given in logits, was based on the conversion of the ordinal score into a linear measure of ability. RESULTS Correlation coefficients (Pearson r) were moderate to large between the ABILHAND and SIS physical domains (.54-.66), fair to moderate between the ABILHAND and FIM-motor and NEADL (.28-.48), and moderate between the ABILHAND and accelerometer data (.45-.54). The responsiveness of the ABILHAND was large (standardized response mean=1.27). The minimal clinically important difference range for the ABILHAND was .26 to .35, and 51.0% of the patients showed a positive change that exceeded the lower bound of a clinically important difference after intervention. CONCLUSIONS The results support that the ABILHAND is an appropriate outcome measure for assessing upper extremity performance in daily activities in patients with stroke and is sensitive to detect change after rehabilitative interventions. The change score of a patient with stroke on the ABILHAND should reach .26 to .35 logits points to be regarded as a clinically important change.

Effects of Constraint-Induced Therapy Combined With Eye Patching on Functional Outcomes and Movement Kinematics in Poststroke Neglect

OBJECTIVE. We investigated the effect of constraint-induced therapy (CIT) plus eye patching (EP), CIT alone, and conventional treatment on functional performance, eye movement, and trunk-arm kinematics in stroke patients with neglect syndrome. METHOD. Twenty-four participants were recruited and randomly allocated to three intervention groups. All participants received intervention 2 hr/day, 5 days/wk, for 3 wk. Outcome measures included the Catherine Bergego Scale, eye movement, and trunk-arm kinematic analysis. RESULTS. The CIT + EP and CIT groups demonstrated larger improvements in functional performance than the control group. The CIT group showed better performance with left fixation points than the CIT+EP group and shorter reaction time than the control group. The CIT + EP group improved more in preplanned control and leftward trunk shift than the other two groups. CONCLUSION. CIT + EP and CIT were more effective interventions than conventional treatment of patients with neglect syndrome in daily functional performance.

Ability of three motor measures to predict functional outcomes reported by stroke patients after rehabilitation.

OBJECTIVE This investigation examined the demographic characteristics along with 3 measures of motor function in determining outcomes in activities of daily living (ADL) after distributed constraint-induced therapy (dCIT). METHODS The study recruited 69 stroke patients who received 3 weeks of dCIT for 2 hours daily, 5 days a week. The self-reported outcome measures for daily function were the Motor Activity Log (MAL) including the amount of use (AOU) and quality of movement (QOM), Nottingham Extended Activities of Daily Living Questionnaire (NEADL), and the Stroke Impact Scale (SIS). Age, sex, onset, side of stroke, Fugl-Meyer assessment (FMA), Wolf Motor Function Test (WMFT), and Action Research Arm Test (ARAT) were the potential predictors. RESULTS The ARAT grasp-grip-pinch score was the most dominant predictor for MAL-AOU and NEADL (P< 0.05), and the ARAT total score for the subscore of the ADL/instrumental ADL section of the SIS (P< 0.05). The FMA wrist-hand score was a significant predictor for MAL-QOM (P< 0.05). Age was the only demographic factor that significantly predicted NEADL performance (P< 0.05). CONCLUSION Among the 3 commonly used measures of motor function after stroke, ARAT was the strongest determinant in predicting MAL-AOU, MAL-QOM, and SIS-ADL/instrumental ADL after dCIT.

Logistic Regression Analyses for Predicting Clinically Important Differences in Motor Capacity, Motor Performance, and Functional Independence after Constraint-Induced Therapy in Children with Cerebral Palsy.

Given the growing evidence for the effects of constraint-induced therapy (CIT) in children with cerebral palsy (CP), there is a need for investigating the characteristics of potential participants who may benefit most from this intervention. This study aimed to establish predictive models for the effects of pediatric CIT on motor and functional outcomes. Therapists administered CIT to 49 children (aged 3-11 years) with CP. Sessions were 1-3.5h a day, twice a week, for 3-4 weeks. Parents were asked to document the number of restraint hours outside of the therapy sessions. Domains of treatment outcomes included motor capacity (measured by the Peabody Developmental Motor Scales II), motor performance (measured by the Pediatric Motor Activity Log), and functional independence (measured by the Pediatric Functional Independence Measure). Potential predictors included age, affected side, compliance (measured by time of restraint), and the initial level of motor impairment severity. Tests were administered before, immediately after, and 3 months after the intervention. Logistic regression analyses showed that total amount of restraint time was the only significant predictor for improved motor capacity immediately after CIT. Younger children who restrained the less affected arm for a longer time had a greater chance to achieve clinically significant improvements in motor performance. For outcomes of functional independence in daily life, younger age was associated with clinically meaningful improvement in the self-care domain. Baseline motor abilities were significantly predictive of better improvement in mobility and cognition. Significant predictors varied according to the aspects of motor outcomes after 3 months of follow-up. The potential predictors identified in this study allow clinicians to target those children who may benefit most from CIT.

Neuromotor outcomes in children with very low birth weight at 5 yrs of age

Objective: The aim of this study was to assess a cohort of children with very low birth weight (VLBW) with premature history at the age of 5 yrs for the proportion of deficits in growth, motor, cognitive, and adaptive functions and to compare them with children with normal birth weight (>2500 g) in these areas. Design: This is a descriptive, exploratory study using a convenience sample. A cohort of 160 children with VLBW and 124 children with normal birth weight were examined. Standardized clinical and neuropsychologic assessments were administered. Correlation and multiple comparison procedures were used to analyze the relationships among all continuous outcome variables. Results: There is a significant difference in overall performance between the VLBW children and children with normal birth weight. Deficits in motor, cognitive, visual perception, visual‐motor, and adaptive functions were more prominent when we further examined the VLBW children with motor problems. Conclusions: The VLBW children performed more poorly at age 5 yrs than did their counterparts. This validates the need for early screening and regular follow‐up of VLBW preterm children, particularly those who have motor problems.

Psychometric comparison of the shortened Fugl-Meyer Assessment and the streamlined Wolf Motor Function Test in stroke rehabilitation

Objective: We aimed to compare the responsiveness, concurrent and predictive validity of the shortened Fugl-Meyer Assessment (S-FMA) and the streamlined Wolf Motor Function Test (S-WMFT) in persons with subacute stroke. Design: Test–retest design. Setting: Departments of physical medicine and rehabilitation at three hospitals. Participants: Participants with first-time stroke (N = 51; 38 men, 13 women; mean age ± SD, 55.1 ± 11.7 years) based on scores of Mini-Mental State Examination and Brunnstrom stage. Interventions: Participants received one of three rehabilitation therapies for three weeks and were evaluated at baseline and end of treatment. Main outcome measures: Responsiveness was examined using the paired t-test and the standardized response mean (SRM). Criterion validity was investigated using the Pearson’s correlation coefficient (r). Results: Changes from baseline to end of treatment assessed by both tests were significant (P < 0.001). The value for responsiveness of the S-FMA was significantly higher than that of the S-WMFT (SRM difference, 0.48; 95% confidence interval, 0.23–0.63). There were stronger associations between the comparison scales and the S-FMA (r = 0.57–0.68) than with the S-WMFT (r = 0.39–0.58). Conclusions: The S-FMA had better concurrent and predictive validity than the S-WMFT and was more sensitive to changes caused by rehabilitation therapies. The S-FMA is recommended for expedited assessment of arm motor function outcome in stroke patients receiving rehabilitative therapy.