Development of the Affordances in the Home Environment for Motor Development–Infant Scale

Background: The present study reports the development and application of the Affordances in the Home Environment for Motor Development–Infant Scale (AHEMD‐IS), a parental self‐report designed to assess the quantity and quality of affordances in the home environment that are conducive to motor development for infants aged 3–18 months. Methods: Steps in its development included use of expert feedback, establishment of construct validity, interrater and intrarater reliability, and predictive validity. With all phases of the project, 113 homes were involved. Results: Intraclass correlation coefficients for interrater and intrarater reliability for the total score were 1 and 0.94, respectively. In addition, results indicate that the test has the characteristic of differentiating a wide range of scores. Regression analysis for the AHEMD‐IS and motor development using the Alberta Infant Motor Scale supports preliminary evidence for predictive validity. Conclusion: Our findings suggest that the AHEMD‐IS has sufficient reliability and validity as an instrument for assessing affordances in the home environment, with clinical and research applications.     

Pediatric Oral Motor Feeding Assessments: A Systematic Review

Aim: To describe the clinical properties and psychometric soundness of pediatric oral motor feeding assessments. Methods: A systematic search was conducted using Medline, CINAHL, EMBASE, PsycInfo, and HAPI databases. Assessments were analyzed for their clinical and psychometric characteristics. Results: 12 assessment tools were identified to meet the inclusion/exclusion criteria. Clinical properties varied from assessments evaluating oral-motor deficits, screening to identify feeding problems, and monitoring feeding progress. Most assessments were designed for children with developmental disabilities or cerebral palsy. Eleven assessments had psychometric evidence, of these nine had reliability and validity testing (Ability for Basic Feeding and Swallowing Scale for Children, Behavioral Assessment Scale of Oral Functions in Feeding, Dysphagia Disorder Survey, Functional Feeding Assessment–modified, Gisel Video Assessment, Montreal Children's Hospital Feeding Scale, Oral Motor Assessment Scale, Schedule for Oral Motor Assessment, and Screening Tool of Feeding Problems Applied to Children). The Brief Assessment of Motor Function–Oral Motor Deglutition and the Pediatric Assessment Scale for Severe Feeding Problems had reliability testing only. The Slurp Test was not tested for any psychometric properties. Overall, psychometric evidence was inconsistent and inadequate for the evaluative tools.     

Reliability of the peabody developmental gross motor scale in children with cerebral palsy

The test/retest, intrarater, and interrater reliability of the Peabody Development Gross Motor Scale (PDGMS) was assessed in 12 children with mild or moderate cerebral palsy. A baseline test was administered, scored, and videotaped by one rater and rescored from the videotape by a second independent rater. In order to minimize the effect of developmental maturation, test/retest correlation coefficients of the tests were performed two weeks apart. The intraclass correlation coefficients ranged from 0.82 to 0.98. For interrater reliability, testing following the same protocol was repeated at 2 weeks, 3 and 6 months. Interrater correlation coefficients (r) ranged from 0.89 to 0.98. Interrater correlation coefficients (ICC) from scoring and later rescoring ten videotapes with the closest and furthest interrater agreement ranged from 0.88 to 0.99. The balance and locomotor skill categories were most responsive for assessing gross motor function in this population. These data support the use of the PDGMS as an assessment tool for children with cerebral palsy and the reliability of videotaping assessments.     

Validity and reliability of the school function assessment in elementary school students with disabilities

This study examined validity of the School Function Assessment (SFA) and interrater reliability of occupational therapist and teacher ratings of students' school function. The validity of the SFA was examined using the known-group method in 35 participants in kindergarten through 7th grade attending elementary schools; 15 students with learning disabilities (LD), 11 students with autism, and 9 students with traumatic brain injury (TBI). The SFA criterion scores for the 23 individual scales were clustered into five distinct parts for the validity analyses. Significant differences in SFA scores among the 3 groups of students were found using Kruskal-Wallis analyses (Chi2 ranged from 9.28 to 20.55, p <.01). Two discriminant analyses demonstrated high correct classification of students with autism and LD, but showed less accurate classification of students with TBI, indicating that the SFA scores of students with TBI did not fall into a systematic pattern for classification. For the interrater reliability study, 16 students' ratings by their teacher and occupational therapist were analyzed. Intraclass correlations resulted in moderate relationships between teacher and occupational therapist ratings for the average criterion scores for the three main sections of the SFA: participation,.70; task supports,.68; and activity performance,.73. Results of this study are discussed in terms of validity of score interpretation and the reliability of different team members completing the SFA questionnaire.     

中文版脑瘫儿童粗大运动功能分级系统的信度和效度研究

目的 确定中文版脑瘫儿童粗大运动功能分级系统（Gross Motor Function Classification System ,GMFCS）的信度和效度。方法 共有来自上海三家康复机构的91名0-12岁脑瘫儿童参加了此项研究，选择35名脑瘫儿童测定GMFCS的重测信度；以66名脑瘫儿童为对象测定GMFCS的评价者间信度；分别以88名脑瘫儿童的粗大运动功能评估量表（GMFM）和54例脑瘫儿童的Peabody粗大运动发育量表（PDMS-GM）的各项测试结果为效标确定GMFCS的平行效度；对88例同时接受GMFCS和GMFM评价的儿童的测试结果进行结构效度检测，以GMFCS为应变量，GMFM五个功能区的百分比为自变量进行多重逐步回归分析，判断粗大运动中五个分区功能对GMFCS的影响程度。结果 GMFCS具有良好的重测信度（ICC值为0.99），同时具有良好的评估者间信度（ICC为0.95-0.98）；GMFCS与GMFM和PDMS-GM各项分值之间有良好的平行效度，Spearman相关系数在-0.57到-0.84在之间；粗大运动功能中的坐位能力和行走能力是影响GMFCS的主要因素，校正决定系数为0.709（p<0.001）。 结论 中文版脑瘫儿童粗大运动功能分级系统的具有良好的信度和效度，适用于国内对脑瘫儿童进行功能分级。     

Concurrent Validity of Two Gait Performance Measures in Children with Neuromotor Disorders

Aims: To investigate the concurrent validity of two mobility performance measures, the Functional Mobility Scale (FMS) and the Gillette Functional Assessment Questionnaire – walking scale (FAQ) in an inpatient pediatric neurorehabilitation setting. Methods: Cross-sectional data were collected on 71 children (mean age 12.7 years) with neuromotor gait impairments who participated in an inpatient rehabilitation program to evaluate aspects of concurrent validity of the FMS and FAQ. Physiotherapists independently performed ratings. Comparator instruments included the walking item of the Functional Independence Measure for children, 10-m and 6-minute walking tests, and Gross Motor Function Measure-88 dimension E. All tests were completed within 7 days. Spearman correlation coefficients were calculated to test a priori formulated hypotheses regarding the strength and direction of the measures relationships. Results: The children had a broad spectrum of mobility levels, including all levels of FMS and levels 2–10 of FAQ. Spearman correlation coefficients with comparator measures varied between 0.58–0.79 for the FMS and 0.69–0.73 for the FAQ. Hypotheses concerning correlation strengths and directions were met for FMS and FAQ. Conclusions: The findings demonstrate that the FMS and FAQ are valid to evaluate functional mobility in pediatric inpatient neurorehabilitation.     

北极星移动评价量表在Duchenne型肌营养不良患儿中的信度研究

目的　了解北极星移动评价量表（North Star Ambulatory Assessment，NSAA）应用在Duchenne型肌营养不良（Duchenne muscular dystrophy，DMD）患儿中的组间信度及组内信度，并探讨通过录像法评测运动功能的可行性。方法　分析2017年7月至2017年11月北京大学第一医院使用NSAA对40例DMD患儿进行运动功能评估的资料。40例DMD患儿年龄4.3～13.4岁，均为男性；分为3个年龄亚组，＜5岁的10例，5～9岁的18例，＞9岁的12例。由3名治疗师A、 B、 C进行评估。在组间信度的研究中，评估者A应用NSAA对DMD患儿进行现场运动评估并摄像，评估者B、 C分别通过录像进行独立评分，通过三者对同一患儿的评分计算组间信度。在组内信度的研究中，与第1次评估至少间隔1个月以上，评估者分别根据录像对每个患儿进行第2次评估，根据评估者B、 C对同一患儿两次评估的评分计算组内信度。根据评估者A对同一患儿两次评估的评分，计算录像评分与现场评分的一致性。通过计算相关系数检测信度。结果　在组间信度的研究中，总体相关系数为0.990，各年龄亚组相关系数为0.971～0.992； 在组内信度的研究中，总体相关系数为0.987～0.988； 录像评分与现场评分一致性相关系数为0.980。结论　NSAA在评估DMD患儿运动功能水平时具有较高的信度，且现场评分和对录像评分一致性好，可能适用于远程康复评估。     

Reliability of the Functional Independence Measure for children in normal Thai children

BACKGROUND: The Functional Independence Measure for children (WeeFIM) is a new instrument for evaluating functionality in disabled children aged 9-100 months. It was developed to determine a child's functional capacity and performance. With no baseline information about Thai children, it is difficult to assess whether a patient is initially high or low with respect to function. METHODS: The aim of this study, therefore, was to evaluate the interrater, intrarater reliability and appropriateness of the use of the WeeFIM and to establish a normative data profile suitable for Thai children. The WeeFIM is an instrument used to assess independence in self-care, sphincter control, transfer, locomotion, communication, and social cognition. RESULTS: Direct interviews were conducted in the communities for 569 normal Thai children (289 girls and 280 boys) aged 6-100 months. The interrater and intrarater reliability scores were examined. The WeeFIM total and domain scores increased progressively with age. Intraclass correlation coefficients for the reliability for the WeeFIM domain score ranged from 0.90 to 0.99. Total WeeFIM intraclass correlation coefficients values were greater than 0.97 for all analyses. The authors classified the 18 items into six groups according to the degree of correlation with age. Most items were highly correlated with age as indicated by a Spearman's correlation coefficient greater than 0.8. The interrater and intrarater reliability of the WeeFIM subscores was high. CONCLUSION: The current study demonstrated that WeeFIM could be employed as a useful and reliable instrument for assessing functional independence for Thai children. Therefore, usage of WeeFIM with different age criteria for achieving independence should be adopted. Normative functional independence measures for a large group of Thai children will enhance the knowledge base about their development measurement and provide a database for future investigations on clinical population in Thailand.     

Plagiocephalometry: a non-invasive method to quantify asymmetry of the skull; a reliability study

Deformational plagiocephaly (DP) in newborns and very young children is a common problem in daily practice. The intrarater and interrater reliability of plagiocephalometry (PCM), a new, non-invasive, inexpensive instrument to assess and quantify the asymmetry of the skull, is evaluated at the outpatient Department of Physical Therapy of the Bernhoven Hospital at Veghel, The Netherlands. Using a thermoplastic material to mould the outline of the infant’s skull, a reproduction of the skull shape is performed on paper, allowing for accurate cephalometric measurements. Fifty children (aged 0–24 months), with or without positional preference of the head, and with or without DP, were measured three times by two separate, experienced pediatric physical therapists. Intraclass correlation coefficients (ICC) regarding the measurements of the drawn lines were all above 0.92 (intrarater reliability) and 0.90 (interrater reliability). The ICCs of the plagiocephaly indicators ear deviation (ED), antero-sinistra−antero-dextra (ASAD), postero-dextra−postero-sinistra (PDPS) and oblique diameter difference (ODD) were 0.88, 0.57, 0.92 and 0.96, respectively, for the intrarater reliability and 0.90, 0.65, 0.94 and 0.96, respectively, for the interrater reliability. The ICCs of the two indices oblique diameter difference index (ODDI) and cranial proportional index (CPI) were 0.97 and 0.96, respectively, for the intrarater reliability and 0.95 and 0.92, respectively, for the interrater reliability. The limits of agreement according to Bland Altman, comprising 95% of the differences between two measurements (2 sd), were 4.3 mm (ED), 5.9 mm (ASAD), 3.0 mm (PDPS), 3.4 mm (ODD), 2.7% (ODDI) and 4.5% (CPI) for the intrarater reliability, and 3.7 mm (ED), 5.2 mm (ASAD), 2.4 mm (PDPS), 3.3 mm (ODD), 2.9% (ODDI) and 5.8% (CPI) for the interrater reliability. Conclusion: We conclude that PCM is an easy-to-apply, non-invasive and reliable measurement instrument to assess skull asymmetry with good clinical accuracy and low application costs. PCM might serve as an instrument to be used in all levels of care for children with DP, and might provide information concerning the natural course of DP, as well as the assessment of the effects of conservative treatment strategies on DP.     

Motor performance checklist for 5-year-olds: a tool for identifying children at risk of developmental co-ordination disorder

OBJECTIVE: The aim of this study was to further evaluate the 'Motor Performance Checklist for 5-year-olds', an instrument which had been piloted with some success and reported via this journal in 1996. METHOD: Both validity and reliability in identifying children in most need of paediatric occupational therapy services was assessed. The Motor Performance Checklist was compared against a chosen 'gold standard' test, The Bruininks-Oseretsky test of Motor Proficiency, in a group of 141 5-year-old children. RESULTS: Correlations of 0.72 and 0.85 were found between the tests. The checklist was found to have a sensitivity of 83% and a specificity of 98%. Positive predictive validity was found to be 72% and negative predictive validity 99%. Interrater reliability ranged between 0.79 and 0.99 and intrarater reliability was 0.77. CONCLUSIONS: These results indicate that the Motor Performance Checklist has the potential to assist in identifying children in most need of referral to community occupational therapy services.     

Pain assessment in the neonate using the Bernese Pain Scale for Neonates

BACKGROUND: Neonates who require treatment in the neonatal intensive care unit (NICU) are subjected to many invasive painful procedures. AIMS: Assessment of pain in preterm and term neonates with or without ventilation on continuous positive airway pressure using the Bernese Pain-Scale for Neonates (BPSN). The validity and the reliability of the BPSN was established. STUDY DESIGN AND SUBJECTS: Pain assessments (n=288) were performed by 6 health care workers in different situations of term and preterm neonates. Each neonate (n=12) was observed in four given situations (after feeding, while a foot was being warmed, while a routine capillary blood sample was taken and 15 min after the blood sample was taken). Pain assessments were made by two nurses at the bedside using the BPSN, the Visual-Analogue Scale (VAS) and the Premature Infant Pain Profile (PIPP). At the same time, a video sequence was made which was shown later to four different nurses to assess pain using the BPSN, the PIPP, and the VAS. RESULTS: The construct validity of the BPSN was very good (F=41.3, p<0.0001). Moreover, concurrent and convergent validity of the BPSN compared to VAS and PIPP was r=0.86, and r=0.91, p<0.0001, respectively. Finally, the study demonstrated high coefficients for interrater (r=0.86-0.97) and intrarater reliability (r=0.98-0.99). CONCLUSION: The BPSN was shown to be a valid and reliable tool for assessing pain in term and preterm neonates with and without ventilation.     

A Systematic Review of the Predictive Validity of Neurobehavioral Assessments During the Preterm Period

Aims: For high-risk newborns, early assessment of neurobehavior that accurately predicts neurodevelopmental outcome is the first step towards determining early intervention needs. This study reviews systematically the validity of neurobehavioral assessments administered to premature newborns before term-equivalent age to predict long-term neurodevelopmental outcome. Methods: A systematic literature search of CINAHL, EMBASE, MEDLINE, PubMed, Web of Science, PsychInfo, Cochrane Library databases was conducted. PRISMA and COSMIN guidelines were followed. Results: Five assessments and 11 studies were identified: (a) Neonatal Behavioral Assessment Scale (NBAS); (b) Test of Infant Motor Performance (TIMP); (c) General Movements (GMs); (d) Neurobehavioral Assessment of the Preterm Infant (NAPI); (e) Neonatal Oral Motor Assessment Scale (NOMAS). Predictive validity estimates were variable. The GMs and TIMP showed the strongest associations with neurodevelopmental outcome. Threats to validity included small sample size, sample bias, limited reliability testing. Conclusions: Five neurobehavioral measures have established predictive validity for the assessment of premature newborns while they reside in the NICU. Although the GMs and TIMP have the strongest evidence, further higher quality research is required. New methods of testing should be developed that provide accurate prediction and minimize the potential stress induced during developmental assessments.     

Validity and reliability of a Swedish version of the Non‐Communicating Children’s Pain Checklist – Postoperative Version

Aim: To test the validity and reliability of a Swedish version of the Non‐Communicating Children’s Pain Checklist – Postoperative Version (NCCPC‐PV). Methods: Thirty‐two consecutive children/adolescents (2–20 years of age) with cognitive impairment and no verbal communication from four habilitation centres were admitted to the study. Each child’s behaviour was observed by a parent or a caregiver and by a physiotherapist in two calm and two painful situations within the child’s everyday life. The raters independently assessed and graded the child’s behaviour during 5 min according to the translated Swedish version of the NCCPC‐PV. The intrarater and interrater reliability were determined, and the construct validity was examined. Results: The results from 202 assessments showed that the construct validity was good: children’s behavioural signs differed significantly between situations of pain and situations of calm (p < 0.001). Repeated assessments showed poor agreement both within and between raters [intraclass correlation coefficient (ICC) 0.51–0.65]. The agreement for pain was good (ICC 0.83). Conclusion: The Swedish version of the NCCPC‐PV can be used for pain assessment in children with cognitive impairments who lack verbal communication. Aspects of reliability need to be further analysed.     

Reliable Classification of Functional Profiles and Movement Disorders of Children with Cerebral Palsy

ABSTRACT

Objective: To examine the inter-rater reliability of the Communication Function Classification System (CFCS), Bimanual Fine Motor Function (BFMF), Surveillance of Cerebral Palsy in Europe (SCPE) classification tree, and Gross Motor Function Classification System (GMFCS) in children with cerebral palsy (CP) and periventricular white matter injury (PWMI) aged 4–11 years. Method: Twenty children were assessed by two raters using the four tools, in addition parents undertook ratings on the Manual Ability Classification System (MACS). Kappa statistics were used to calculate the level of agreement between raters’ classifications. Results: Participants comprised 12 males and 8 females with CP and PWMI, mean age 8 years 1 month (standard deviation 2 years 3 months). Inter-rater reliability across the four tools was 0.98 (CFCS, BFMF, and GMFCS) and 0.84 (SCPE). Implications: These findings suggest that these four tools are reasonably robust to inter-rater variability supporting their routine use along with the MACS in clinical and research applications.     

复旦中文版神经肌肉疾病运动功能评估量表在儿童和青少年中的信度和效度研究

目的：验证复旦中文版神经肌肉疾病（NMD）运动功能评估量表（MFM）在中国儿童和青少年NMD中的信度和效度。 方法：2013年6月至2017年7月在复旦大学附属儿科医院（我院）神经科经基因检测或肌肉活检明确诊断为各类NMD、＞2岁且在我院康复科接受过复旦中文版MFM 20和MFM 32评估的患儿,排除1年内接受过手术、具有严重认知障碍和测试前3 d内从事过严重影响体力的活动患儿。2名物理治疗师同时进行MFM 20和MFM 32测试,检验不同测试者间的信度;同一评价者在第1次评价后间隔3~7d进行第2次评价,检测重测信度;以6 min步行距离（6MWT）和4项功能性计时测试为效度指标;通过分析MFM分值与之的相关性确定关联效度。通过分析纳入对象中杜氏进行性肌营养不良（DMD）患儿的MFM分值与北极星移动量表（NSAA）分值之间的相关性确定关联效度。 结果：372例患儿符合本文纳入排除标准,平均（6.5±2.7）岁,<7岁222例,男性338例,其中DMD 263例,重测信度（2~7岁16例,>7岁38例）和测试者间信度（2~7岁16例,＞7岁29例）检测结果显示,MFM 32和MFM 20的总分和各分区分值ICC=0.89~0.97。基于372例患儿,MFM 32和MFM 20的总分和D1区分值与6MWT和功能性计时测试结果具有中等和较强的相关性（r=0.48~0.73）,与D2和D3分区的分值相关性为中等和较弱。在263例DMD患儿中,MFM 32和MFM 20的总分和D1区分值与NSAA分值的相关性为强和极强相关性。 结论：复旦中文版MFM量表在儿童和青少年NMD患儿中具有很好的信度和效度,可以有效地测定NMD患儿的运动功能状态。     

复旦中文版脑瘫幼儿手功能分级系统的信度和效度研究

摘要 目的：建立复旦中文版脑瘫幼儿手功能分级系统（Mini-MACS)的信度和效度。方法：以2017年10月至2017年11月在复旦大学附属儿科医院（我院）康复中心以及上海儿童康复合作群（8家单位）接受康复干预的1~4岁的脑瘫（CP）儿童为研究对象,排除有严重视觉和听觉障碍的CP儿童。通过分析现场操作评价和录像评价结果之间的关系确定Mini-MACS的重测信度;分析不同评估者间［主要照顾者、作业治疗师（OT师）、物理治疗师（PT师）］的评价结果确定Mini-MACS的评估者间信度;以脑瘫儿童精细运动能力测试（FMFM）的精细运动能力分值为效标确定Mini-MACS的平行效度。结果：76例CP儿童进入本文分析,其中我院康复中心18例,上海儿童康复合作群单位共58例;男46例,女30例;平均年龄（2.5±0.9）个月,1~2岁组25例,~3岁组23例,~4岁组28例;痉挛型四肢瘫29例,双瘫11例,偏瘫27例,手足徐动型2例,共济失调型2例,无法分类5例;粗大运动功能分级（GMFCS）Ⅰ级7例,Ⅱ级27例,Ⅲ级16例,Ⅳ级16例,Ⅴ级10例。OT师现场评价与录像评价结果间重测信度ICC值为0.96（95%CI：0.94~0.98）;OT师与PT师间的ICC值为0.97（95%CI：0.94~0.98）,OT师与主要照顾者ICC值为0.92（95%CI：0.86~0.95）;1~2岁组、~3岁组和~4岁组重测信度ICC值0.95~1.00,~4岁组评价者间信度低于1~2岁组和~3岁组,尤其是OT师与主要照顾者间的信度明显低于其他两组（ICC=0.64）。Mini-MACS与精细运动能力分值之间平行效度Spearman相关系数为-0.76。结论：中文版Mini-MACS具有良好的评价者间信度和平行效度,适用于对国内脑瘫幼儿进行手功能分级。