Rasch analysis of the assessment of children's hand skills in children with and without disabilities

The Assessment of Children's Hand Skills (ACHS) is a new assessment tool that utilizes a naturalistic observational method to capture children's real-life hand skill performance when engaging in various types of activities. The ACHS also intends to be used with both typically developing children and those presenting with disabilities. The purpose of this study was to further investigate the construct validity of the ACHS using the Rasch analysis. Participants included 64 typically developing children and 70 children with disabilities in the age range of 2-12 years. Rasch analysis results confirmed the appropriateness of the ACHS's 6-level rating scale in this combined group of children. All 22 activity items and 19 of the 20 hand skill items in the ACHS formed a unidimensional scale and were ordered according to difficulty as clinically and developmentally expected. The ACHS also exhibited sufficient response validity and item-difficulty range when applied to children with disabilities as well as typically developing, preschool-age children. Furthermore, less than half of the ACHS items were found to exhibit differential item functioning with regard to gender (5 activity items) and disability (2 activity items and 7 hand skill items). Therefore, the ACHS shows preliminary evidence of construct validity for its clinical use in assessing children's hand skill performance in real-life contexts.     

Psychopathological correlates of anxiety sensitivity: evidence from clinical interviews and self-report measures

Most research on anxiety sensitivity (AS) and its relation to psychopathology has examined the Anxiety Sensitivity Index (ASI) in various clinical samples. The present study was the first to investigate psychopathological correlates of AS using self-report measures, the anxiety, somatoform, and substance use disorders sections of the Structured Clinical Interview for the DSM-IV (SCID), and open-ended interview questions about the subjective meaning and origins of AS. A college student sample (N=317) was used for the correlational analysis, and subsamples of high-AS (n=44) and low-AS (n=41) participants completed the interviews. Despite having an ASI score (Mean=35.0) that was equivalent to that observed in panic disorder samples, the screening questions in the clinical interview indicated that only 55% of high-AS participants had panic attacks and the diagnostic assessment indicated that only 30% met criteria for an anxiety disorder. Several findings suggested that AS, at least as measured by the ASI, was strongly related to anxiety disorder symptoms and diagnoses, although there was substantial variation within the anxiety disorder classifications. There was also evidence that AS might extend to a broader catastrophic style concerning bodily symptoms and health that go beyond anxiety symptoms per se. The subjective meaning of AS derived from the interview data stressed the need for a formal, structured interview of AS.     

Construct validity of the Children's Hand-Skills ability Questionnaire (CHSQ) in children with disabilities: a Rasch analysis

The Children's Hand-Skill ability Questionnaire (CHSQ) is a new parent-report questionnaire that assesses children's manual ability in three domains: leisure and play, school/education, and activities of daily living. The CHSQ can be used with children presenting with a range of disabilities and works as a companion assessment before detailed performance-based observations of hand skill are completed. This study further investigated the internal and external construct validity of the CHSQ. Participants included 53 Australian children and 70 Taiwanese children with known disabilities ranging age from 2 to 12 years. Rasch analysis results confirmed the appropriateness of the CHSQ's 3-level rating scale in this combined group of children. Twenty-one of the 22 items in the CHSQ formed three individual unidimensional scales representing with the domains of leisure and play, school/education, and activities of daily living. The CHSQ also exhibited sufficient person-response validity (all the three domains) and item-difficulty range (all but one domain) when applied to children with disabilities. Less than half of the CHSQ items were found to exhibit differential item functioning with regards to gender (4 items) and cultural difference (7 items). In addition, moderate to high correlations (0.61 ≤ Pearson's r coefficients ≤ 0.76, p<0.01) were found with the assessments of self-care and hand skill performance. Therefore, the CHSQ exhibits preliminary evidence of construct validity for its clinical use in obtaining children's manual ability based on parent-report information.     

Neuropsychological measures of attention and memory function in schizophrenia: relationships with symptom dimensions and serum monoamine activity

Background  

Some clinical symptoms or cognitive functions have been related to the overall state of monoamine activity in patients with schizophrenia, (e.g. inverse correlation of the dopamine metabolite HVA with delusions or visual-masking performance). However, profiles (as presented here) of the relations of the activity of dopamine, noradrenaline and serotonin to neuropsychologic (dys)functions in major patient sub-groups with their very different symptomatic and cognitive characteristics have not been reported.     

水中运动训练对帕金森病患者运动功能、平衡功能和行走能力的康复作用

目的探讨水中运动训练对帕金森病患者运动功能、平衡功能和行走能力的康复作用。方法共40例原发性帕金森病患者随机接受常规陆上康复训练(陆上组,20例)和水中运动训练(水中组,20例),分别于训练前和训练8周时采用统一帕金森病评价量表第三部分(UPDRSⅢ)评价运动功能、Berg平衡量表(BBS)和起立-行计时走测验(TUGT)评价平衡功能、6分钟步行试验(6MWT)和10米步行试验(10MWT)评价行走能力。结果两组患者训练8周时UPDRSⅢ评分(P=0.000)和TUGT时间(P=0.000)低于训练前,BBS评分(P=0.000)、6MWT时间(P=0.000)和10MWT步速(P=0.000)高于训练前;训练8周时水中组患者UPDRSⅢ评分(P=0.037)和TUGT时间(P=0.013)低于陆上组,BBS评分高于陆上组(P=0.018)。结论常规陆上康复训练和水中运动训练均可以改善帕金森病患者运动功能、平衡功能和行走能力,特别是在运动功能和平衡功能方面水中运动训练效果优于常规陆上康复训练。     

Behavioral problems of adolescents with chronic physical illness: A comparison of parent-report and self-report measures

This study reports on the extent of behavior problems in Israeli adolescents suffering from chronic illness. A comparison was made between parent-reported and self-reported behavioral symptomatology using the Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR). 103 outpatients, aged 11–16 years, suffering from cystic fibrosis (CF), asthma, or hematological/oncological conditions were assessed. Healthy adolescents and adolescents referred for psychiatric assessment comprised the comparison groups. Parent- and self-reports were significantly positively correlated in each group (all chronically ill children r=.22; Healthy group r=.27; psychiatric group r=.50), but the correlations were particularly low (and non-significant) in younger adolescents with hematological/oncological conditions or HCF., pointing to the need for physicians to include parents' and adolescents' viewpoints in their assessments of these adolescents' psychosocial state. The mean number of parent-reported and self-reported behavior problems in the illness groups was no different from that of the Healthy group but significantly lower than that of the psychiatric group.

---

Zusammenfassung Diese Studie beleuchtet das Ausmaß von Verhaltensauffälligkeiten bei Jugendlichen aus Israel, die an einer chronischen Erkrankung leiden. Die Symptomatologie auf der Verhaltensebene wurde einerseits von den Eltern mit Hilfe der Child Behavior Checklist (CBCL), andererseits von den Jugendlichen selbst mit Hilfe des Youth Self-Report (YSR) erhoben und miteinander verglichen. Es wurden 103 ambulante Patienten im Alter von 11–16 Jahren untersucht, die an zystischer Fibrose, Asthma oder hämatologischen/ onkologischen Erkrankungen litten. Gesunde Jugendliche und Jugendliche, die zur psychiatrischen Untersuchung überwiesen worden waren, bildeten die Kontrollgruppen. Die Eltern- und Selbsteinschätzungen zeigten eine signifikante positive Korrelation in allen Gruppen (alle chronisch kranken Kinder r=.22; gesunde Gruppe r=.27; psychiatrische Gruppe r=.50). Aber die Korrelationen waren besonders niedrig (und nicht signifikant) bei den jüngeren Jugendlichen mit hämatologischen/onkologischen Erkrankungen oder zystischer Fibrose, woraus gefolgert werden kann, daß Ärzte sowohl die Eltern- als auch die Selbsteinschätzungen für eine adäquate Beurteilung des psychosozialen Zustandes dieser Jugendlichen einbeziehen müssen. Die durchschnittliche Anzahl der von den Eltern und den Jugendlichen selbst berichteten Verhaltensauffälligkeiten in den Erkrankungsgruppen wichen nicht signifikant von der gesunden Kontrollgruppe ab, waren jedoch signifikant niedriger als in der psychiatrischen Kontrollgruppe.

---

Résumé Cette étude rapporte les problèmes de comportement d'adolescents israéliens souffrant de maladie chronique. Une comparaison fut faite entre les rapports établis par les parents et la Symptomatologie comportementale auto-évaluée au moyen de la Child Behavior Checklist (CBCL) et la Youth Self-Report (YSR). 103 patients de la consultation âgés de 11 à 16 ans souffrant de mucovicidose (CF) d'asthme ou de pathologie hématologique ou oncologique furent évaluée. Des adolescents sains et des adolescents adressés pour une évaluation psychiatrique fournissaient les groupes de comparaison. Les rapports des parents et les rapports des adolescents étaient positivement corrélés dans chaque groupe (tous les enfants ayant une maladie chronique r=.22; group sain r=.27; groupe psychiatrique r=.50), mais les corrélations étaient particulièrement basses (et non significatives) chez les adolescents plus jeunes avec les pathologies hématologique ou oncologique ou la mucovicidose (CF), pointant le besoin pour les médecins d'inclure les points de vue des parents et des adolescents tant leurs évaluations de l'état psychosocial de ces adolescents. Le nombre moyen de problèmes comportementaux rapportés par les parents et par les adolescents dans le groupe malade, n'était pas différent de celui du groupe sain, mais significativement plus bas que celui du groupe psychiatrique.

     

Health-related quality of life in children with epilepsy: development and validation of self-report and parent proxy measures

PURPOSE: To answer a need to include and measure accurately the impact and burden of epilepsy as outcomes of interventions with affected children, we developed and validated self-report and parent-proxy respondent health-related quality of life (HRQL) instruments for preadolescent children with epilepsy. METHODS: We combined qualitative and quantitative research methods. Items were extracted from focus group discussions involving children with epilepsy and their parents. We created scales formatted with alternative paired options of forced responses and used factor analysis to generate relevant subscales and reduce the number of items. We checked internal consistency, assessed test-retest reliability 10-14 days apart, and documented construct validity. RESULTS: A sample of 381 children with epilepsy, age 6-15 years, and their parents independently completed a 67-item questionnaire, from which we chose five items for each subscale. The measures share four subscales, but each measure has an additional distinct subscale. The children and parents could discern differences and report differentially between the various aspects of the HRQL. Internal consistency measured with Cronbach's alpha was acceptable for all subscales; construct validity has been demonstrated from the testing of several hypotheses. Test-retest reliability examined with the intraclass correlation coefficient was satisfactory for the parents and for children age 8 years and older. The correlations between the mothers' and children's responses was poor to moderate. CONCLUSIONS: The data demonstrate sound psychometric properties for both related measures, which are easy to administer for children with epilepsy who are 8 years and older and their parents. The subscales encompass HRQL dimensions judged most important by children with epilepsy for the self-report measure and by parents for the proxy response measure. The parent-proxy measure should be useful as a complement to the child self-report measure in evaluating the validity of parental assessment of the child's health status; in longitudinal outcome research; and in HRQL assessment of children who are unable to respond independently.     

Somatosensory system in two types of motor reorganization in congenital hemiparesis: topography and function

This study investigates the (re-)organization of somatosensory functions following early brain lesions. Using functional magnetic resonance imaging (fMRI), passive hand movement was studied. Transcranial magnetic stimulation (TMS) and magnetoencephalography (MEG) were used as complementary methods. fMRI data was analyzed on the first level with regard to topographical variability; second-level group effects as well as the overall integrity of the somatosensory circuitry were also assessed. Subjects with unilateral brain lesions occurring in the third trimester of pregnancy or perinatally with different types of motor reorganization were included: patients with regular, contralateral motor organization following middle cerebral artery strokes (CONTRA(MCA), n = 6) and patients with reorganized, ipsilateral motor functions due to periventricular lesions (IPSI(PL), n = 8). Motor impairment was similar, but sensory impairment was more pronounced in the CONTRA(MCA) group. Using fMRI and MEG, both groups showed a normal pattern with a contralateral somatosensory representation, despite the transhemispherically reorganized primary motor cortex in the IPSI(PL) group, as verified by TMS. Activation topography for the paretic hands was more variable than for the nonparetic hand in both groups. The cortico-cerebellar circuitry was well-preserved in almost all subjects. We conclude that in both models of motor reorganization, no interhemispheric reorganization of somatosensory functions occurred. Also, no relevant intrahemispheric reorganization was observed apart from a higher topographical variability of fMRI activations. This preserved pattern of somatosensory organization argues in favor of a differential lesion effect on motor and somatosensory functions and demonstrates a limited compensatory potential for the latter.     

Glycine-immunoreactive terminals in the rat trigeminal motor nucleus: light- and electron-microscopic analysis of their relationships with motoneurones and with GABA-immunoreactive terminals

Post-embedding immunolabelling methods were applied to semi-thin and ultrathin resin sections to examine the relationships between glycine- and γ-aminobutyric acid (GABA)-immunoreactive terminals on trigeminal motoneurones, which were identified by the retrograde transport of horseradish peroxidase injected into the jaw-closer muscles. Serial sections were cut through boutons and alternate sections were incubated with antibodies to glycine and GABA. Light-microscopic analysis of semi-thin sections revealed a similar pattern of glycine and GABA-immunoreactive boutons along the motoneurone soma and proximal dendrites, and of immunoreactive cell bodies in the parvocellular reticular and peritrigeminal areas surrounding the motor nucleus. Immunoreactive synaptic terminals on motoneurones were identified on serial ultrathin sections at electron-microscopic level using a quantitative immunogold method. Three populations of immunolabelled boutons were recognized: boutons immunoreactive for glycine alone (32%), boutons immunoreactive for GABA alone (22%), and boutons showing co-existence of glycine and GABA immunoreactivities (46%). Terminals which were immunoreactive for glycine only contained a higher proportion of flattened synaptic vesicles than those which were immunoreactive for GABA only, which contained predominantly spherical vesicles. Terminals which exhibited both immunoreactivities contained a mixture of vesicle types. All three classes of terminal formed axo-dendritic and axo-somatic contacts onto retrogradely labelled motoneurones. A relatively high proportion (25%) of boutons that were immunoreactive for both transmitters formed synapses on somatic spines. However, only GABA-immunoreactive boutons formed the presynaptic elements at axo-axonic contacts: none of these were found to contain glycine immunoreactivity. These data provide ultrastructural evidence for the role of glycine and GABA as inhibitory neurotransmitters at synapses onto jaw-closer motoneurones, but suggest that presynaptic control of transmission at excitatory (glutamatergic) synapses on motoneurones involves GABAergic, but not glycinergic inhibition.     

Long-term immune-endocrine effects of bereavement: relationships with anxiety levels and mood

Psychological, endocrine and immune parameters were measured over a 6-month period in 14 healthy subjects who underwent an unpredictable acute emotional stress (e.g. sudden death of a loved one) compared with 14 controls who did not. Probands were profoundly stressed as assessed 10 days after bereavement by their scores on the Hamilton Rating Scales of Anxiety and Depression, adrenocorticotropin and cortisol plasma concentrations, and non-suppression in response to dexamethasone. Functional alterations of immune parameters, such as responsiveness of peripheral blood lymphocytes to mitogens, were found 40 days after bereavement. Despite a normal number of circulating lymphocyte subsets, the functional activity of natural killer (NK) cells was markedly reduced at day 40. Changes in the intracellular concentration of beta-endorphin in peripheral blood mononuclear cells correlated with anxiety and depression scores. Controls showed no changes in psychometric, endocrine and immune measures during the 6-month study. Cluster analysis revealed two groups of bereaved subjects with different patterns of immune and endocrine changes: (1) Five subjects, characterized by harm-avoidant temperament and long-lasting dysphoric mood, showed reduced responsiveness of peripheral blood lymphocytes to mitogens, decreased NK cell activity and non-suppression in response to dexamethasone that persisted for 6 months. (2) Nine subjects showed significant changes only during the early phase after bereavement. Our data suggest that the immunological consequences of stress do not simply overlap with psychological and endocrine alterations, and are particularly severe and long-lasting in a subgroup of subjects, indicating the importance of individual variability in the capacity to cope with stress.     

Conversations with autistic children: Contingent relationships between features of adult input and children's response adequacy

The relationship between certain features of adult speech and autistic children's response adequacy was examined within the context of unstructured, dyadic conversations. On separate sessions, four verbal, nonecholalic children were observed talking with their mothers and teachers. Analysis of conversational turns showed that as the number of facilitating features contained in adults' eliciting utterances increased, the proportion of adequate replies from the children increased. In this analysis, facilitating features included the use of Yes/No questions, questions that were conceptually simple, and questions that were semantically contingent on the child's topic. In a further analysis, it was found that adults tended to modify their use of these features in response to child feedback, although this tendency was relatively small and observed only in a minority of the sequences evaluated. The findings are discussed in terms of pragmatic deficits associated with autism and implications for intervention with this population.This research was supported in part by grants from the Boston University Graduate School and the National Institute of Mental Health (MH 38704). We thank Michelle Pellerin, Deborah Hay, and John Houlihan for their assistance with data collection and analysis. We also gratefully acknowledge the assistance and patience of participating staff, parents, and children of the League School, Newton, Massachusetts.     

Inter-relationships of functional status in cerebral palsy: analyzing gross motor function, manual ability, and communication function classification systems in children

Aim To investigate the relationships among the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS) in children with cerebral palsy (CP). Method Using questionnaires describing each scale, mothers reported GMFCS, MACS, and CFCS levels in 222 children with CP aged from 2 to17 years (94 females, 128 males; mean age 8y, SD 4). Children were referred from pediatric developmental/behavioral, physiatry, and child neurology clinics, in the USA, for a case–control study of the etiology of CP. Pairwise relationships among the three systems were assessed using Spearman’s correlation coefficients (r_s), stratifying by age and CP topographical classifications. Results Correlations among the three functional assessments were strong or moderate. GMFCS levels were highly correlated with MACS levels (r_s=0.69) and somewhat less so with CFCS levels (r_s=0.47). MACS and CFCS were also moderately correlated (r_s=0.54). However, many combinations of functionality were found. Of the 125 possible combinations of the three five‐point systems, 62 were found in these data. Interpretation Use of all three classification systems provides a more comprehensive picture of the child’s function in daily life than use of any one alone. This resulting functional profile can inform both clinical and research purposes.     

Techniques and applications of EMG: measuring motor units from structure to function

Needle electromyography (EMG) is an established method of evaluating motor unit and muscle fibre function and pathology in clinical practice, while the development of advanced techniques including single-fibre EMG and combined recordings with other modalities have become increasingly useful in research. The development of quantitative EMG in particular had led to greater reproducibility and inter-rater reliability. This review provides an overview of standard needle EMG as well as discussing advanced recording and analysis techniques and their increasing role in clinical research.     

基于镜像视觉反馈的作业疗法对偏瘫儿童运动功能及生活能力的影响

目的 探讨基于镜像视觉反馈的作业疗法对偏瘫儿童运动功能及生活能力的影响。方法 选取2016年1月-2018年1月本院收治的偏瘫患儿200例,依据随机数字表法分为镜业组和常业组,每组各100例,常业组给予常规作业疗法治疗,镜业组给予基于镜像视觉反馈的作业疗法治疗,比较干预前后2组运动功能、生活能力、康复效果。结果 镜业组和常业组干预3、6个月后Fugl-Meyer运动功能评分法(FMA)、日常生活能力量表(ADL)得分明显高于干预前,镜业组干预3、6个月后FMA、ADL得分明显高于常业组(P<0.05); 镜业组治疗有效率明显高于常业组(P<0.05)。结论 基于镜像视觉反馈的作业疗法可有效改善偏瘫患儿运动功能及生活能力,有利于提高康复效果。     

Association of lipid levels with motor and cognitive function and decline in advanced Parkinson's disease in the Mark-PD study

ObjectivesIn prospective cohort studies different blood lipid fractions have been identified as risk factors of Parkinson's disease (PD). However, data relating lipoproteins to disease phenotypes and progression in advanced PD patients are sparse. Therefore, we assessed the most common lipoproteins in a case-control design and evaluated their associations with motor and cognitive function and decline in PD patients.MethodsTriglycerides, LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), and lipoprotein a (Lp(a)) were analyzed in 294 PD patients of the MARK-PD study cohort and 588 controls matched for age, sex and cardiovascular risk factors. In PD patients, motor (MDS-UPDRS III, Hoehn-Yahr stage) and cognitive function (MoCA) were examined. In a sub-cohort (n = 98 patients), baseline lipid levels were correlated with motor and cognitive disease progression during a follow-up period of 523 ± 199 days.ResultsAt baseline, HDL-C levels were lower in PD patients compared to matched controls after adjustment. We observed a very weak association of Lp(a) levels with UDPRS III scores. In cross-sectional analyses, no other lipid fraction revealed a significant and consistent association with motor or cognitive function. During follow-up, no lipid fraction level was associated with motor or cognitive progression.ConclusionIn advanced PD, there is no strong and consistent association of lipid levels with motor or cognitive function and decline.     

Aspects of foot preference: Differential relationships of skilled and unskilled foot movements with motor asymmetry

In this research different aspects of foot preference were examined in 50 participants. The relationship between foot preference, hand preference, and hand/foot-tapping performance was analysed in detail. For foot preference, a practical behavioural test consisting of 14 daily foot movements was developed. After statistical analysis, five items were dropped. The test–retest reliabilities of the nine-item foot preference test and the foot-tapping task were found to be high. The factor analysis indicated a two-factor structure (skilled and unskilled foot movements). Foot preference in skilled and unskilled movements was correlated with hand preference and foot/hand-tapping speed. This correlation was found to be higher in skilled movements than in unskilled movements. Additionally, foot preference for skilled movements was strongly lateralised. The results indicate that the motor control of fine movements is similar for upper and lower limbs. The fact of lateralisation indicates that skilled and unskilled foot movements utilise different pathways. We propose that the asymmetrical lateral (corticospinal) pathway controls skilled movements while the medial pathways control unskilled movements. We therefore suggest that both skilled and unskilled foot tasks should be evaluated separately in order to assess foot preference.