Construct validity of the Capacity Profile in preschool children with cerebral palsy

The Capacity Profile (CAP) classifies additional care needs, subdivided into five domains of body functions (physical health, motor, sensory, mental, and voice/speech) of children with stable conditions. Construct validity of the CAP was established in 72 children (56 males, 16 females) with cerebral palsy (CP); median age 2 years 7 months, range 2 years 6 months to 3 years; 34 unilateral and 37 bilateral spastic-type CP, one dyskinetic-type CP. Gross Motor Function Classification System (GMFCS) classification was 24 in level I, eight in level II, 18 in level III, 14 in level IV, and eight in level V. All CAP domains were significantly associated ( p <0.001) with the Functional Skills (rho=−0.42 to −0.85) and Caregiver Assistance scales (rho=−0.42 to −0.82) of the Dutch Paediatric Evaluation of Disability Inventory. The CAP-motor domain and GMFCS were strongly correlated (rho=0.91, p <0.001). Stepwise regression analysis demonstrated that the CAP domains contributed 74% to mobility (CAP-motor 66%, mental 6%, voice 2%); 75% to self-care (CAP-voice 61%, mental 12%, physical 2%); and 70% to social functionality (CAP-mental 68%, voice 2%). CAP demonstrated good construct validity in young children with CP. The independent contribution of CAP domains to daily function underscores the importance of comprehensive assessment with regard to all domains of body functions in heterogeneous conditions like CP.     

Rapid and efficient method for the preparation of Fmoc-amino acids starting from 9-fluorenylmethanol

A method is presented for the high-yield synthesis of Fmoc amino acids, which precludes racemization and over-reaction due to carboxyl activation. A detailed procedure is given for the preparation of Fmoc-ONSu.     

运用《国际功能、残疾和健康分类》比较脑卒中康复功能性结局测量的内容

目的确定常用于脑卒中康复结局测量内容，主要是关于活动和参与的，并与《国际功能、残疾和健康分类》（ICF）对照。方法将以下量表的结构与ICF建立联系：Barthel指数（BI）、Berg平衡功能量表（BBS）、Chedoke McMaster脑卒中评定量表（CMSA）、Euroqol-5D欧洲牛活质量量表（EQ5D）、FIM功能独立性测量、Frenchay活动指数、Nottingham健康测验（NHP）、Rankin量表（Rs）、Rivermead动作测量（RMA）、Rivermead移动指数（RMI）、中风影响测验-30（SASIP30）、医学结局研究简表（SF36），卒中影响量表（SIS）、脑卒中特定生存质量量表（SSQOL）和站苞行走测验（TUG）。结果功能性结局测量中的绝大多数结构可与ICF分类建立联系。这些测量工具可以归入活动和参与的成份，活动是测量工具中最常见的类目内容。虽然测量工具的选择是基于它们主要关注的“活动”与“参与”内容，但有27％的结构属于身体功能类目，也有大约10％的结构与ICF不相关。结论在脑卒中的康复中，ICF是一种有效的工具来检测和比较脑卒中各测量工具的内容。这些内容上的比较使得临床医生和研究者们选择最符合他们兴趣和要求的测量。     

Relationship between gross motor capacity and daily‐life mobility in children with cerebral palsy

Aim The aim of this study was to examine the relationship between gross motor capacity and daily‐life mobility in children with cerebral palsy (CP) and to explore the moderation of this relationship by the severity of CP. Method Cross‐sectional analysis in a cohort study with a clinic‐based sample of children with CP (n=116; 76 males, 40 females; mean age 6y 3mo, SD 12mo, range 4y 8mo–7y 7mo) was performed. Gross motor capacity was assessed by the Gross Motor Function Measure (GMFM‐66). Daily‐life mobility was assessed using the Pediatric Evaluation of Disability Inventory (PEDI): Functional Skills Scale (FSS mobility) and Caregiver Assistance Scale (CAS mobility). Severity of CP was classified by the Gross Motor Function Classification System (48% level I, 17% level II, 15% level III, 8% level IV, 12% level V), type of motor impairment (85% spastic, 12% dyskinetic, 3% ataxic), and limb distribution (36% unilateral, 49% bilateral spastic). Results Scores on the GMFM‐66 explained 90% and 84% respectively, of the variance of scores on PEDI‐FSS mobility and PEDI‐CAS mobility. Limb distribution moderated the relationship between scores on the GMFM‐66 and the PEDI‐FSS mobility, revealing a weaker relationship in children with unilateral spastic CP (24% explained variance) than in children with bilateral spastic CP (91% explained variance). Interpretation In children aged 4 to 7 years with unilateral spastic CP, dissociation between gross motor capacity and daily‐life mobility can be observed, just as in typically developing peers.     

Use of the GMFCS in infants with CP: the need for reclassification at age 2 years or older

The stability of the Gross Motor Function Classification System (GMFCS) over time is described in 77 infants (41 boys, 36 girls) with cerebral palsy (CP; mean age 19.4mo [SD 1.6 mo]; 27 unilateral spastic, 42 bilateral spastic, eight dyskinetic type) and in the same children at follow-up at age 2 to 4 years. The overall level of agreement over time (linear weighted kappa) was 0.70 (95% confidence interval [CI] 0.61−0.79). The overall percentage of children whose GMFCS level changed one or two levels was 42%, of which the majority were reclassified to a less functional level (McNemar's Chi² test p =0.11). The chance that children initially classified in the combination of GMFCS Levels I, II, and III would subsequently be classified in the same level in early childhood was 96% (positive predictive value [PPV] 0.96, 95% CI 0.85−0.99), whereas the PPV for the combination of Levels I and II was 0.88, 95% CI 0.70−0.96. These findings indicate that GMFCS classification in infants is less precise than classification over time in older children. In conclusion, children can be classified by the GMFCS early on, but there is a need for reclassification at age 2 or older as more clinical information becomes available.     

Relation between physical fitness and gross motor capacity in children and adolescents with cerebral palsy

Aim  To examine the relation between physical fitness and gross motor capacity in children with cerebral palsy (CP) who were classified in Gross Motor Function Classification System levels I or II.
Method  In total, 68 children with CP (mean age 12y 1mo, SD 2y 8mo; 44 males, 24 females; 45 classified as having spastic unilateral CP, 23 as having spastic bilateral CP) participated in this study. All participants performed a maximal aerobic exercise test (10m Shuttle Run Test), a short-term muscle power test (Muscle Power Sprint Test), an agility test (10×5m sprint test), and a functional muscle strength test (30s repetition maximum) within 2 weeks. Gross motor capacity was concurrently assessed using dimensions D (standing) and E (walking, running, and jumping) of the 88-item version of the Gross Motor Function Measure (GMFM).
Results  No relation between aerobic capacity, body mass index, and dimensions D and E of the GMFM was found. The correlations between short-term muscle power, agility, functional muscle strength, and dimensions D and E of the GMFM were moderate to high ( r ∼0.6–0.7).
Interpretation  The relations found between short-term muscle power, agility, functional muscle strength, and gross motor capacity indicate the importance of these components of physical fitness, and may direct specific interventions to maximize gross motor capacity in children and adolescents with CP.