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ABSTRACT: AIM: The aim of this study was to describe patterns for gross motor development by level of severity in a Dutch population of individuals with cerebral palsy (CP). METHOD: This longitudinal study included 423 individuals (260 males, 163 females) with CP. The mean age at baseline was 9 years 6 months (SD 6y 2mo, range 1-22y). The level of severity of CP among participants, according to the Gross Motor Function Classification System (GMFCS), was 50% level I, 13% level II, 14% level III, 13% level IV, and 10% level V. Participants had been assessed up to four times with the Gross Motor Function Measure (GMFM-66) at 1- or 2-year intervals between 2002 and 2009. Data were analysed using non-linear mixed effects modelling. For each GMFCS level, patterns were created by contrasting a stable limit model (SLM) with a peak and decline model (PDM), followed by estimating limits and rates of gross motor development. RESULTS: The SLM showed a better fit for all GMFCS levels than the PDM. Within the SLM, significant differences between GMFCS levels were found for both the limits (higher values for lower GMFCS levels) and the rates (higher values for GMFCS levels I-II vs level IV and for GMFCS levels I-IV vs level V) of gross motor development. INTERPRETATION: The results validate the existence of five distinct patterns for gross motor development by level of severity of CP.
Developmental Medicine & Child Neurology 01/2013; · 2.92 Impact Factor
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ABSTRACT: Background:
Major trauma is the leading cause of mortality and morbidity in children of developed countries. Little research has been
done about the health-related quality of life (HRQL) in these children. The aim of the current research is to describe the
HRQL of children in the long term after major trauma and to compare it with healthy peers.
Methods:
A prospective cohort study of severely injured children (ISS ≥ 16, age < 16 years) who survived the trauma and were admitted
to the emergency department of a Dutch level 1 trauma center in 1999 and 2000 (n = 40) was conducted. Between 6 and 8 years
after trauma (mean 7.3, SD 0.7 years), outcome was assessed by the Pediatric Quality of Life Inventory (PedsQL 4.0), the EuroQol
5D (EQ-5D), and the EuroQol Visual Analogue Scale (EQ-VAS).
Results:
The mean age at the time of the accident was 8.9 years (SD 4.6 years), the mean ISS was 24.9 (SD 11.1), and 25 (63%) cases
were male; 28 out of 40 patients were followed up. The mean score on the PedsQL was 81.2 and this did not differ significantly
from the norm value. On the EQ-5D, more health problems were reported than in a healthy reference population. The mean EQ-VAS
score was 79.4 and was significantly lower than in healthy peers. The lowest scores on the PedsQL and the EQ-VAS were seen
in teenagers and in respondents with spinal cord and/or severe cerebral injury.
Conclusion:
The results on HRQL in children in the long term after major trauma are inconclusive. Special attention should be given to
teenagers with spinal cord or severe cerebral injury who reported the lowest HRQL.
European Journal of Trauma and Emergency Surgery 04/2012; 35(4):371-377. · 0.33 Impact Factor
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Jan Willem Gorter
Developmental Medicine & Child Neurology 11/2011; 53(11):973-4. · 2.92 Impact Factor
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ABSTRACT: To review the literature on participation outcomes used in children and adolescents with acquired brain injury (ABI) and to synthesize the available evidence on recovery trajectories in participation after ABI.
This study searched electronic databases (Medline, Cinahl, Embase and PsychInfo) from March 2011 back to the earliest available time (1966) using the following terms with brain injury (brain tumours excluded) and children: social or community or school and outcome assessment or participation. Retrieved articles were rated for methodological quality using Oxford Centre for Evidence Based Medicine criteria (CEBM).
Sixteen articles were included for analysis. The methodological characteristics and quality of these studies varied considerably. Three studies used an explicit participation measure, nine studies featured an implicit participation measure and four used tailored participation measures. There is level 1c evidence that children and adolescents with ABI have participation restrictions at home, at school and in the community 18 months (SD = 14) after discharge.
The available literature indicates that children and adolescents with ABI are at risk for participation restrictions. Research on recovery trajectories in participation after ABI in children is lacking. Longitudinal studies using explicit participation measures and higher quality research methodologies (quantitative, qualitative and mixed methods) are recommended.
Brain Injury 09/2011; 25(13-14):1279-87. · 1.36 Impact Factor
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ABSTRACT: To assess the responsiveness of Goal Attainment Scaling compared with the Pediatric Evaluation of Disability Inventory (PEDI) and the 66-item Gross Motor Function Measure (GMFM-66) in multidisciplinary rehabilitation practice.
Observational study. Pretest-posttest design.
Twenty-three children with cerebral palsy, aged 2-13 years.
Goal Attainment Scaling, PEDI and GMFM-66 assessments were performed before and after six months of treatment. Physical, occupational and speech therapists constructed and scored 6-point Goal Attainment Scaling scales meeting predetermined criteria, describing the main functional goal per discipline. The contents of the three measures were compared using International Classification of Functioning, Disability and Health child and youth version (ICF-CY) codes. Spearman's rho correlations between Goal Attainment Scaling change scores per discipline and change scores obtained with the PEDI functional skills scales and GMFM-66 were calculated. Complete goal attainment was compared with significant change in terms of the standardized measures.
Twenty per cent of the Goal Attainment Scaling items were not covered by items of the PEDI or the GMFM-66. Inconclusive correlations were found between Goal Attainment Scaling and PEDI change scores (r 0.28-0.64). Even after exclusion of the non-corresponding items, correlations were moderate (r 0.57-0.73). Of 39/64 Goal Attainment Scaling scales scored as complete goal attainment, 16 individual PEDI scores did not show change on the corresponding scale. Low correlation was found between Goal Attainment Scaling change scores and GMFM-66 change scores.
Goal Attainment Scaling, PEDI and GMFM-66 were complementary in their ability to measure individual change over time in children with cerebral palsy. Using only the standardized instruments could have caused many individual rehabilitation goals actually attained being missed in the outcome evaluation.
Clinical Rehabilitation 07/2011; 25(12):1128-39. · 2.12 Impact Factor
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ABSTRACT: BACKGROUND. Autism is a serious neurodevelopmental disorder that has a reportedly rising prevalence rate. The American Academy of Pediatrics recommends that screening for autism be incorporated into routine practice. It is important to consider the pros and cons of conducting autism screening as part of routine practice and its implications on the community. We have explored this question in the context of screening from a scientific point of view.
A literature search was conducted to assess the effectiveness of community screening programs for autism.
Judged against critical questions about autism, screening programs failed to fulfill most criteria. Good screening tools and efficacious treatment are lacking, and there is no evidence yet that such a program would do more good than harm.
On the basis of the available research, we believe that we do not have enough sound evidence to support the implementation of a routine population-based screening program for autism. Ongoing research in this field is certainly needed, including the development of excellent screening instruments and demonstrating with clinical trials that such programs work and do more good than harm.
PEDIATRICS 06/2011; 128(1):e211-7. · 4.47 Impact Factor
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ABSTRACT: The purpose of this study was to examine professionals' perceptions on classifying learning styles in the context of teaching motor activities to children and adolescents with cerebral palsy (CP). The participants were 21 pediatric physical therapists (PPTs) and seven physical educators (PEs) in three schools for special education in The Netherlands. All participants were introduced to the key descriptions of two existing learning style instruments (Kolb's Learning Style Inventory and Myers-Briggs Type Indicator), applied them to children and adolescents with CP, and reported their perceptions in written surveys. This study had a mixed-methods design. Quantitative and qualitative data analyses showed that PPTs and PEs are mostly positive about the idea of classifying learning styles in the context of teaching motor activities to children and adolescents with CP, giving three main reasons: individual approach, professional communication, and treatment awareness. Additionally, qualitative data analysis showed that the key descriptions of the two learning style instruments were not feasible as classifications for children and adolescents with CP. It is therefore recommended that other learning style classification instruments should be explored and that possibly a new learning style classification instrument should be developed in the context of teaching motor activities to children and adolescents with CP.
Physical & Occupational Therapy in Pediatrics 05/2011; 31(4):403-12. · 1.21 Impact Factor
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ABSTRACT: Resistance training of the lower limbs is now commonly used in clinical practice in children and adolescents with spastic cerebral palsy (CP). However, the effectiveness of this type of training is still disputed. The most recently published systematic review with meta-analysis included interventions such as electrical stimulation and resistance training and found insufficient evidence to support or refute the efficacy of these exercises in children with CP. Thus, the aim of this article is to evaluate the extent to which training protocols from the most recent randomized controlled trials are in keeping with the evidence for effective resistance training in children who are developing typically, as reflected in the training guidelines of the National Strength and Conditioning Association. RECOMMENDATIONS: for resistance training protocols, based on this evidence and appropriate to children with CP, are provided to help guide both future research and clinical practice for resistance training in children with CP.
Physical Therapy 05/2011; 91(7):1130-9. · 3.11 Impact Factor
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ABSTRACT: Idiopathic Toe Walking (ITW) is present in children older than 3 years of age still walking on their toes without signs of neurological, orthopaedic or psychiatric diseases. ITW has been estimated to occur in 7% to 24% of the childhood population. To study associations between Idiopathic Toe Walking (ITW) and decrease in range of joint motion of the ankle joint. To study associations between ITW (with stiff ankles) and stiffness in other joints, muscle strength and bone density.
In a cross-sectional study, 362 healthy children, adolescents and young adults (mean age (sd): 14.2 (3.9) years) participated. Range of joint motion (ROM), muscle strength, anthropometrics sport activities and bone density were measured.
A prevalence of 12% of ITW was found. Nine percent had ITW and severely restricted ROM of the ankle joint. Children with ITW had three times higher chance of severe ROM restriction of the ankle joint. Participants with ITW and stiff ankle joints had a decreased ROM in other joints, whereas bone density and muscle strength were comparable.
ITW and a decrease in ankle joint ROM might be due to local stiffness. Differential etiological diagnosis should be considered.
BMC Musculoskeletal Disorders 03/2011; 12:61. · 1.58 Impact Factor
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ABSTRACT: To examine incidence and severity of cerebral palsy (CP), and associated factors among preterm survivors (gestational age <34 weeks), admitted to a neonatal intensive care unit from 1990-2005.
Eighteen antenatal, perinatal and postnatal factors were analyzed. The cohort was divided in four birth periods: 1990-1993 (n=661), 1994-1997 (n=726), 1998-2001 (n=723), and 2002-2005 (n=850). The Gross Motor Function Classification System was used as primary outcome measure (mean age: 32.9 ± 5.3 months). Logistic regression analyses were used.
CP incidence decreased from 6.5% in period I, to 2.6%, 2.9% and 2.2% (P<.001) in period II-IV, respectively. Simultaneously, cystic periventricular leukomalacia (c-PVL) decreased from 3.3% in period I to 1.3% in period IV (P=.004). Within the total cohort (n=3287), c-PVL grade III decreased from 2.3% in period I to 0.2% in period IV (P=.003). The number of children with Gross Motor Function Classification System levels III-V decreased from period I to IV (P=.035). Independent risk factors for CP were c-PVL and severe intraventricular hemorrhage, whereas antenatal antibiotics, presence of an arterial line, Caesarean section, and gestational age were independent protective factors.
CP incidence and severity decreased from 1990-1993 onward, which could be attributed to a reduction of 93% in severe c-PVL.
The Journal of pediatrics 02/2011; 159(1):86-91.e1. · 4.02 Impact Factor
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ABSTRACT: Adolescents with cerebral palsy (CP) show a reduced physical activity (PA). Currently there are no interventions for adolescents with CP in this critical life phase that optimise and maintain the individuals' physical activity in the long term. To develop such a program it is important to fully understand the factors that influence physical activity behaviours in adolescents with CP. The aim of this study is to explore what makes it easy or hard for adolescents with CP to be and to become physically active.
A qualitative research method is chosen to allow adolescents to voice their own opinion. Because we will investigate the lived experiences this study has a phenomenological approach. Thirty ambulatory and non-ambulatory adolescents (aged 10-18 years) with CP, classified as level I to IV on the Gross Motor Function Classification System and 30 parents of adolescents with CP will be invited to participate in one of the 6 focus groups or an individual interview. Therapists from all Children's Treatment Centres in Ontario, Canada, will be asked to fill in a survey. Focus groups will be audio- and videotaped and will approximately take 1.5 hours. The focus groups will be conducted by a facilitator and an assistant. In preparation of the focus groups, participants will fill in a demographic form with additional questions on physical activity. The information gathered from these questions and recent research on barriers and facilitators to physical activity will be used as a starting point for the content of the focus groups. Recordings of the focus groups will be transcribed and a content analysis approach will be used to code the transcripts. A preliminary summary of the coded data will be shared with the participants before themes will be refined.
This study will help us gain insight and understanding of the participants' experiences and perspectives in PA, which can be of great importance when planning programs aimed at helping them to stay or to become physically active.
BMC Pediatrics 01/2011; 11:1. · 1.88 Impact Factor
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ABSTRACT: This paper outlines the application of video gait analysis (VGA) for children with cerebral palsy (CP) when full instrumented three dimensional gait analysis (3DGA) is either not indicated or not available.
Gait analysis is an important part of the assessment of ambulant children with CP for diagnosing gait deviations and for evaluating change. Many regard 3DGA as the most informative method of assessing gait, however, it is not always accessible, practical, or feasible and the detail obtained is not always indicated. VGA in conjunction with other carefully selected outcome measures can provide a comprehensive gait assessment in situations where 3DGA is not available or not indicated. Indications for VGA use include: documenting change in gait pattern over time, frequent monitoring in the rehabilitation phase following treatments and interventions (including surgery, spasticity management, serial casting and intensive therapy), monitoring orthotic changes, and for very young children and those with behavioural/cognitive issues that preclude them from cooperating with a 3DGA. Simple and inexpensive VGA systems can be set up in most settings. In an effort to make the process more objective and reliable a number of observational gait scales have been developed. Of these the Edinburgh Gait Score (EGS) has the strongest psychometric properties and is the most comprehensive by including both the coronal and the sagittal planes.
While 3DGA remains an important part of complex clinical decision-making, there is also an increasingly important role for VGA. Guidelines need to be developed for its use within the field of gait analysis.
Gait & posture 12/2010; 33(3):501-3. · 2.58 Impact Factor
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ABSTRACT: Little is known about the efficacy and the working mechanisms of physical and occupational therapy interventions for children with cerebral palsy (CP). In recent years a shift from a child-focused intervention approach to a more context-focused intervention approach can be recognized. Until now the evidence on the efficacy and the working mechanisms of these interventions for children with CP is inconclusive. This study aims to evaluate the efficacy and working mechanisms of two intervention approaches compared to regular care intervention in improving mobility and self-care skills of children (2-3 years) with CP and their families: a child-focused intervention approach and a context-focused intervention approach.
A multi-centre, randomized controlled trial research design will be used. Ninety-four children with CP (Gross Motor Function Classification System (GMFCS) level I-IV; age 2 to 3 years), their parents, and service providers (physical and occupational therapists) will be included. During a period of six months children will receive child-focused, context-focused or regular care intervention. Therapists will be randomly assigned to deliver either a child-focused intervention approach, a context-focused intervention approach or regular care intervention. Children follow their therapist into the allocated intervention arm. After the six months study-intervention period, all participants return to regular care intervention. Outcomes will be evaluated at baseline, after six months and at a three months follow-up period. Primary outcome is the capability of functional skills in self-care and mobility, using the Functional Skills Scale of the Pediatric Evaluation of Disability Inventory (PEDI). Other outcomes will be quality of life and the domains of the International Classification of Functioning, Disability and Health - for Children and Youth (ICF-CY), including body function and structure, activities (gross motor capacity and performance of daily activities), social participation, environmental variables (family functioning, parental empowerment).
This paper presents the background information, design, description of interventions and protocol for this study on the efficacy and working mechanisms of child-focused intervention approach and context-focused intervention approach compared to regular care intervention in mobility and self-care skills of children (2-3 years) with CP.
This study is registered in the Dutch Trial Register as NTR1900.
BMC Pediatrics 11/2010; 10:80. · 1.88 Impact Factor
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ABSTRACT: The purpose of this study was to describe the course of capabilities in self-care, mobility, and social function in school-age children with cerebral palsy (CP) and to investigate associations with CP-, child-, and family-characteristics. A clinic-based sample of children with CP (n = 116; 76 males, 40 females; mean age 6 y 3 mo, SD 12 mo) was followed longitudinally in three yearly measurements. Children's capabilities were assessed with the Pediatric Evaluation of Disability Inventory Functional Skills Scale (PEDI-FSS). Averaged for the total group, significant increases over time were shown in PEDI-FSS scores in all three domains. For self-care, the course was best predicted by a model including level of gross motor function (measured by the Gross Motor Function Classification System) and intellectual capacity (measured by Raven's Coloured Progressive Matrices). For mobility, the course was best predicted by a model containing only level of gross motor function. For social function, the course was best predicted by a model comprising level of bimanual function (measured by the Manual Ability Classification System) and paternal educational level. Generally, the increase in capabilities was greater if level of functioning was higher, except for level of paternal education. The findings indicate that there are different sets of determinants for the course of different domains of daily activities. Such different sets of determinants may help to set realistic expectations and to create appropriate treatment plans for different domains of daily activities in school-age children with CP.
Research in developmental disabilities 10/2010; 32(1):222-34. · 4.41 Impact Factor
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Developmental Medicine & Child Neurology 03/2010; 52(7):682-3; author reply 683-4. · 2.92 Impact Factor
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ABSTRACT: To determine the interrater reliability of Goal Attainment Scaling (GAS) in the routine practice of interdisciplinary rehabilitation of children with cerebral palsy, and to examine the difference in the interrater reliability of the scores between GAS scales constructed by the children's own therapists and the scales constructed by independent therapists.
Individually tailored GAS scales, based on predetermined criteria, were constructed at the start of a 6-month rehabilitation period. The outcome was rated independently by 2 therapists at the end of the treatment period. Two different data sets were acquired, one consisting of scores on GAS scales constructed by the children's own therapists, the other of scores on GAS scales constructed by matched independent raters of the same profession.
A children's unit of a medium-sized rehabilitation center in The Netherlands.
Physical therapists (n=8), occupational therapists (n=8), and speech therapists (n=4) participated in pairs. They constructed 2 sets of 64 GAS scales each, for 23 children with cerebral palsy.
A 6-month interdisciplinary pediatric rehabilitation program.
Interrater reliability was assessed using linear-weighted Cohen's kappa.
The scales constructed by the children's therapists had an interrater reliability of .82 (95% confidence interval [CI], .73-.91). The interrater reliability for scales constructed by the independent raters was .64 (95% CI, .49-.79). The main reason for disagreement between raters was discrepancies in the professionals' interpretation of the children's capacities versus their actual performance during assessment.
The interrater reliability of GAS used under optimal conditions was good, particularly for scales constructed by the children's own therapists.
Archives of physical medicine and rehabilitation 03/2010; 91(3):429-35. · 2.18 Impact Factor
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ABSTRACT: The purpose of this study was to examine the inter-rater reliability of two tests measuring selective motor control (SMC) of the lower extremities in children with cerebral palsy (CP).
Two testers independently assessed 21 children (13 boys, eight girls; mean age 6 years 5 months, SD 12 months) with spastic CP (14 unilateral and seven bilateral) using the Boyd and Graham SMC test (with an existing protocol) and the modified Trost SMC test (with a newly developed protocol). Inter-rater reliability was analysed using Cohen's Kappa.
For the Boyd and Graham SMC test for ankle dorsiflexion, Kappa was 0.55 (95% CI = 0.36-0.74). For the modified Trost SMC test for ankle dorsiflexion, knee extension, hip abduction and hip flexion, Kappas were 0.65 (0.47-0.84), 0.69 (0.49-0.88), 0.57 (0.37-0.78) and 0.71 (0.51-0.91), respectively.
The SMC tests showed moderate (Boyd and Graham SMC test) to good (modified Trost SMC test) inter-rater reliability.
Developmental neurorehabilitation 01/2010; 13(4):258-65.
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ABSTRACT: The aim of this study was to describe the physical activity levels of 5- and 7-year-old children with cerebral palsy (CP, n = 97), to compare their physical activity levels with those of typically developing peers (TD, n = 57) and the Dutch recommendation for physical activity, and to investigate the associated factors.
The level of physical activity (hours spent on sports and physical activity per week) and contextual factors were assessed with standardised questionnaires.
Mean duration of self-reported physical activity for children with CP was 3.4 (+/- 1.9) h/week, which was significantly less than the 5.8 (+/- 2.3) h/week for TD-peers. Ninety-three percent of the children with CP were insufficiently physically active according to the Dutch recommendation for physical activity. Multiple regression analyses showed that younger age and lower educational level of the mother were significantly associated with lower levels of physical activity for children with CP, while severity of CP was not associated with physical activity levels. Twenty-two percent of the parents reported that more facilities in sport and games are required for children with CP.
Physical activity is low in young children with CP and needs to be promoted at an early stage.
Disability and Rehabilitation 01/2010; 32(18):1501-8. · 1.50 Impact Factor
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ABSTRACT: 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.
Cross-sectional analysis in a cohort study with a clinic-based sample of children with CP (n=116; 76 males, 40 females; mean age 6 y 3 mo, SD 12 mo, range 4 y 8 mo-7 y 7 mo) 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).
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).
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.
Developmental Medicine & Child Neurology 12/2009; 52(3):e60-6. · 2.92 Impact Factor
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ABSTRACT: 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.
Developmental Medicine & Child Neurology 10/2009; 51(11):866 - 871. · 2.92 Impact Factor
