Anita Bagley

University of California, Davis, Davis, California, United States

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Publications (74)161.87 Total impact

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    ABSTRACT: Although the treatment of cerebral palsy should be based on improving function as assessed by measures of impairment, activity, and participation, the standard indications for surgical treatment of upper extremity cerebral palsy (UECP) are impairment measures, primarily active and passive range of motion (ROM). Recently, validated activity measures have been developed for children with UECP. The purposes of this study were to determine the relationship between impairment and activity measures in this population, and whether measures of activity correlate with each other. A total of 37 children, ages 5 to 16 years, who met standard ROM surgical indications for UECP were evaluated with the impairment measures of active and passive ROM and stereognosis, as well as 3 activity measures [Assisting Hand Assessment (AHA), Box and Blocks test, and the Shriners Hospitals Upper Extremity Evaluation Dynamic Positional Analyses (SHUEE DPA)]. Impairment measures were correlated with activity measures using Spearman rank correlation coefficients. Impairment measures showed inconsistent correlation with activity measures. Of the 12 comparisons, only 4 correlated: active forearm supination (ρ=0.47, P=0.003), wrist extension (ρ=0.55, P=0.001), and stereognosis scores (ρ=0.54, P=0.001) were correlated with AHA; and wrist extension was correlated with the SHUEE DPA (ρ=0.41, P=0.01). When the results of activity tests were compared, the AHA was correlated with the Box and Blocks tests (ρ=0.63, P<0.001), and the SHUEE DPA and Box and Blocks tests were correlated with each other (ρ=0.35, P=0.04). The goal of surgery in UECP is to improve the child's ability to perform activities, and ultimately to participate in life situations. Impairment measures, such as ROM, were inconsistently correlated with validated measures of activity. Some activity measures correlated with each other, although they did not correlate with the same impairment measures. We conclude that impairment measures, including ROM, do not consistently predict functional dynamic ROM used to perform activities for children with UECP. Activity limitation measures may provide more appropriate indicators than impairment measures for upper extremity surgery for this population. Level II-diagnostic.
    Journal of pediatric orthopedics 07/2015; DOI:10.1097/BPO.0000000000000591 · 1.47 Impact Factor
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    ABSTRACT: Background: Excessive internal or external tibial torsion is frequently present in children with cerebral palsy. Several surgical techniques have been described to correct excessive tibial torsion, including isolated distal tibial rotation osteotomy (TRO). The anatomic changes surrounding this technique are poorly understood. The goal of the study was to examine the anatomic relationship between the tibia and fibula following isolated distal TRO in children with cerebral palsy. Methods: Twenty patients with 29 limbs were prospectively entered for study. CT scans of the proximal and distal tibiofibular (TF) articulations were obtained preoperatively, at 6 weeks, and 1 year postoperatively. Measurements of tibia and fibula torsion were performed at each interval. Qualitative assessments of proximal and distal TF joint congruency were also performed. Results: The subjects with internal tibia torsion (ITT, 19 limbs) showed significant torsional changes for the tibia between preoperative, postoperative, and 1 year time points (mean torsion 13.21, 31.05, 34.84 degrees, respectively). Measurement of fibular torsion in the ITT treatment group also showed significant differences between time points (mean -36.77, -26.77, -18.54 degrees, respectively). Proximal and distal TF joints remained congruent at all time points in the study. Subjects with external tibia torsion (ETT, 10 limbs) showed significant differences between preoperative and postoperative tibial torsion, but not between postoperative and 1 year (mean torsion 54, 19.3, 23.3 degrees, respectively). Measurement of fibular torsion in the ETT treatment group did not change significantly between preoperative and postoperative, but did change significantly between postoperative and 1 year (mean torsion -9.8,-16.9, -30.7 degrees, respectively). Nine of 10 proximal TF joints were found to be subluxated at 6 weeks postoperatively. At 1 year, all 9 of these joints had reduced. Conclusions: Correction of ITT by isolated distal tibial external rotation osteotomy resulted in acute external fibular torsion. The fibular torsion alignment remodeled over time to accommodate the corrected tibial torsional alignment and reduce the strain associated with the plastic deformity of the fibula. Correction of ETT by isolated distal internal TRO resulted in acute subluxation of the proximal TF articulation in almost all cases. Subsequent torsional remodeling of the fibula resulted in correction of the TF subluxation in all cases. Acute correction of TT by isolated distal TRO occurs by distinct mechanisms, based upon the direction of rotational correction. Level of Evidence: Level II-Diagnostic.
    Journal of Pediatric Orthopaedics 05/2015; DOI:10.1097/BPO.0000000000000525 · 1.47 Impact Factor
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    ABSTRACT: The aim of this study was to examine differences in gait kinematics and spatiotemporal parameters in ambulatory children and adolescents with bilateral spastic cerebral palsy (BSCP) among Gross Motor Function Classification System (GMFCS) levels I-III. A retrospective review was conducted of individuals with BSCP who had three-dimensional motion analysis (3DGA) at one of seven pediatric hospitals. Means and standard deviations of each gait parameter were stratified by GMFCS levels (I-III) and for a typically developing comparison group. Data from 292 children and adolescents with BSCP (189 males, 103 females; mean age 13y) were compared to a typically developing comparison group (24 male, 26 female; mean age 10y 6mo). Gait patterns differed from typically developing in all GMFCS levels, with increasing deviation as GMFCS level increased in 21 out of 28 parameters. Despite significant differences in selected mean kinematic parameters among GMFCS levels such as knee angle at initial contact of 24°, 29°, and 41° in GMFCS levels I, II and III respectively, there was also substantial overlap among GMFCS levels. GMFCS levels cannot be identified using specific gait kinematics. Treatment decisions should be guided by comprehensive 3DGA that allows measurement of gait impairments at the joint level for each individual. © 2015 Mac Keith Press.
    Developmental Medicine & Child Neurology 04/2015; 57(10). DOI:10.1111/dmcn.12766 · 3.51 Impact Factor
  • Ann E Van Heest · Anita Bagley · Fred Molitor · Michelle A James ·
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    ABSTRACT: For children with upper-extremity cerebral palsy (CP) who meet standard indications for tendon transfer surgery, we hypothesized that surgical treatment would result in greater functional improvement than treatment with botulinum toxin injections or regular, ongoing therapy. Thirty-nine children with upper-extremity CP, who were four to sixteen years of age and surgical candidates for the transfer of the flexor carpi ulnaris to the extensor carpi radialis brevis, pronator teres release, and extensor pollicis longus rerouting with adductor pollicis release, were prospectively assigned, either randomly (twenty-nine patients) or by patient/family preference (ten patients), to one of three treatment groups: surgical treatment (Group 1); botulinum toxin injections (Group 2); or regular, ongoing therapy (Group 3). Seven centers participated. Assessment measurements included active range of motion, pinch and grip strength, stereognosis, and scores as measured with eight additional functional or patient-oriented outcome instruments. Thirty-four patients (twenty-five randomized and nine from the patient-preference arm) were evaluated twelve months post-treatment as the study cohort. For the primary outcome of the Shriners Hospital Upper Extremity Evaluation (SHUEE) dynamic positional analysis (DPA), significantly greater improvement was seen in Group 1 than in the other two groups (p < 0.001). Improvements in SHUEE DPA reflected improved supination and wrist extension during functional activities after surgical treatment. Group 1 showed more improvement in the Pediatric Quality of Life Inventory (PedsQL) CP module domain of movement and in the Canadian Occupational Performance Measure (COPM) score for satisfaction than Groups 2 and 3. Both Groups 1 and 3 showed more improvement in pinch strength than did Group 2. For children with upper-extremity CP who were candidates for standard tendon transfer, surgical treatment was demonstrated to provide greater improvement, of modest magnitude, than botulinum toxin injections or regular, ongoing therapy at twelve months of follow-up for the SHUEE DPA, the PedsQL CP module domain of movement, and COPM satisfaction. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.
    The Journal of Bone and Joint Surgery 04/2015; 97(7):529-36. DOI:10.2106/JBJS.M.01577 · 5.28 Impact Factor
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    ABSTRACT: To determine how the affected hemiplegic hand and contralateral dominant hand in children with hemiplegic cerebral palsy compare with age-matched norms for grip strength, pinch strength, and dexterity. We enrolled 37 children with hemiplegic cerebral palsy (26 boys; average age, 9.8 y). Grip and pinch strength and Box and Blocks Test for dexterity were measured in both hands. Affected and contralateral hands results were analyzed and compared with each other and with norms for age and sex. Affected hands had significantly less grip and pinch strength than the contralateral hands. Subjects transported significantly fewer blocks in one minute with the Box and Blocks Test (mean, 10.8 blocks) with the affected hand than the contralateral hand. Compared with normative values, affected-side grip and pinch strengths were significantly less, whereas contralateral hand grip and pinch strengths were similar. Dexterity in both affected and contralateral hands was significantly less than normative values. Decreased dexterity in the contralateral hand was correlated with decreased nonverbal intelligence quotient. Dexterity of the contralateral hand is diminished in children with hemiplegia. Assessment of the contralateral hand may reveal opportunities for therapeutic intervention that improve fine motor function. Therapeutic IV. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
    The Journal Of Hand Surgery 03/2015; 40(5). DOI:10.1016/j.jhsa.2014.12.039 · 1.67 Impact Factor
  • Jon R Davids · Anita M Bagley ·
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    ABSTRACT: Identification and classification of common gait deviation patterns in children with cerebral palsy facilitates communication between healthcare providers, provides insight into the natural history of functional ambulation, guides clinical decision making, and clarifies outcomes assessment. Previous classification schemes have been based on experiential and intuitive approaches or systematic and analytical approaches. The current gait disruption classification system has been refined to incorporate the most clinically useful aspects of previous systems. This paradigm uses the concept of primary versus compensatory deviations to identify common patterns and common causes for these patterns. The primary sagittal plane patterns include jump, crouch, and stiff gait. The primary transverse plane patterns include internal, external, and neutral progression gait. Apparent coronal plane deviation patterns are usually the consequence of sagittal and transverse plane deviations seen out of plane. Individualized assessment is essential because of the great variation in and combinations of possible patterns. Copyright 2014 by the American Academy of Orthopaedic Surgeons.
    The Journal of the American Academy of Orthopaedic Surgeons 12/2014; 22(12):782-790. DOI:10.5435/JAAOS-22-12-782 · 2.53 Impact Factor
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    ABSTRACT: Background: The natural history of ambulatory function in individuals with cerebral palsy (CP) consists of deterioration over time. This is thought to be due, in part, to the relationship between strength and weight, which is postulated to become less favorable for ambulation with age. Methods: The study design was prospective, case series of 255 subjects, aged 8 to 19 years, with diplegic type of CP. The data analyzed for the study were cross-sectional. Linear regression was used to predict the rate of change in lower extremity muscle strength, body weight, and strength normalized to weight (STR-N) with age. The cohort was analyzed as a whole and in groups based on functional impairment as reflected by Gross Motor Function Classification System (GMFCS) level. Results: Strength increased significantly over time for the entire cohort at a rate of 20.83 N/y (P=0.01). Weight increased significantly over time for the entire cohort at a rate of 3.5 kg/y (P<0.0001). Lower extremity STR-N decreased significantly over time for the entire cohort at a rate of 0.84 N/kg/y (P<0.0001). The rate of decline in STR-N (N/kg/y) was comparable among age groups of the children in the study group. There were no significant differences in the rate of decline of STR-N (N/kg/y) among GMFCS levels. There was a 90% chance of independent ambulation (GMFCS levels I and II) when STR-N was 21 N/kg (49% predicted relative to typically developing children). Discussion: The results of this study support the longstanding clinically based observation that STR-N decreases with age in children with CP. This decrease occurs throughout the growing years, and across GMFCS levels I to III. Independent ambulation becomes less likely as STR-N decreases. This information can be used to support the rationale, and provide guidelines, for a range of interventions designed to promote ambulation in children with CP.
    Journal of pediatric orthopedics 09/2014; 35(5). DOI:10.1097/BPO.0000000000000320 · 1.47 Impact Factor
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    ABSTRACT: Objective To investigate whether body composition and lower extremity strength relate to oxygen cost of walking in children with cerebral palsy (CP), and to evaluate the relative contributions of these measures to explain variation in oxygen cost seen in this population. Methods A total of 116 children with spastic diplegic CP, Gross Motor Function Classification System levels I - III, aged 8-18 participated. Strength, body composition (body mass index (BMI) and percent body fat) and oxygen cost were recorded. Pearson correlations assessed relationships between variables of body composition and strength to oxygen cost. Forward stepwise linear regression analyzed variance explained by strength and body composition measures. Oxygen data were analyzed by weight status classifications using one-way analysis of variance with significance set at p < 0.05. Results Total strength (r = -0.27) and total extensor strength (r = -0.27) had fair inverse relationships with oxygen cost. Total extensor strength explained 7.5% (r2 = 0.075, Beta = -0.274, p < 0.01) of the variance in oxygen cost. Body composition did not explain significant variance in oxygen cost, however significant differences were found in oxygen consumption (p = 0.003) and walking velocity (p = 0.042) based on BMI weight classifications. Conclusions For ambulatory children with CP, oxygen cost during walking can be partially explained by total extensor strength and not body composition. However, those categorized as obese may adjust to a slower walking speed to keep their oxygen cost sustainable, which may further affect their ability to keep up with typically developing peers and possibly lead to greater fatigue.
    Gait & Posture 09/2014; 40(4). DOI:10.1016/j.gaitpost.2014.07.010 · 2.75 Impact Factor
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    ABSTRACT: To determine the amount of variability in scores on activity and participation measures used to assess ambulatory individuals with cerebral palsy explained by strength, body composition, gait impairment and participant characteristics.
    Clinical Rehabilitation 07/2014; 28(10). DOI:10.1177/0269215513511343 · 2.24 Impact Factor
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    ABSTRACT: AimThis prospective multicenter study assessed performance and changes over time, with and without surgical intervention, in the modified Timed Up and Go (mTUG) and One-Minute Walk tests (1MWT) in children with bilateral cerebral palsy (CP). Minimum clinically important differences (MCIDs) were established for these tools.Method Two hundred and nineteen participants with bilateral spastic CP (Gross Motor Function Classification System [GMFCS] levels I–III) were evaluated at baseline and 12 months follow-up. The non-surgical group (n=168; 54 females, 114 males; mean age 12y 11mo, [SD 2y 7mo], range 8y 1mo–19y) had no surgical interventions during the study. The surgical group (n=51; 19 females, 32 males; mean age 12y 10mo [SD 2y 8mo] range 8y 2mo–17y 5mo) underwent soft-tissue and/or bony procedures within 12 months from baseline. The mTUG and 1MWT were collected and MCIDs were established from the change scores of the non-surgical group.ResultsDependent walkers (GMFCS level III) required more time to complete the mTUG (p≤0.01) than independent walkers (GMFCS levels I and II). For the 1MWT, distance walked decreased with increasing impairment (p≤0.01). 1MWT and mTUG change scores were not significantly different at any GMFCS level for either the surgical or non-surgical groups (p≤0.01).InterpretationChildren with varying levels of function (GMFCS level) perform differently on the 1MWT and mTUG. The data and MCID values can assist clinicians in interpreting changes over time and in assessing interventions.
    Developmental Medicine & Child Neurology 05/2014; 56(5). DOI:10.1111/dmcn.12325 · 3.51 Impact Factor
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    ABSTRACT: Commercially available interactive video games are commonly used in rehabilitation to aide in physical recovery from a variety of conditions and injuries, including burns. Most video games were not originally designed for rehabilitation purposes and although some games have shown therapeutic potential in burn rehabilitation, the physical demands of more recently released video games, such as Microsoft Xbox Kinect™ (Kinect) and Sony PlayStation 3 Move™ (PS Move), have not been objectively evaluated. Video game technology is constantly evolving and demonstrating different immersive qualities and interactive demands that may or may not have therapeutic potential for patients recovering from burns. This study analyzed the upper extremity motion demands of Kinect and PS Move using three-dimensional motion analysis to determine their applicability in burn rehabilitation. Thirty normal children played each video game while real-time movement of their upper extremities was measured to determine maximal excursion and amount of elevation time. Maximal shoulder flexion, shoulder abduction and elbow flexion range of motion were significantly greater while playing Kinect than the PS Move (p≤0.01). Elevation time of the arms above 120° was also significantly longer with Kinect (p<0.05). The physical demands for shoulder and elbow range of motion while playing the Kinect, and to a lesser extent PS Move, are comparable to functional motion needed for daily tasks such as eating with a utensil and hair combing. Therefore, these more recently released commercially available video games show therapeutic potential in burn rehabilitation. Objectively quantifying the physical demands of video games commonly used in rehabilitation aides clinicians in the integration of them into practice and lays the framework for further research on their efficacy.
    Burns: journal of the International Society for Burn Injuries 11/2013; 40(5). DOI:10.1016/j.burns.2013.11.005 · 1.88 Impact Factor
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    ABSTRACT: The aim of this article was to determine item measurement properties of a set of items selected from the Gillette Functional Assessment Questionnaire (FAQ) and the Pediatric Outcome Data Collection Instrument (PODCI) using Rasch analysis, and to explore relationships between the FAQ/PODCI combined set of items, FAQ walking scale level, Gross Motor Function Classification System (GMFCS) levels, and the Gait Deviation Index on a common measurement scale. Rasch analysis was performed on data from a retrospective chart review of parent-reported FAQ and PODCI data from 485 individuals (273 males; 212 females; mean age 9 y 10 mo, SD 3 y 10 mo) who underwent first-time three-dimensional gait analysis. Of the 485 individuals, 289 had a diagnosis of cerebral palsy (104 GMFCS level I, 97 GMFCS level II, 69 GMFCS level III, and 19 GMFCS level IV). Rasch-based person abilities and item difficulties based on subgroups defined by the FAQ walking scale level, Gait Deviation Index, and the GMFCS level were compared. The FAQ/PODCI item set demonstrated necessary Rasch characteristics to support its use as a combined measurement scale. Item groupings at similar difficulty levels were consistent with the mean person abilities of subgroups based on FAQ walking scale level, Gait Deviation Index, and GMFCS level. Rasch-derived person ability scores from the FAQ/PODCI combined item set are consistent with clinical measures. Rasch analysis provides insights that may improve interpretation of the difficulty of motor functions for children with disabilities.
    Developmental Medicine & Child Neurology 03/2012; 54(5):443-50. DOI:10.1111/j.1469-8749.2012.04231.x · 3.51 Impact Factor
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    ABSTRACT: Elbow flexion contracture is a well-known complication of brachial plexus birth palsy that adversely affects upper-extremity function. The prevalence, risk factors, and rate of progression of elbow flexion contracture associated with brachial plexus birth palsy have not been established, and the effectiveness of nonoperative treatment involving nighttime splinting or serial casting has not been well studied. The medical records of 319 patients with brachial plexus birth palsy who had been seen at our institution between 1992 and 2009 were retrospectively reviewed to identify patients with an elbow flexion contracture (≥10°). The chi-square test for trend and the Kaplan-Meier estimator were used to evaluate risk factors for contracture, including age, sex, and the extent of brachial plexus involvement. Longitudinal models were used to estimate the rate of contracture progression and the effectiveness of nonoperative treatment. An elbow flexion contracture was present in 48% (152) of the patients with brachial plexus birth palsy. The median age of onset was 5.1 years (range, 0.25 to 14.8 years). The contracture was ≥30° in 36% (fifty-four) of these 152 patients and was accompanied by a documented radial head dislocation in 6% (nine). The prevalence of contracture increased with increasing age (p < 0.001) but was not significantly associated with sex or with the extent of brachial plexus involvement. The magnitude of the contracture increased by 4.4% per year before treatment (p < 0.01). The magnitude of the contracture decreased by 31% when casting was performed (p < 0.01) but thereafter increased again at the same rate of 4.4% per year. The magnitude of the contracture did not improve when splinting was performed but the rate of increase thereafter decreased to <0.1% per year (p = 0.04). The prevalence of elbow flexion contracture in children with brachial plexus birth palsy may be greater than clinicians perceive. The prevalence increased with patient age but was not significantly affected by sex or by the extent of brachial plexus involvement. Serial casting may initially improve severe contractures, whereas nighttime splinting may prevent further progression of milder contractures.
    The Journal of Bone and Joint Surgery 03/2012; 94(5):403-9. DOI:10.2106/JBJS.J.00750 · 5.28 Impact Factor
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    ABSTRACT: Commercially available interactive video games (IVG) like the Nintendo Wii™ (NW) and PlayStation™II Eye Toy (PE) are increasingly used in the rehabilitation of patients with burn. Such games have gained popularity in burn rehabilitation because they encourage range of motion (ROM) while distracting from pain. However, IVGs were not originally designed for rehabilitation purposes but rather for entertainment and may lack specificity for achieving rehabilitative goals. Objectively evaluating the specific demands of IVGs in relation to common burn therapy goals will determine their true therapeutic benefit and guide their use in burn rehabilitation. Upper extremity (UE) motion of 24 normal children was measured using 3D motion analysis during play with the two types of IVGs most commonly described for use after burn: NW and PE. Data was analyzed using t-tests and One-way Analysis of Variance. Active range of motion for shoulder flexion and abduction during play with both PE and NW was within functional range, thus supporting the idea that IVGs offer activities with therapeutic potential to improve ROM. PE resulted in higher demands and longer duration of UE motion than NW, and therefore may be the preferred tool when UE ROM or muscular endurance are the goals of rehabilitation. When choosing a suitable IVG for application in rehabilitation, the user's impairment together with the therapeutic attributes of the IVG should be considered to optimize outcome.
    Burns: journal of the International Society for Burn Injuries 02/2012; 38(4):493-500. DOI:10.1016/j.burns.2012.02.010 · 1.88 Impact Factor
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    Mitell Sison-Williamson · Anita Bagley · Tina Palmieri ·
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    ABSTRACT: Children with upper extremity burns frequently develop axillary contractures that can restrict movement. Surgical axillary contracture release is performed to restore function. The purpose of this study is to determine the long-term effects (up to 7 years) of surgical axillary contracture release on upper extremity motion during simulated activities of daily living using three-dimensional motion analysis. Motion analysis was conducted on 10 subjects (9 males and 1 female; 16 axillary contractures; mean age 10 ± 3 years at baseline; mean TBSA burn 40 ± 15%) before, 1 year after, and 2 to 7 years (mean 3 ± 2 years) after axillary contracture release with split-thickness skin graft surgery. Movements were analyzed during three functional tasks including high reach (reaching overhead for an object), hand to head (combing hair), and hand to back pocket (toileting). Two-tailed paired t-tests were used to compare presurgical and postsurgical scores. Surgical release of the axillary contracture increased shoulder mobility and decreased compensatory movements. Improvements were maintained at long-term follow-up. All shoulder movements with the exception of shoulder flexion during the high reach task and shoulder abduction during the hand to back task were not significantly different than normal values at long-term follow-up. Axillary contracture release surgery improves shoulder function in the short and long term. Motion analysis is a modality that may prove valuable in objectively quantifying changes in movement patterns immediately and in subsequent years after burn injury.
    Journal of burn care & research: official publication of the American Burn Association 11/2011; 33(2):228-34. DOI:10.1097/BCR.0b013e3182331df4 · 1.43 Impact Factor
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    ABSTRACT: Purpose: Congenital thumb hypoplasia is a spectrum of clinical abnormalities ranging from a small digit to absence of the thumb resulting in abnormal opposition. Surgical repair requires understanding the abnormal anatomy and its effect on altered thumb opposition. Presently, there are limited clinical methods to assess thumb motion and, indirectly, the impact of abnormal opposition on thumb function. Therefore, the purpose of this study is develop and validate a kinematic model of the hand to measure thumb joint range of motion (ROM) and functional workspace of the thumb for future use in children with congenital thumb hypoplasia. Methods: A mathematic model of the hand describing the three-dimensional (3D) spatial relationship between the thumb and fingertips was developed using Motion Analysis Corporation and MATLAB software. The model included positioning twelve retroreflective markers on landmarks of the thumb, hand and fingertips to determine relative positions in 3D space. Marker positions were recorded using an eight-camera system. The mathematic model was validated by fabricating a rigid frame model of the hand. With markers attached to the frame, three tests were performed: (1) the joint angle calculation was validated by articulating the thumb through known angles; (2) the functional workspace calculation was validated by comparing intersection of two known volumes; (3) simulation of ROM tasks (full ROM and Kapandji test). Data Analysis: Custom MATLAB software calculated joint ROM and functional thumb workspace. For the functional workspace, a 3D triangular mesh shell was generated overlying marker data. All data points within the shell were interpolated and common data points between the thumb-tip and fingertips were determined (Figure). Data were compared using a two-tailed t-test. Results: There were no significant differences between goniometric and calculated joint angles for the CMC, MCP and IP joints (Table). The mean error for the functional workspace calculation was 3.1% and was not affected by volume size. The workspace calculated from the simulated Kapandji test was 72.2% smaller (p < 0.05) than the overall thumb ROM. Of note, the simulated Kapandji test measured decreased palmar abduction. Conclusion: This study presents an accurate kinematic model for measurement of the ROM and functional workspace of the thumb. Current clinical measurements of the thumb examine functionality but may not adequately assess deficiencies since thumb motion is not quantified. Future investigations will examine the functional ROM and workspace of the thumb in normal children and children with congenital thumb hypoplasia. Joint Angle () CMC Flex-Ext Abd-Add MCP Flex-Ext IP Flex-Ext 15 1.5 1.1 1.7 1.6 30 2.0 1.4 2.2 1.8 45 2.1 1.2 2.4 1.4 60 1.1 0.9 2.7 1.6 75 1.2 1.3 3.1 2.0 90 1.1 3.3 4.0 2.7 Table 1: Angle differences (calculated vs. goniometric) for thumb carpometacarpal (CMC), metacarpophalangeal (MCP), and interphalangeal (IP) joints.
    2011 American Academy of Pediatrics National Conference and Exhibition; 10/2011
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    ABSTRACT: To test a model of determinants of intensity of participation in leisure and recreational activities by youth with cerebral palsy (CP). Prospective cohort study. Children's hospitals (N=7). Youth with CP (N=205; age, 13-21y) and their parents. The sample included 107 (57.2%) males and 26 (12.7%) to 57 (27.8%) youth in each of the 5 levels of the Gross Motor Function Classification System (GMFCS). Not applicable. Youth completed the Children's Assessment of Participation and Enjoyment by means of an interview. Parents completed the Pediatric Outcomes Data Collection Instrument, Family Environment Scale, Coping Inventory, Measure of Processes of Care, a demographic questionnaire, and a services questionnaire. Structural equation modeling was used to test the model. Fit statistics indicate good model fit. The model explains 35% of the variance in intensity of participation. Path coefficients (P ≤ .05) indicate that higher physical ability, higher enjoyment, younger age, female sex, and higher family activity orientation are associated with higher intensity of participation. GMFCS level and caregiver education have indirect effects on intensity of participation. The path between services and intensity of participation was not significant. Participation by youth with CP is influenced by multiple factors. The influence of physical activity supports the importance of activity accommodations and assistive technology for youth who are not capable of improving physical ability. Knowledge of family activity orientation is important for identifying opportunities for participation. The unexplained variance suggests that the model should include other determinants, such as physical accessibility and availability of transportation and community leisure and recreational activities.
    Archives of physical medicine and rehabilitation 09/2011; 92(9):1468-76. DOI:10.1016/j.apmr.2011.04.007 · 2.57 Impact Factor
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    ABSTRACT: The objective of this work was to quantitatively describe the relationships among overall lower extremity strength and body composition with measures of activity in ambulatory children with cerebral palsy (CP). The design was a prospective, multicenter cohort, cross-sectional study among seven pediatric orthopedic facilities. The participants included children ages eight to 18 years (n = 392; 249 male, 143 female), GMFCS levels I- III (I = 155; II = 160; III = 77) with diplegia (n = 280, mean age 12.9 ± 2.7 years) and hemiplegia (n = 112, mean age 12.6 ± 2.9 years). Main outcome measures include lower extremity strength, body composition, and activity. Quantitative relationships among variables were reported using Pearson correlation coefficients with p < 0.001. Results show strength had fair to moderate correlations with GMFM-66 and PODCI global function, sports and physical function, and transfer and basic mobility scores for children with diplegia. Children with hemiplegia demonstrated a fair correlation between strength and GMFM-66 score. For children with diplegia and hemiplegia, BMI was not correlated with measures of function or activity. Body fat percentage demonstrated a fair correlation with PODCI global function scores for children with hemiplegia. Body composition measures had a fair correlation to overall strength for both those with hemiplegia and diplegia. Stronger relationships among measures were observed in higher functioning children. It is concluded that a positive relationship exists between lower extremity strength and measures of activity in ambulatory children with CP. There are multiple factors influencing activity in children with CP, and strength and body composition should not be ignored.
    Critical Reviews in Physical and Rehabilitation Medicine 01/2011; 23(1-4):15-29. DOI:10.1615/CritRevPhysRehabilMed.v23.i1-4.20
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    ABSTRACT: The purpose of this work is to provide comparison data for muscle strength and measures of activity and participation stratified by GMFCS level, age, and cerebral palsy (CP) type. Clinicians can use the data to determine treatment goals based on the patients' matched peer group. Methods used were data were collected on 377 individuals with hemiplegia and diplegia, GMFCS levels I-III, ages eight to18 years. Lower extremity muscle strength, Gillette gait index (GGI), one-minute walk test (1MWT), and timed up-and-go (TUG) were collected. Results showed that strength differed among GMFCS levels and age for both CP types. The GGI and 1 MWT discriminated among GMFCS levels within each CP type. The TUG discriminated between GMFCS levels I and III and levels II and III for the diplegic group. We conclude that differences in strength and measures of activity and participation were found across GMFCS levels and CP type. The reported stratified data can serve as an important clinical tool in determining realistic treatment goals and clinical outcomes.
    Critical Reviews in Physical and Rehabilitation Medicine 01/2011; 23(1-4):1-14. DOI:10.1615/CritRevPhysRehabilMed.v23.i1-4.10
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    ABSTRACT: To determine dimensionality and item-level properties of the Gillette Functional Assessment Questionnaire (FAQ) 22-item skill set using factor and Rasch analyses. A retrospective review of parent-reported FAQ 22-item skill set data was conducted of 485 individuals (273 males, 212 females; mean age 9 y 10 mo, SD 3 y 10 mo), including 289 with cerebral palsy and 196 with a variety of other neuromusculoskeletal conditions with orthopedic impairments. Factor analyses to validate unidimensionality of the skill set and Rasch analyses to determine relative item difficulty, item and test level information, and content coverage of the item set were performed. Differential item functioning analysis of sub-groups based on sex, diagnosis grouping, and age was conducted. Precision of score estimates for the item set was analyzed. The FAQ 22-item skill set demonstrates unidimensional structure and good item fit statistics. No floor or ceiling effects were noted. Differential item functioning (DIF) based on age was noted for seven items, four items showed diagnosis group-related DIF, and one item sex-related DIF. Precision was adequate in the mid-range range of abilities. Based on this analysis, the FAQ 22-item skill set is a hierarchical set of interval scaled items suitable for measuring locomotor skill ability in children.
    Developmental Medicine & Child Neurology 11/2010; 53(3):250-5. DOI:10.1111/j.1469-8749.2010.03832.x · 3.51 Impact Factor

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  • 2007-2015
    • University of California, Davis
      • • Department of Orthopaedic Surgery
      • • School of Medicine
      Davis, California, United States
  • 1995-2015
    • Shriners Hospitals for Children
      Tampa, Florida, United States
  • 2004-2006
    • California State University, Sacramento
      Sacramento, California, United States