-
[show abstract]
[hide abstract]
ABSTRACT: This study examines the criterion-related validity and clinimetric properties of the Assessment of Preschool Children's Participation (APCP) for children with cerebral palsy (CP). Eighty-two children with CP (age range, two to five years and 11 months) and their caregivers participated in this study. The APCP consists of diversity and intensity scores in the areas of play (PA), skill development (SD), active physical recreation (AP), social activities (SA), and total areas. Tests were administered at baseline and at six-month follow-up. Concurrent and predictive validities were identified by assessing the strength of correlations between APCP scores and criterion-related measures-the 66-item Gross Motor Function Measure (GMFM-66) and Functional Independence Measure for Children (WeeFIM). Responsiveness was measured by standardized response mean (SRM). Minimal detectable change (MDC) at the 95% confidence level (MDC95) and minimal clinically important difference (MCID) were analyzed. The APCP with GMFM-66 and WeeFIM had fair to excellent concurrent validity (r=0.39-0.85) and predictive validity (r=0.46-0.82). The SRM values of the APCP diversity and intensity scales in all areas were 0.8-1.3. The MDC95 and MCID ranges for all areas (i.e., PA, SD, AP, SA, and total areas) were 0.1-0.7 and 0.4-1.2 points for intensity scores, respectively, and 4-17% and 10-19% for diversity scores, respectively. Therefore, the APCP scale was markedly responsive to change. Clinicians and researchers can use these clinimetric APCP data to determine whether a change score represents a "true" or clinically meaningful effect at post-treatment and follow-up.
Research in developmental disabilities 03/2013; 34(5):1528-1535. · 4.41 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study examined criterion-related validity and clinimetric properties of the pediatric balance scale (PBS) in children with cerebral palsy (CP). Forty-five children with CP (age range: 19-77 months) and their parents participated in this study. At baseline and at follow up, Pearson correlation coefficients were used to determine criterion-related validity by analyzing the correlation between the PBS, including PBS-static, PBS-dynamic, and PBS-total, and criterion measures, including the Gross Motor Function Measure-66 items (GMFM-66) and Functional Independence Measures for Children (WeeFIM). Responsiveness was examined by paired t test and by standardized response mean (SRM). The minimal detectable change (MDC) was analyzed at the 90% confidence level, and the minimal clinically important differences (MCID) was estimated by anchor-based and distribution-based approaches. The PBS with GMFM-66 and WeeFIM showed fair-to-excellent concurrent validity at pretreatment and follow up and predictive validity. The SRM values of all PBS scales were 0.75. For the PBS-static, PBS-dynamic, and PBS-total, the MDC(90) values were 0.79, 0.96, and 1.59, and the MCID ranges were 1.47-2.92, 2.23-2.92, and 3.66-5.83, respectively. Improvement of at least MDC values on the PBS can be considered a true change, not measurement error. A mean change must exceed the MCID range on PBS to be considered clinically important change. Therefore, all PBS scales were moderately responsive to change. Clinicians and researchers can use these clinimetric data for PBS to determine if a change score represents a true or clinically meaningful effect at posttreatment and follow up.
Research in developmental disabilities 01/2013; 34(3):916-922. · 4.41 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Very few studies have investigated predictors of change in various gross motor outcomes in ambulatory children with cerebral palsy (CP). The aim of this study was to identify potential predictors for change in gross motor outcomes measured during various tasks in children with CP. A group of 45 children (age, 6-15 years) with CP and 7 potential predictors were identified, including age, gender, CP subtypes, gross motor function classification system (GMFCS) levels, abdominal muscle endurance, and muscles strength of knee extensor and knee flexor measured by isokinetic dynanometer. Motor outcome was assessed by means of the gross motor composite (GMC) of Bruininks-Oseretsky Test of Motor Proficiency (BOTMP), including four gross motor subtests: running speed and agility (RSA), balance (BAL), bilateral coordination (BCO), and strength (STR). The outcomes were measured at baseline and 12-week later (follow-up). The regression analyses showed that knee extensor strength was a robust predictor of change in BAL, BCO, and GMC (adjusted R(2)=0.07-0.19, P<0.05). Additionally, abdominal muscle strength was a negative predictor for the changes in the RSA (adjusted R(2)=0.08, P<0.05). However, STR model revealed no significant predictors. These findings suggest that ambulatory children with greater knee muscle strength may benefit more from therapy than those with lower strength. The knee muscle strength can be used as a biomarker to predict the changes in the gross motor functions.
Research in developmental disabilities 11/2012; 34(1):721-728. · 4.41 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to evaluate the relationships of muscle strength at different angular velocities and gross motor functions in ambulatory children with cerebral palsy (CP). This study included 33 ambulatory children with spastic CP aged 6-15 years and 15 children with normal development. Children with CP were categorized into level I (n=17) or level II (n=16) according to Gross Motor Function Classification System (GMFCS) levels. All children underwent curl-up test and isokinetic tests of the knee extensor and flexor muscle. Children with CP underwent the gross motor function assessments, including the Gross Motor Function Measure (GMFM-66) and the gross motor subtests of Bruininks-Oseretsky Test of Motor Proficiency (BOTMP). The hamstring-quadriceps ratio (HQ ratio) was calculated as 100%×(isokinetic peak torque of hamstring (knee flexor)/isokinetic peak torque of quadriceps (knee extensor)). Children with GMFCS level II had lower BOTMP and GMFM-66 scores, curl-up scores, HQ ratio, and knee muscle strength, especially knee flexor, compared to those with GMFCS level I. The regression analysis showed that knee flexor torques at 60 and 90°/s are mainly related to balance (r(2)=0.167, p=0.011) and strength (r(2)=0.243, p=0.002) while knee flexor torques at 120°/s mainly contribute to running speed and agility (r(2)=0.372, p<0.001). These findings suggest that children with CP had knee strength deficits, especially knee flexor. Postural muscle (knee flexor) strength dominated gross motor function than antigravity muscle strength (knee extensor). The knee flexor strength at different angular velocities was associated with various gross motor tasks. The HQ ratio may be used as a potential biomarker to probe the therapeutic effectiveness for muscle strengthening in these children. These data may allow clinician for formulating effective muscle strengthening strategies for these children.
Research in developmental disabilities 07/2012; 33(6):2308-16. · 4.41 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study is the first well-designed randomized controlled trial to assess the effects of a novel home-based virtual cycling training (hVCT) program for improving muscle strength in children with spastic cerebral palsy (CP). Twenty-eight ambulatory children with spastic CP aged 6-12 years were randomly assigned to an hVCT group (n=13) or a control group (n=15). Outcome measures, including gross motor function of the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) and muscle strength (isokinetic torque of knee extensor and flexor muscle), were administered before and immediately after the 12-week intervention. Analysis of covariance (ANCOVA) at post-treatment showed that, compared to the control group, the hVCT group had significantly higher isokinetic torque in the knee extensor and flexor muscles at 60°/s and 120°/s angular velocities (p<0.05). At post-treatment, the hVCT group also showed greater isokinetic strength improvement in the knee flexor than in the knee extensor at 60°/s (knee flexor: 41%; knee extensor: 19%) and at 120°/s (knee flexor: 36%; knee extensor: 30%). However, the BOTMP scores at post-treatment did not differ between the two groups. Although the proposed 12-week hVCT protocol does not improve gross motor function, it enhances knee muscle strength in children with CP. The protocol obtains larger gains in the knee flexor than in the knee extensor at different angular velocities. The study findings will help clinicians to provide more effective and efficient strategies for muscle strength training in children with CP.
Research in developmental disabilities 07/2012; 33(4):1087-94. · 4.41 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To better generalize training effects to the context of daily living, home-based constraint-induced therapy has been proposed. Therapeutic success of constraint-induced therapy is limited as to whether the improvements in functional performance can be transferred to quality of life. This randomized controlled trial aimed to investigate the efficacy of home-based constraint-induced therapy on functional performance and health-related quality of life. Twenty-two children with spastic unilateral cerebral palsy (6-8 years, 10 boys) were randomly assigned to receive constraint-induced therapy or traditional rehabilitation. Home-based constraint-induced therapy had immediate and maintaining effects on motor efficacy and functional performance and induced greater gains in health-related quality of life in the long run than in the short term. The home-based constraint-induced therapy protocol (relatively moderate intensity and shortened constraint time), which might balance the effectiveness and compliance of participants and caregivers, may be an effective alternative to conventional constraint-induced therapy.
Journal of child neurology 01/2012; 27(8):992-9. · 1.59 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE:: This study aimed to examine the relationship between fine and gross motor skills and cerebral palsy-specific quality-of-life in ambulatory children with cerebral palsy. DESIGN:: Thirty-nine children with cerebral palsy (29 boys, 10 girls; mean age ± SD, 8.8 ± 2.3 yrs) classified under Gross Motor Function Classification System Level I or II were enrolled. Health-related quality-of-life was evaluated using the Cerebral Palsy Quality of Life Questionnaire for Children (parent-proxy version). Motor functions were measured using the Bruininks-Oseretsky Test of Motor Proficiency. RESULTS:: Regression analysis for QOL revealed fine motor skills, including upper-limb speed and dexterity, which are positively correlated to functioning (r = 0.205, P < 0.01), and visual-motor control that is positively correlated to other domains, including social well-being and acceptance, participation and physical health, emotional well-being and self-esteem, and family health (r = 0.150-0.188, P < 0.05). CONCLUSIONS:: Fine motor functions, including upper-limb speed and dexterity and visual-motor control, were the most important motor factors associated with health-related quality-of-life in ambulatory children with cerebral palsy.
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 09/2011; · 1.56 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Elucidating developmental profiles and temperament patterns in children with cerebral palsy (CP) could help clinicians elaborate more flexible strategies for treating these children. This study investigated the developmental profiles and temperament patterns in children with spastic CP (sCP) of different subtypes and severities.
One hundred and five children, aged 3-6 years, with sCP and 66 children with typical development (TD) were analyzed. Children with sCP were classified into spastic diplegia (SD; n = 60), and spastic quadriplegia (SQ; n = 45) groups. Motor severity was classified via the Gross Motor Function Classification System (GMFCS). Development quotients (DQs) of eight domains and temperament scores of nine dimensions were evaluated.
The SQ group had lower DQs in all developmental functions than the SD group (p < 0.01). The DQ distributions of developmental profiles showed the same trend in SD and SQ groups, and both groups displayed lowest DQs in the gross motor domain. The SQ group was less adaptable and approachable than the TD group (p < 0.05), and both sCP groups had lower attention span and persistence and a higher threshold of responsiveness than the TD group (p < 0.05). Correlation analysis showed that GMFCS levels were highly related to all developmental functions (r < -0.54, p<0.01) and weakly related to some temperament dimensions in children with sCP.
The subtype and severity of sCP were associated with developmental profiles in children with sCP Temperament patterns were different between SD and SQ groups, but only weakly related to motor deficit. These data could allow clinicians to anticipate the developmental profiles and temperament patterns and plan appropriate therapeutic strategies for children with sCP.
Journal of the Formosan Medical Association 08/2011; 110(8):527-36. · 1.13 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Intrasalivary gland injection of botulinum toxin type A is known to treat sialorrhea effectively in children with cerebral palsy. However, oral health may be compromised with escalating dose. In this randomized, double-blind, and placebo-controlled pilot trial, the authors aim to determine the therapeutic effect of low-dose, ultrasonography-controlled botulinum toxin type A injection to bilateral parotid and submandibular glands on oral health in the management of sialorrhea. Twenty children diagnosed with cerebral palsy were randomly assigned to 2 groups. The treatment group received botulinum toxin type A injections, whereas the control received normal saline in the same locations. The authors evaluated subjective drooling scales, salivary flow rate, and oral health (salivary compositions and cariogenic bacterial counts). A significant decrease was found in salivary flow rate at the 1- and 3-month follow-up in the botulinum toxin-treated group. The authors suggest that current protocol can effectively manage sialorrhea while maintaining oral health.
Journal of child neurology 05/2011; 26(7):838-43. · 1.59 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Severe obstructive sleep apnea (OSA) increases the risk of stroke recurrence and mortality after stroke. Since nocturia is common in post-stroke patients with OSA, this study explored the predictive role of nocturia for severe OSA in patients with ischemic stroke. This was a cross-sectional, prospective study involving 65 consecutive patients with ischemic stroke admitted to rehabilitation ward. All participants received polysomnography and clinical assessments, including a 3-day urinary frequency-volume recording. Differences in study variables between patients with and without severe OSA were compared, and logistic regression analyses with backward selection procedures were used to assess the relationship between OSA severity and nocturia. Patients with severe OSA were older (69.6 ± 9.9 vs. 62.6 ± 11.5 year), had a significantly higher desaturation index (37.9 ± 16.1 vs. 8.8 ± 6.1 episodes/night) and had a higher frequency of nocturia (2.2 ± 1.0 vs. 1.5 ± 0.8 episodes/night) than those without. In addition, men with severe OSA had a larger neck circumference (409 ± 26 vs. 381 ± 32 mm) than those without. The frequency of nocturia, age, sex, and interaction between sex and neck circumference remained significant in the final regression model for severe OSA. In this model, the area under the receiver operating characteristic curve was 0.87 (95% CI 0.79-0.96; P < 0.001) with sensitivity and specificity of 80.6 and 82.8%, respectively. The odds ratio of nocturia was highest (3.5) among the four variables. Nocturia is an independent predictor for severe OSA, and the final prediction model might be used when screening for severe OSA in patients with ischemic stroke.
Journal of Neurology 02/2011; 258(2):189-94. · 3.47 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To determine the effects of magnetic knee wraps (MKWs) on joint position sense (JPS) in individuals with mild-to-moderate knee osteoarthritis.
Randomized, double-blind, placebo-controlled pilot trial.
Rehabilitation clinic of a tertiary hospital.
Fifty volunteers with mild-to-moderate knee osteoarthritis participated and 33 (66%) completed the trial; only one (2%) withdrew due to study-related adverse effects.
Knee wraps with a static magnetic field (35 mT) were compared with control knee wraps for 12 weeks.
The main outcome measure was JPS at first, fourth, and twelfth week while applying of the knee wrap, quantified as the ability to replicate target knee joint angles. The secondary outcome was the Comprehensive Osteoarthritis Test (COAT) total score.
In the intention-to-treat analysis with an alpha-level of 0.05, 12-week application of the MKWs did not significantly reduce the mean absolute error (MAE) of JPS (n = 18; P = 0.627); contrarily, the MAE was found to decrease significantly after wearing the sham MKWs (n = 20; P = 0.01). The COAT total score gradually improved in both groups (P < 0.05). When comparing the improvement of MAE and COAT total score at each follow-up between two groups, no significant differences were found; the maximal difference in the improvement of MAE between two groups was noted at week 12 (mean difference: 1.2°; 95% confidence interval -0.4 to 2.9; P = 0.144). In the per-protocol analysis, the study group showed better improvement in the COAT total score at week 12 (P = 0.033).
The 35-mT MKWs could not significantly influence knee JPS in individuals with mild-to-moderate knee osteoarthritis.
Clinical Rehabilitation 10/2010; 25(3):228-37. · 2.12 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Cerebral palsy (CP) is a disorder of movement and posture control with multiple impairments. The clinical manifestations of CP vary among children. The aim of this study was to compare the developmental profiles of preschool children with either of two types of CP: spastic diplegic (SD) CP and spastic quadriplegic (SQ) CP. Relationships between the children's various developmental functions were also investigated. We recruited 137 children with spastic CP, aged 1-5 years (mean age = 3.7 +/- 2.1 years), and we classified them into two groups: SD (n = 59) and SQ (n = 78). The comparison group comprised 18 children with typical development. Developmental functions were assessed in all the children, using the Chinese Child Development Inventory with the updated norms. This scale addressed eight functional domains: gross motor ability, fine motor ability, expressive language ability, concept comprehension ability, situation comprehension ability, self-help ability, personal-social skills, and general development. A development quotient (DQ) was determined for each domain as a percentage of the developmental age divided by the chronological age. The developmental profiles of the CP subtypes were found to differ. Children with SQ were found to have lower DQs than those with SD (p < 0.01). There was also a difference in the distribution of DQs between the SD and SQ groups, although the lowest DQ in both groups was for the gross motor domain. An uneven delay in the development of gross motor function was found in both groups of children with CP. Motor functions, including gross motor and fine motor functions, were significantly related to self-help ability. Complex and significant correlations among developmental functions were also identified in children with CP. The findings in the present study may allow clinicians to anticipate the developmental profile of children with CP on the basis of whether they have the SD or SQ subtype. This, in turn, is likely to facilitate individual assessment, goal setting, and the planning of interventions in children with CP.
The Kaohsiung journal of medical sciences 07/2010; 26(7):341-9. · 0.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the follow-up course of developmental profiles in preschool children with spastic quadriplegic (SQ) cerebral palsy (CP) who had varying ambulatory abilities.
Forty-eight children with SQ CP between 1 and 5 years old were classified into 2 groups, the ambulatory and non-ambulatory groups, based on Gross Motor Function Classification System (GMFCS) levels during the initial assessment. The developmental profiles, consisting of development quotients (DQs) of 8 domains, were evaluated during the initial assessment and the final assessment one year later. The DQ change index (%) was calculated as 100% X (final DQ-initial DQ)/initial DQ.
The DQs of all developmental domains in the non-ambulatory group were lower than those in the ambulatory group on both initial and final assessments (p<0.01). As indicated by the DQ change indices, most DQs in the ambulatory group decreased slightly, whereas those in the non-ambulatory group decreased considerably (p<0.05). Furthermore, fine motor function increased proportionally with age in the ambulatory group, but not in the non-ambulatory group.
The DQs of the developmental profiles varied in preschool CP children with different ambulatory abilities. The course of developmental profiles in preschool children with SQ CP evolves with age and relates to the degree of ambulatory function. Knowledge of these developmental profiles may be helpful in understanding, predicting, and managing the developmental problems of these children.
Chang Gung medical journal 01/2010; 33(5):524-31.
-
[show abstract]
[hide abstract]
ABSTRACT: To determine the effects of magnetic knee wrap on isokinetic quadriceps strength in patients with painful knee osteoarthritis (OA).
Randomized, double-blinded, placebo-controlled and before-after trial.
Rehabilitation clinic in a tertiary hospital.
Eligible patients (N=50) (mean age+/-SD, 66.0+/-8.6 y) with mild to moderate knee OA were recruited from the outpatient department and 37 (74%) completed the trial. Only 3 (6%) withdrew due to study-related adverse effects.
Wearing the active (n=24) or sham (n=26) magnetic knee wrap for 12 weeks.
The primary outcome measure was isokinetic quadriceps strength. Secondary outcome measures included the Health Assessment Questionnaire Disability Index (HAQ-DI) and the Health Assessment Questionnaire (HAQ) Pain Scale.
Using intention-to-treat analyses, the peak isokinetic quadriceps strength increased significantly in the treated leg at 30 degrees/s (P=.007) and 60 degrees/s (P=.022) after wearing the magnetic knee wrap. Compared with baseline, the median strength increase for the treated leg in the study group significantly exceeded that in the control group at week 4 (.05 Nm/kg vs -.09 Nm/kg at 60 degrees/s, P=.038) and week 12 (30 degrees/s, .09 Nm/kg vs .04 Nm/kg, P=.044; 60 degrees/s, .17 Nm/kg vs .02 Nm/kg, P=.031). The HAQ-DI and HAQ Pain Scales improved significantly in both groups. Compared with baseline, the improvement at week 12 in terms of the HAQ-DI in the study group significantly exceeded that in the control group.
Magnetic knee wrap may significantly facilitate isokinetic quadriceps strength in patients with mild to moderate knee OA.
Archives of physical medicine and rehabilitation 11/2008; 89(12):2258-64. · 2.18 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Attention deficit hyperactivity disorder (ADHD) was characterized by deficit in the attention mechanism. Until now, the visual-spatial attention deficit in children with ADHD remains controversial. We report a study of the visual spatial attention to assess covert shifts of attention and sustained attention theoretically linked to two neuroanatomically defined attentional system in the posterior and anterior parts of the human brain.
Using the Neuroscan system, the reaction time (RT) was measured according to three different within-subject conditions including cueing (valid, invalid and neutral); delay (800 msec and 100 msec); side [right visual field (RVF) and left visual field (LVF)] as well as one between-subject condition (healthy, ADHD).
The AHDH group showed slower RTs overall (RT = 760 msec) than the comparison group (RT = 650 msec) (p = 0.001). RTs in the delayed condition of 800 msec (RT = 680 msec) were faster than in the delayed condition of 100 msec (RT = 730 msec) in all children (p < 0.001). The ADHD group showed significant lateral differences in RT (RTRVF: 880 msec > RTLVF: 830 msec) in the 100 msec delay for the invalid cueing condition (p = 0.045) that was not found in the comparison group.
General dysfunction including posterior-based covert shift of attention and anterior-based sustained attention was found in ADHD group. Furthermore, asymmetric left parietal dysfunction in the disengaged operation was noted in those with ADHD.
Chang Gung medical journal 08/2002; 25(8):514-21.
-
[show abstract]
[hide abstract]
ABSTRACT: To study ground reaction force (GRF) patterns in stroke patients with various degrees of motor recovery, using plantar dynamic analysis.
Forty-three people with hemiplegic stroke and 20 healthy subjects were enrolled in the study. Motor impairment (motor recovery and muscle tone) and plantar dynamic data (GRF patterns, peak pressure, and walking speeds) were analyzed. GRF patterns were categorized into four patterns based on the force magnitude (spatial features) through time (temporal features) of the vertical GRF. Then stroke patients were classified into good (patterns III and IV) and poor groups (patterns I and II).
Patients with hemiplegic stroke showed characteristic GRF patterns which could be categorized from bimodal (pattern IV) to pathological shapes (I-III). The peak pressures on the paretic side in the metatarsal and toe areas were reduced in stroke patients compared with those in healthy subjects. Walking speeds were higher in the good group than in the poor group (p < 0.05). The peak pressures on both sides in the metatarsal and midfoot areas were lower in the poor group than in the good group (p < 0.05). GRF patterns were highly correlated with walking speeds (r = 0.92, p < 0.01). GRF patterns and walking speeds were positively correlated with motor recovery of knee movement (r > 0.4, p < 0.01), but not with hip and ankle movement or muscle tone in the lower limb.
GRF patterns, correlated with walking speeds, indicate underlying motor control of hemiplegic or hemiparetic gait. Knee motor control may be the most important factor in determining walking performance. Plantar dynamic analysis could allow clinicians an alternative assessment in detecting gait changes and planning therapeutic strategies in stroke patients.
Chang Gung medical journal 30(1):62-72.
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to investigate longitudinal changes in the developmental profiles of children with spastic quadriplegic (SQ) cerebral palsy (CP). Additionally, the relationship of developmental functions between the initial and final stages was determined.
This prospective study enrolled forty-six children with SQ CP between 2-6 years old and assessed their developmental profiles using the Chinese Child Developmental Inventory on the initial and final assessments. The interval between two assessments was 1.0 +/- 0.3 years. Eight developmental domains, including gross motor, fine motor, expressive language, concept comprehension, situation comprehension, self help, personal social and general development, were evaluated and qualified by the development quotient (DQ). The DQ change index (%) was calculated to evaluate the differences in each domain between the two assessments. The paired t test was used to compare differences in each domain between the two assessments. Pearson's correlation was used to analyze the relationship of each domain between the final and initial assessments.
Children with SQ CP had lower DQs than normal children in all developmental functions on both assessments (23 - 66%). The DQ distributions were lowest in the gross motor and self help domains, higher in the fine motor, situation comprehension, and personal social domains, and highest in the expressive language, concept comprehension, and general development domains. Except for the fine motor and concept comprehension domains, the DQs of the developmental functions were significantly decreased on the final assessment (p < 0.05).
These findings suggest preschool children with SQ CP had impairments in the full spectrum of developmental profiles. The course of developmental profiles evolves with age. Most developmental functions did not increase proportionally with increasing age in children with SQ CP.
Chang Gung medical journal 32(6):628-35.
-
[show abstract]
[hide abstract]
ABSTRACT: This study compares the longitudinal change of developmental patterns in preschool children with spastic diplegic (SD) and spastic quadriplegic (SQ) cerebral palsy (CP).
Sixty children with spastic CP, aged 1-5 years (3.2 +/- 1.2 years), were classified into 2 groups: SD (n = 29) and SQ (n = 31). Gross Motor Function Classification System (GMFCS) levels were classified during the initial assessments. Developmental profiles, including development quotients (DQs) of gross motor, fine motor, expressive language, concept comprehension, situation comprehension, self help, personal social and general development, were evaluated on initial and final assessments and an average of one year later. The DQ change index (%) was calculated as 100% x (final DQ - initial DQ)/initial DQ.
Children with SQ had lower DQs in all developmental functions than those with SD on both assessments (p < 0.01). The DQ distributions of developmental profiles were different in SD and SQ groups, although both groups displayed the lowest DQs in the gross motor domain. As indicated by the DQ change index, most DQs increased with age in children with SD; however, most decreased with age in children with SQ (p < 0.05).
These findings suggest different CP subtypes demonstrate various development profiles. The evolvement of developmental patterns with age was different in children with various CP subtypes.
Chang Gung medical journal 33(4):407-14.
-
[show abstract]
[hide abstract]
ABSTRACT: Speech production is often impaired in children with cerebral palsy (CP). This study investigated the factors associated with motor speech control in children with spastic cerebral palsy.
Thirty-three children with spastic CP who were able to speak were identified for this study. They were classified into two groups: group A (spastic diplegia or hemiplegia, n = 17) and group B (spastic quadriplegia, n = 16). Each child received various assessments, namely cognition, language, modified Verbal Motor Production Assessment for Children (VMPAC), speech intelligibility, CP subtype, and Gross Motor Function Classification System (GMFCS).
Group A showed better cognition and language function, higher modified VMPAC scores and better GMFCS levels than group B (p < 0.05). However, the two groups did not significantly differ in speech intelligibility. Linear regression indicated that all modified VMPAC scores were negatively related to CP subtype (adjusted r2 = 0.51~0.63, p < 0.001). The average modified VMPAC scores had a positive relationship with global language scores (adjusted r2 = 0.63, p < 0.001), and the modified VMPAC scores of the sequence subtests were positively related to the full intelligence quotients (adjusted r2 = 0.55, p < 0.001).
The findings of this study suggest that motor impairment severity, cognition and language functions are associated with the motor speech control among children with CP.
Chang Gung medical journal 33(4):415-23.
