Inter and Intra Rater Reliability of the 10 Meter Walk Test in the Community Dweller Adults with Spastic Cerebral Palsy

How to Cite This Article: Bahrami F, Noorizadeh Dehkordi SH, Dadgoo M. Inter and Intra Rater Reliability of the 10 Meter Walk Test in the Community Dweller Adults with Spastic Cerebral Palsy. Iran J Child Neurol.Winter 2017; 11(1): 57-64. AbstractObjectiveWe aimed to investigation the intra-rater and inter-raters reliability of the 10 meter walk test (10 MWT) in adults with spastic cerebral palsy (CP).Materials&MethodsThirty ambulatory adults with spastic CP in the summer of 2014 participated (19 men, 11 women; mean age 28 ± 7 yr, range 18- 46 yr). Individuals were non-randomly selected by convenient sampling from the Ra’ad Rehabilitation Goodwill Complex in Tehran, Iran. They had GMFCS levels below IV (I, II, and III). Retest interval for inter-raters study lasted a week. During the tests, participants walked with their maximum speed. Intra class correlation coefficients (ICC) estimated reliability.ResultsThe 10 MWT ICC for intra-rater was 0.98 (95% confidence interval (CI) 0.96-0.99) for participants, and >0.89 in GMFCS subgroups (95% confidence interval (CI) lower bound>0.67). The 10 MWT inter-raters’ ICC was 0.998 (95% confidence interval (CI) 0/996-0/999), and >0.993 in GMFCS subgroups (95% confidence interval (CI) lower bound>0.977). Standard error of the measurement (SEM) values for both studies was small (0.02< SEM< 0.07).ConclusionExcellent intra-rater and inter-raters reliability of the 10 MWT in adults with CP, especially in the moderate motor impairments (GMFCS level III), indicates that this tool can be used in clinics to assess the results of interventions.References1. Bottos M, Feliciangeli A, Sciuto L, Gericke C, Vianello A. Functional status of adults with cerebral palsy and implications for treatment of children. Dev Med Child Neurol 2001; 43:516-28.2. Andersson C, Mattsson E. Adults with cerebral palsy: a survey describing problems, needs, and resources, with special emphasis on locomotion. Dev Med Child Neurol 2001; 43:76-82.3. Murphy KP, Molnar GE, Lankasky K. Medical and Functional Status of Adults with Cerebral Palsy. Dev Med Child Neurol 1995; 37:1075-84. 4. Rapp Jr CE, Torres MM. The adult with cerebral palsy. Arch Family Med 2000; 9:466.5. Peters DM, Fritz SL, Krotish DE. Assessing the reliability and validity of a shorter walk test compared with the 10-meter walk test for measurements of gait speed in healthy, older adults. J Geriatr Phys Ther 2013; 36:24-30.6. Fritz S, Lusardi M. White paper:“walking speed: the sixth vital sign”. J Geriatr Phys Ther 2009; 32:2-5.7. Lord SE, McPherson K, McNaughton HK, Rochester L, Weatherall M. Community ambulation after stroke: how important and obtainable is it and what measures appear predictive? Arch Phys Med Rehabil 2004; 85:234-9. 8. Maki BE. 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Spinal Cord 49:736-40.19. Thompson P, Beath T, Bell J, Jacobson G, Phair T, Salbach NM, et al. Test-retest reliability of the 10 meter fast walk test and 6 minute walk test in ambulatory school aged children with cerebral palsy. Dev Med Child Neurol 2008;50:370-6. 20. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997; 39:214-23. 21. Graham JE, Ostir GV, Fisher SR, Ottenbacher KJ. Assessing walking speed in clinical research: a systematic review. J Eval Clin Pract 2008; 14:552-62.22. Portney LG, Watkins MP. Foundations of clinical research: applications to practice, FA Davis; 2015 Mar 18. 23. Stratford PW.Getting more from the literature: estimating the standard error of measurement from reliability studies. Physiother Can 2004; 56: 27-30. 24. Bland JM, Altman DG. 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The efficacy of treadmill training on walking and quality of life of adults with spastic cerebral palsy: A randomized controlled trial

AbstractObjectives:We aimed to evaluate the efficacy of treadmill training on walkings peed and endurance and quality of life in ambulatory adults with spastic cerebral palsy (CP) versus traditional physiotherapy.Material & Methods, Participants (17 men, 13 women; mean (SD) age 25y, 9m (7y, 10m) range 18y- 45y) with GMFCS levels I, II, and III, from the Ra’ad Rehabilitation Goodwill Complex, randomly allocated to the experimental and the control groups. The trainings (treadmill for experimental group and conventional physiotherapy for control group) conducted two times a week for 8 consecutive weeks. Main outcome measures were the 10 meter walk test for the gait speed, the 6 minute walk test for the gait endurance and the WHOQOL- Brief questionnaire for the quality of life. Assessments had done at the baseline, ninth and 16th session (three times) during the treatment.Results: Although the experimental group showed a significant improve in the gait speed [1.08(0.47)m/s to 1.22(0.50)m/s](P=0.004) and in the gait endurance [291.13(160.28)m to 342.63(174.62)]( P=0/002), but between groups changes of the outcome measures of walking and quality of life were not significant.Conclusions: Treadmill training without body weight support would be no more effective than traditional physiotherapy to improve gait speed and endurance and quality of life in adults with spastic cerebral palsy. There is a hope to improve walking performance and function in adults with cerebral palsy.

Comparing the Effect of Voluntary and Electrical Fatigue of Quadriceps on Postural Control

Introduction: Postural control is necessary for conducting all activities and is the result of corporation of somatosensory, visual and vestibular systems. Impairment in each of these systems leads to disturbance of postural control and increases the risk of falling and injury. Fatigue is one of the common conditions that can affect postural control. The aim of this study was to elucidate different effects of Electrical Stimulation (ES) and Voluntary (Vol) quadriceps fatigues on postural control. Methods and Materials: This cross-sectional randomized order of testing study was performed at Biomechanics Laboratory of Iran University of Medical Sciences, Tehran, Iran from December 2014 to May 2015. Sixteen healthy active males (24.5±1.36 yr; height: 155.37±53.79 cm and body weight: 70.93±4.5 kg) participated. All the participants underwent two fatigue protocols: ES and VOL contractions. Each fatigue procedure contains isometric contraction with five seconds holding contraction, two seconds rest between each contraction and intensity of voluntary contraction was 20% of Maximal Voluntary Contraction (MVC). In each fatigue protocols, muscles MVC decreased to 30% in both ES and VOL protocols. MVC and postural control measured by using a digital dynamometer and a force plate that registered the Canter of Pressure (COP). Data collected before and after completion of each fatigue protocol. Monopedal postural control was recorded in eyes closed condition. Results: Results did not show significance effect of fatigue on area and mean velocity while showed significant effect on the anterior-posterior (Y-axis) and on the mediolateral direction (X-axis). Conclusion: Thirty percent loss of MVC in quadriceps muscle did not impair postural control.Keywords: Postural control, Quadriceps muscle fatigue, Voluntary contraction, Electrical stimulatio

The Immediate Effects of Static versus Proprioceptive Neuromuscular Facilitation Stretching with Kinesiology Taping on Hamstring Flexibility in Teenage Taekwondo Players

Introduction: This study evaluated the acute responses to static stretching versus the proprioceptive neuromuscular facilitation stretching technique with and without applying kinesio tape on hamstring muscle flexibility, as scarce evidence exists in this field. Materials and Methods: Twenty teenage professional black/red belt taekwondo players participated in this study. Proprioceptive Neuromuscular Facilitation (PNF) and static hamstring stretching was performed for both legs of each subject. Then a Y-shape Kinesio Tape (KT) with 30% tension was applied over one leg chosen randomly. Active Knee Extension Test (AKET) and Passive Straight Leg Raise (PSLR) were performed at base line, immediately and 24 hours after interventions. Results: Repeated measures ANOVA was used to statistically analyze the data. PSLR test results demonstrated a significant increase in hamstring flexibility over time, while the AKET results showed no significant changes. No significant differences were observed between PNF and Static stretch (SS) or the KT and Non-Taped (NT) groups immediately or after 24 hours. Conclusion: The current study showed that there is no superiority in SS or PNF stretching techniques for increasing hamstring flexibility, and using KT over stretched muscles could not help improve flexibility.Keywords: Flexibility; Kinesiology taping; Stretching; Taekwondo playe

Mobility Compensatory Strategies in Individuals With Multiple Sclerosis (A Qualitative Study)

Background and Objectives: The complications and motor disorders caused by multiple sclerosis (MS) not only affect the individual’s movement abilities but also play a crucial and valuable role in how these individuals carry out their daily activities. In this way, patients with MS use certain compensatory methods, depending on individual differences, their environment, and their family’s support, to help with the complications of this disorder. For this reason, this study aims to identify the compensatory strategies that people with MS use to adapt to their mobility limitations. Methods: In this study, 13 patients with MS (7 women and 6 men), with informed consent, an average age of 43 years, and a qualitative content analysis approach, were included in the study. The sampling was performed purposefully with maximum variation, and the data was collected via quasi-structured in-depth interviews. Immediately after each interview, the data was analyzed using Cheevakumjorn`s method. Results: After analyzing the data and extracting the resulting codes, the codes were classified according to their similarities and differences. Ultimately, three main components of “compensatory strategies for home mobility”, “compensatory strategies for outdoor mobility”, and “compensatory strategies for carrying out daily activities” were formed. Conclusion: Although families play a major role in compensating for the mobility problems of these patients, it is necessary for health providers to reduce the burden placed on their families, and to educate MS people on self-care and adjust their living environment. Furthermore, providing mobility assistive devices for the patients should be done according to their differences and their environment

Impaired Ipsilateral Upper Extremity Dexterity and Its Relationship with Disability in Post-Stroke Right Hemiparesis

Background: The objectives of this study were to compare manual dexterity (gross and fine) and coordination performance of the ipsilateral upper extremity of the right hemisphere stroke patients with the same side of a healthy group, and to determine the relationship of ipsilateral upper extremity dexterity and disability. Methods: In a non-randomized analytical study, 30 individuals with a unilateral first-ever stroke from outpatient rehabilitation clinics and 30 age and sex-matched adults without history of neurological disorders were enrolled. Purdue Pegboard, Box and Block, and Finger to Nose tests were used to measure dexterity (fine and gross) and coordination performance of the stroke group compared with the same hand of the healthy group. The Barthel index was also used to assess disability or dependency of stroke patients in basic activities of daily living. Results: Results showed that stroke individuals with involvement of ipsilateral hand had less coordination and dexterity when compared to the same hand of normal subjects (P=0.001). In addition, the relationship of gross and fine manual dexterity performance of the ipsilateral upper extremity with disability, including dependence in basic activities of daily living, were significant respectively (r=0.376, r=0.391). Conclusion: People with right stroke had significant ipsilateral upper extremity impairments (manual dexterity and coordination tasks), and this hand dexterity deterioration had an impact on their dependence in basic activities of daily living

Investigating the Relationship among Stability Indices with Severity of Pain, Disability and Duration of Disease in People with Cervicogenic Headache

Introduction: Cervicogenic headache is a secondary headache, whose cervicogenic disorders is known as its background factor. Considering the important role of cervical spine in providing deep-feeling entrances, a change in deep-feeling entrances can lead to disorder in these individuals. The aim of this study was to investigate the relationship between stability and severity of pain, disability and duration of headache in these patients. Methodology: In this cross-sectional study, 30 cervicogenic patients, headache index, duration of illness, disability inventory and visual acuity scale were recorded. To measure the stability, stability tests were performed in four standing positions on two extremities with open and closed eyes and with low and high stability level by Biodex stability device. The overall stability index, internal-external index and anterior-posterior index were measured. Pearson correlation test was used to examine the relationship between variables. Results: There was a significant relationship between the history of headache reporting and most of the stability indices (p=0.002, r=0.548). There was a significant relationship between the general stability index (p=0.001, r=0.563) and internal-external index and pain severity, and no significant correlation was found between the anterior-posterior index. There was no significant relationship between disability inventory (p=0.727) and headache index (p=0.186) with stability indices. Conclusion: With increasing duration of headache and increased pain intensity, stability indices increase, which can indicate a weaker stability in cervicogenic headache patients with longer illness history and more pain intensity.Keywords: Biodex Stability Device, Cervicogenic Headache, Disability, Duration Of Illness, Pain, Stabilit

Misdiagnosis of Patients with Cervicogenic Headache: A Case Series Study

Background and Objectives: Cervicogenic headache is considered to be one of the most controversial headaches because of its diagnostic challenges. It has several pathogeneses resulting in different signs and symptoms that make therapists prone to misdiagnosis. The aim of this study was to estimate the prevalence of diagnostic errors in cervicogenic headache patients. Methods: In this study that was conducted in the physiotherapy ward of the Ministry of Cooperatives, Labour, and Social Welfare clinic in summer 2018, 60 patients with chronic headache were examined using the International Headache Society Diagnostic criteria and five physical tests. The aim of this study was to determine the number of the patients with cervicogenic headache who were not diagnosed or were misdiagnosed before this study. Results: Fifty-three of the volunteers had cervicogenic headache. Only four of them were diagnosed correctly before this study, indicating that 92% of the cervicogenic headache patients were not diagnosed properly in this study. Conclusion: There is a significantly high rate of misdiagnosis in patients with cervicogenic headache. Because of the physical mechanisms that induce this type of headache, applying valid and reliable physical tests together with diagnostic criteria may lead to accurate diagnosis of cervicogenic headache

Effect of Duration of Smartphone Use on Cervical Repositioning Error in Forward Head Posture and Normal Posture

Introduction: The purpose of this study was to assess the influence of the duration of smartphone usage on repositioning error in the cervical spine in forward head posture and normal posture. Materials and Methods: Thirty subjects (normal group: mean age 22.2±.90 years, mean height 161.00±.87 cm, mean weight 56.46±1.40 kg; and FHP group: mean age 24.26±.98 years, mean height 165.80±1.69 cm, mean weight 61.66±1.52 kg) were classified into two groups (15 forward head posture and 15 normal subjects) whose used their own smartphone for 20 minutes. Cervical repositioning error (for flexion, extension, right and left rotation) was calculated for all subjects before and after use of smartphone. All statistical analyses were conducted using IBM SPSS Statistics 24. Results: Position sense error for flexion in normal group had a significant difference before and after using the smartphone. However, there was no significant difference in FHP groups and between the two groups. There was no significant difference either in extension and left rotation before and after use of smartphone and between two groups. Position sense error for the right rotation before and after using the smartphone in two groups had no significant difference, but after using the smartphone there was significant difference between the two groups. Conclusion: There were no significant differences in cervical repositioning error before and after use of smartphone in the normal group and FHP group as well as between the two groups.Keywords: Cervical, Forward Head Posture, Repositioning Error, Smart Phon

Mobility Barriers for People with Multiple Sclerosis: a Qualitative Study

Background & Objectives: The purpose of this study was to identify the experiences of people with multiple sclerosis (MS) from mobility barriers they are faced with. Methods: This study included 13 patients with MS (7 women and 6 men), with informed consent, whose average age is 43 years. A qualitative content analysis approach was used. According to the EDSS criteria, the severity of their disability was between 8-4. The sampling was carried out purposefully with maximum variation, and the data was collected through semi-structured in-depth interviews. Immediately after each interview, the data was analyzed using the Cheevakumjorn`s method.  Results: After analyzing the obtained data and categorizing the resulting codes; three main categories were observed: “disease-affected barriers”, “personal barriers” and “environmental barriers”. The data of each theme were classified as subthemes.  Conclusion: Based on research findings and experiences of the participants, rehabilitation specialists during the assessment, management and treatment of patients with MS should alert and educate patients about personal mobility barriers and try to help them fit in their physical environment