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. Gait changes in older adults: predictors of falls or indicators of fear. J Am Geriatr Soc 1997; 45:313-20. 9. Tyson S, Connell L. The psychometric properties and clinical utility of measures of walking and mobility in neurological conditions: a systematic review. Clin Rehabil 2009; 23:1018-33.10. Bohannon RW. Comfortable and maximum walking speed of adults aged 20—79 years: reference values and determinants. Age Ageing 1997; 26:15-9.11. Judith G, Claudia L, Hubertus VH. Test-retest reliability of gait parameters in children with neurological gait disorders. International Neurorehabilitation Symposium 2013, Science City, ETH Zurich.12. Watson MJ. Refining the ten-metre walking test for use with neurologically impaired people. Physiotherapy2002; 88:386-97. 13. van Loo MA, Moseley AM, Bosman JM, de Bie RA, Hassett L. Test-re-test reliability of walking speed, step length and step width measurement after traumatic brain injury: a pilot study. Brain Inj 2004 Oct; 18:1041-8.14. Steffen T, Seney M. Test-retest reliability and minimal detectable change on balance and ambulation tests, the 36-item short-form health survey, and the unified Parkinson disease rating scale in people with parkinsonism. Phys Ther 2008 Jun; 88:733-46.15. Pirpiris M, Wilkinson AJ, Rodda J, Nguyen TC, Baker RJ, Nattrass GR, et al. Walking speed in children and young adults with neuromuscular disease: comparison between two assessment methods. J Pediatr Orthop 2003 May-Jun; 23:302-7.16. Collen FM, Wade DT, Bradshaw CM. Mobility after stroke: reliability of measures of impairment and disability. Int Disability Stud 1990 Jan-Mar; 12 :6-9.17. Bowden MG, Behrman AL. Step Activity Monitor: accuracy and test-retest reliability in persons with incomplete spinal cord injury. J Rehabil Res Dev 2007; 44:355-62.18. Scivoletto G, Tamburella F, Laurenza L, Foti C, Ditunno J, molinari M. Validity and Reliability of the 10-m walk test and the 6 min walk test in spinal cord injury patients. 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. Statistic and random error in repeated measurements of temporal and distance parameters of gait after stroke. Arch Phys Med Rehabil 1997; 78: 725-29.25. Wolf S, Catlin P, Gage K, Gurucharri K, et al. Establishing the reliability and validity of measurements of walking time using the Emory Functional Ambulation Profile. Phys ther 1999; 79:1122-33

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.

MODEM: a multi-agent hierarchical structure to model the human motor control system

In this study, based on behavioral and neurophysiological facts, a new hierarchical multi-agent architecture is proposed to model the human motor control system. Performance of the proposed structure is investigated by simulating the control of sit to stand movement. To develop the model, concepts of mixture of experts, modular structure, and some aspects of equilibrium point hypothesis were brought together. We have called this architecture MODularized Experts Model (MODEM). Human motor system is modeled at the joint torque level and the role of the muscles has been embedded in the function of the joint compliance characteristics. The input to the motor system, i.e., the central command, is the reciprocal command. At the lower level, there are several experts to generate the central command to control the task according to the details of the movement. The number of experts depends on the task to be performed. At the higher level, a "gate selector” block selects the suitable subordinate expert considering the context of the task. Each expert consists of a main controller and a predictor as well as several auxiliary modules. The main controller of an expert learns to control the performance of a given task by generating appropriate central commands under given conditions and/or constraints. The auxiliary modules of this expert learn to scrutinize the generated central command by the main controller. Auxiliary modules increase their intervention to correct the central command if the movement error is increased due to an external disturbance. Each auxiliary module acts autonomously and can be interpreted as an agent. Each agent is responsible for one joint and, therefore, the number of the agents of each expert is equal to the number of joints. Our results indicate that this architecture is robust against external disturbances, signal-dependent noise in sensory information, and changes in the environment. We also discuss the neurophysiological and behavioral basis of the proposed model (MODEM

Exploring the dynamic interplay between learning and working memory within various cognitive contexts

IntroductionThe intertwined relationship between reinforcement learning and working memory in the brain is a complex subject, widely studied across various domains in neuroscience. Research efforts have focused on identifying the specific brain areas responsible for these functions, understanding their contributions in accomplishing the related tasks, and exploring their adaptability under conditions such as cognitive impairment or aging.MethodsNumerous models have been introduced to formulate either these two subsystems of reinforcement learning and working memory separately or their combination and relationship in executing cognitive tasks. This study adopts the RLWM model as a computational framework to analyze the behavioral parameters of subjects with varying cognitive abilities due to age or cognitive status. A related RLWM task is employed to assess a group of subjects across different age groups and cognitive abilities, as measured by the Montreal Cognitive Assessment tool (MoCA).ResultsAnalysis reveals a decline in overall performance accuracy and speed with differing age groups (young vs. middle-aged). Significant differences are observed in model parameters such as learning rate, WM decay, and decision noise. Furthermore, among the middle-aged group, distinctions emerge between subjects categorized as normal vs. MCI based on MoCA scores, notably in speed, performance accuracy, and decision noise

Dysconnection and cognition in schizophrenia: A spectral dynamic causal modeling study

Schizophrenia (SZ) is a severe mental disorder characterized by failure of functional integration (aka dysconnection) across the brain. Recent functional connectivity (FC) studies have adopted functional parcellations to define subnetworks of large-scale networks, and to characterize the (dys)connection between them, in normal and clinical populations. While FC examines statistical dependencies between observations, model-based effective connectivity (EC) can disclose the causal influences that underwrite the observed dependencies. In this study, we investigated resting state EC within seven large-scale networks, in 66 SZ and 74 healthy subjects from a public dataset. The results showed that a remarkable 33% of the effective connections (among subnetworks) of the cognitive control network had been pathologically modulated in SZ. Further dysconnection was identified within the visual, default mode and sensorimotor networks of SZ subjects, with 24%, 20%, and 11% aberrant couplings. Overall, the proportion of discriminative connections was remarkably larger in EC (24%) than FC (1%) analysis. Subsequently, to study the neural correlates of impaired cognition in SZ, we conducted a canonical correlation analysis between the EC parameters and the cognitive scores of the patients. As such, the self-inhibitions of supplementary motor area and paracentral lobule (in the sensorimotor network) and the excitatory connection from parahippocampal gyrus to inferior temporal gyrus (in the cognitive control network) were significantly correlated with the social cognition, reasoning/problem solving and working memory capabilities of the patients. Future research can investigate the potential of whole-brain EC as a biomarker for diagnosis of brain disorders and for neuroimaging-based cognitive assessment

The Relationship Between Knee Moments and Function with Western Ontario and McMaster Universities in Moderate Knee Osteoarthritis

Introduction: The knee is the most affected weight-bearing joint by osteoarthritis. The kinetics parameters are correlated with the progression of knee osteoarthritis (KOA). This study was done to investigate the relationship between kinetics parameters and functional tests with Western Ontario and McMaster Universities osteoarthritis index (WOMAC) scores in people with moderate KOA. Materials and Methods: Twenty- three participants with moderate KOA participated in this study. Gait analysis involved the measurement of the external peak knee adduction moment (PKAM), peak knee flexion moment (PKFM), knee adduction moment impulse (KAM impulse), and knee flexion moment impulse (KFM impulse) during level walking. Functional tests included timed up and go (TUG) and figure of eight walkings (FO8W) tests. Pearson’s correlation coefficient was used to investigate the correlation between kinetics parameters and functional test scores with WOMAC total scores and sub-scores. Results: There was a significant inverse correlation between the first PKAM and WOMAC total score and pain sub-score (r=-0.43 P=0.03 and r=-0.6 P=0.002, respectively). Also, there was a significant inverse correlation between the second PKAM and pain sub-score (r=-0.46 P=0.02). There was no significant correlation between functional tests and WOMAC scores. Conclusion: The low score of the WOMAC in the moderate KOA should not be attributed to the low level of joint knee moments

MODEM: a multi-agent hierarchical structure to model the human motor control system

Abstract In this study, based on behavioral and neurophysiological facts, a new hierarchical multi-agent architecture is proposed to model the human motor control system. Performance of the proposed structure is investigated by simulating the control of sit to stand movement. To develop the model, concepts of mixture of experts, modular structure, and some aspects of equilibrium point hypothesis were brought together. We have called this architecture MODularized Experts Model (MODEM). Human motor system is modeled at the joint torque level and the role of the muscles has been embedded in the function of the joint compliance characteristics. The input to the motor system, i.e., the central command, is the reciprocal command. At the lower level, there are several experts to generate the central command to control the task according to the details of the movement. The number of experts depends on the task to be performed. At the higher level, a âgate selectorâ block selects the suitable subordinate expert considering the context of the task. Each expert consists of a main controller and a predictor as well as several auxiliary modules. The main controller of an expert learns to control the performance of a given task by generating appropriate central commands under given conditions and/or constraints. The auxiliary modules of this expert learn to scrutinize the generated central command by the main controller. Auxiliary modules increase their intervention to correct the central command if the movement error is increased due to an external disturbance. Each auxiliary module acts autonomously and can be interpreted as an agent. Each agent is responsible for one joint and, therefore, the number of the agents of each expert is equal to the number of joints. Our results indicate that this architecture is robust against external disturbances, signal-dependent noise in sensory information, and changes in the environment. We also discuss the neurophysiological and behavioral basis of the proposed model (MODEM)

Investigating various parts of the nervous system to model motion

The motion control system involves a complex network of structures that are observed at all levels of the central nervous system. Different parts of the brain, especially the cerebral cortex, the cerebellum, and basal ganglia, have an important role in the motion system. Motion commands are transmitted through the motor neurons in the spinal cord to the muscles and motion organs. At the level of the spinal cord, some control operations are performed on the motion system, such as reflexes and adjustment of motor neuron coefficients. The harmonious and complex movements that require skill are performed through the circuits that exist between the cortex, the basal ganglia, and the cerebellum. In this study, we examine the factors affecting movement and describe the role of each item in a specialized way

Exposure rate of cardiovascular risk factors among clients of health-care clinics in Kashan, Autumn 2010

زمینه و هدف: بیماری های قلبی وعروقی، بیماری های غیر واگیر هستند که توسط عوامل متعدد ایجاد می شوند. یکی از مهمترین آنها، سبک زندگی ناسالم است. در ایران این بیماری از مشکلات دهه اخیر بوده و از سویی در مقایسه با 10 علت اول مرگ و میر در سال 1387، با 8./44 بیش ترین عامل مرگ و میر در شهر کاشان بوده است. لذا این مطالعه با هدف بررسی میزان مواجهه با عوامل خطر بیماری های قلبی عروقی در شهر کاشان می باشد. روش بررسی: این مطالعه توصیفی – تحلیلی بر روی 336 نفرمراجعه کنندگان به مراکز بهداشتی درمانی کاشان که به صورت خوشه ای انتخاب شده بودند انجام گرفت. اطلاعات بوسیله پرسشنامه سبک زندگی که از 5 قسمت اطلاعات دموگرافیک، سابقه بیماری، تغذیه، مصرف سیگار و فعالیت بدنی تشکیل شده بود جمع آوری و با کمک آزمون های آماری کای دو تجزیه و تحلیل گردید. یافته ها: میانگین شاخص توده بدنی (BMI) بین افراد 69/25 بود. شایع ترین ریسک فاکتورها در بین افراد به ترتیب عبارت بودند از: مصرف غذای سرخ کرده (9/97)، مصرف کم ماهی (8/90)، مصرف کم حبوبات (8/79)، مصرف کم تخم مرغ (3/75) مصرف زیاد گوشت قرمز (3/69)، مصرف زیاد شیرینی جات (9/67)، مصرف غذای چرب (7/66) و میزان کم فعالیت بدنی (4/66) می باشد. بین سبک زندگی با جنسیت (016/0=P) و تحصیلات (019/0=P) و فعالیت بدنی با شغل (013/0=P) رابطه ی معنی داری یافت شد. نتیجه گیری: با توجه به نتایج حاصل از این مطالعه سبک زندگی افراد در وضعیت مطلوبی قرار نداشته در نتیجه لزوم توجه و آموزش بیشتر در جهت کاهش مصرف غذای سرخ کرده، گوشت قرمز، غذای چرب و شیرینی جات و افزایش متعادل مصرف ماهی، حبوبات، تخم مرغ، میوه جات و سبزیجات، در رژیم غذایشان افزایش فعالیت بدنی و کاهش مصرف سیگار توصیه می شود.