Reliability of Ashworth and Modified Ashworth Scales in Children with Spastic Cerebral Palsy

Background Measurement of spasticity is a difficult and unresolved problem, partly due to its complexity and the fact that there are many factors involved. In the assessment of spasticity in the pediatric disabled population, methods that are easily used in practice are ordinal scales that still lack reliability. A prospective cross-sectional observational study was planned to determine the reliability of the Ashworth Scale (AS) and the Modified Ashworth Scale (MAS) in children with spastic cerebral palsy (CP). Methods The study included 38 children with spastic diplegic CP. The mean age for the children was 52.9 months (SD: 19.6) ranging from 18 to 108 months. The functional levels of children were classified according to the Gross Motor Function Classification System. 20 children were in Level II (52.6%), 18 were in Level III (47.4%) and 9 were in Level I (23.7%). Spasticity in hip flexors, adductors, internal rotators, hamstrings, gastrocnemius were assessed by AS and MAS. Each child was assessed by three physiotherapists in two different sessions, a week apart. The intrarater reliability was determined by paired comparison of measurements for each therapist for the two assessments. Interrater reliability was determined by paired comparisons of the three therapists' measurements on the same day. The inter and intrarater reliability of the scales were evaluated by the intraclass correlation coefficient (ICC). Results According to ICC scores, interrater reliability of AS and MAS varied from moderate to good. ICC scores of AS were between 0.54 and 0.78 and MAS were between 0.61–0.87. Test-retest results of AS and MAS varied from poor to good. ICC values were between 0.31 and 0.82 for AS and between 0.36 and 0.83 for MAS. Conclusion The interrater and intrarater reliability of AS and MAS are related to muscle and joint characters. The repetition of measurements by the same physiotherapist, and experience may not affect reliability. These scales are not very reliable and assessments of spasticity using these scales should be therefore interpreted with great caution

Cerebral Palsy:Early Markers of Clinical Phenotype and Functional Outcome

The Prechtl General Movement Assessment (GMA) has become a cornerstone assessment in early identification of cerebral palsy (CP), particularly during the fidgety movement period at 3-5 months of age. Additionally, assessment of motor repertoire, such as antigravity movements and postural patterns, which form the Motor Optimality Score (MOS), may provide insight into an infant's later motor function. This study aimed to identify early specific markers for ambulation, gross motor function (using the Gross Motor Function Classification System, GMFCS), topography (unilateral, bilateral), and type (spastic, dyskinetic, ataxic, and hypotonic) of CP in a large worldwide cohort of 468 infants. We found that 95% of children with CP did not have fidgety movements, with 100% having non-optimal MOS. GMFCS level was strongly correlated to MOS. An MOS > 14 was most likely associated with GMFCS outcomes I or II, whereas GMFCS outcomes IV or V were hardly ever associated with an MOS > 8. A number of different movement patterns were associated with more severe functional impairment (GMFCS III-V), including atypical arching and persistent cramped-synchronized movements. Asymmetrical segmental movements were strongly associated with unilateral CP. Circular arm movements were associated with dyskinetic CP. This study demonstrated that use of the MOS contributes to understanding later CP prognosis, including early markers for type and severity

Investigation of the Relationship Between Physical Fitness And Birth Weight, Income Level And School Period in Preschool Children

Bu çalışmadaki amacımız okul öncesi çocukların doğum ağırlığının, sosyo-ekonomik durumun ve okul süresinin fiziksel uygunlukla ilişkisini araştırmaktır. Çalışma Muş İl Milli Eğitim Bakanlığı’na bağlı okulların ana sınıflarında bulunan, 4-6 yaş aralığındaki 212 sağlıklı çocuklarda yapıldı. Çocukların sosyodemografik ve doğum özellikleri kaydedildikten sonra çocukların fiziksel uygunluklarını değerlendirmek için bu yaş aralığına özel geliştirilen PREschool Physical FITness (PREFIT) test bataryası kullanıldı. Çocukların okulda geçirdikleri toplam dönem sayısı kaydedildi. Çocukların fiziksel uygunlukları ile okuldaki dönem süresi arasında ilişki bulunmuştur (p<0.05). Okul öncesi çocuklarda doğum ağırlığının ve ailenin gelir düzeyinin çocukların fiziksel uygunluklarını etkilemediği bulunmasına rağmen, okulda geçirilen sürenin artmasıyla çocukların fiziksel uygunlukları artmaktadır.Our aim of this study is to investigate the relationship between birth weight, socio-economic status and school environment with physical fitness in preschool children.The study was carried out in 212 healthy children aged 4-6 years. PREschool Physical FITness (PREFIT) test battery developed specifically for this age range was used to evaluate the physical fitness of children. The total number of school terms that children spent at school was recorded. The statistical relationship between the physical fitness of children and the duration of school terms was found (p <0.05). In preschool children, although the birth weight and the family income level do not affect the physical fitness of children, the physical fitness of children increases with the increasing of their school term period

Investigation of the relationship between physical fitness and gestational age among pre-school children

Amaç: Bu çalışmadaki amacımız okul öncesi çocuklarda fiziksel uygunluk ve gestasyonel yaş arasındaki ilişkiyi araştırmaktır. Yöntem: Çalışma Muş İl Milli Eğitim Bakanlığı’na bağlı okulların ana sınıflarında bulunan, 4-6 yaş aralığındaki 212 sağlıklı (107 kız ve 105 erkek) çocuklarta yapıldı. Çocuklara ait sosyodemografik ve doğum özellikler kaydedildi. Çocukların fiziksel uygunluklarını değerlendirmek için bu yaş aralığına özel geliştirilen Preschool Physical Fitness (PREFIT) test bataryası kullanıldı. Çocukların gelişim parametrelerini değerlendirmek için Denver Gelişimsel Tarama Testi (DGTT) II kullanıldı. Çocukların kognitif seviyelerini belirlemek için ailelere sorulan anket şeklindeki bir form kullanıldı. Bulgular: Çocukların gestasyonel yaşıyla fiziksel uygunlukları (tek bacak denge) arasında pozitif yönde anlamlı ilişki bulundu (p<0,025). Çocukların kognitif seviyeleriyle gelişimleri arasında (p<0,001) ve çocukların kognitif seviyeleriyle fiziksel uygunlukları arasında (kavrama kuvveti (p<0,019).Çocukların kognitif seviyeleriyle tek bacak üzerinde denge (p<0,008)) arasında pozitif yönde ilişki bulundu. Sonuç: Okul öncesi çocukların gestasyonel yaşlarıyla fiziksel uygunlukları arasında ilişki bulunmaktadır. Ayrıca okul öncesi çocukların kognitif seviyesi ile fiziksel uygunluk ve gelişimleri arasında ilişki bulunması; bu çocukların bir bütün olarak değerlendirilmesi gerektiğini göstermektedir.Purpose: The aim of this study was to investigate the relationship between physical fitness and gestational age among preschool children. Methods: The study was carried out in 212 healthy children (107 girls and 105 boys) aged 4-6 years in schools of Muş Province depending Ministry of National Education. The sociodemographic and birth characteristics of children were recorded. To evaluate the physical fitness of children, Preschool Physical Fitness (PREFIT) test battery developed specifically for this age range was used. The Denver Developmental Screening Test (DDST) II was used to evaluate the developmental parameters of children. A parent-based questionnaire form was used to determine the cognitive level of children. Results: There was a positive correlation between gestational age and physical fitness (one-leg balance test) in pre-school children (p<0.025). There were positive correlation between cognitive level and development in preschool children (p<0.001), and between children's cognitive level and physical fitness (grip strength (p<0.019). ). There were positive correlation between cognitive level and one-leg balance test (p<0.008). Conclusion: There is a relationship between gestational age and physical fitness in pre-school children. The fact that there is relationship between cognitive level and physical fitness, between cognitive level and development indicates that children should be evaluated as a whole

Developmental parameters and physical fitness in preschool children with minor neurological dysfunction

Background. The preschool years constitute a critical period during which significant changes are experienced in the acquisition of locomotor skills due to maturation of the nervous system. Our aim was to investigate the developmental parameters and physical fitness in preschool children with Minor Neurological Dysfunction (MND). Methods. The study was carried out in 212 preschool children without any known health problems. Sociodemographic characteristics of children were recorded. Denver Developmental Screening Test (DDST) II, Touwen Neurological Examination, and Preschool Physical Fitness (PREFIT) test battery were used to assess developmental parameters, neurological status, and physical fitness, respectively. Results. There was a statistical difference in the physical fitness and developmental parameters in preschool children with MND compared with healthy peers (p<0.05). There was also a relationship between physical fitness and developmental parameters (p<0.05). Conclusions. Early identification of problems in developmental parameters and physical fitness in preschool children with MND might help to implement early supportive physiotherapy and rehabilitation. © 2021, Turkish National Pediatric Society. All rights reserved

Serebral Palsi’li Çocukların Dil Gelişimleri ile Motor Fonksiyonları Arasındaki İlişkinin İncelenmesi

Amaç: Serebral Palsi’li (SP) çocukların %31-88’inde dil ve konuşma bozukluğu bildirilmektedir. Bu çalışmada, SP’li çocukların kelime bilgisi gelişimi ile motor fonksiyonları arasındaki ilişkinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Bu çalışmaya 54 SP’li çocuk ve annesi dahil edildi. Olguların motor fonksiyon seviyeleri, Kaba Motor Fonksiyon Sınıflandırma Sistemi (Gross Motor Function Classification System- KMFSS) ve El Yetenek Sınıflandırma Sistemi (Manual Ability Classification System-MACS) ile, alıcı dil kelime bilgisi gelişimleri Peabody Resim-Kelime Testi ile, tahmini kognitif seviyeleri Avrupa SPARCLE projesi kognitif bozukluk formu ile ailelere sorularak belirlendi. Veriler SPSS 18,0 istatistik programı kullanılarak analiz edildi ve p0,05 istatistiksel anlamlı fark kabul edildi. Sonuçlar: SP’li çocukların alıcı dil gelişimleri ile motor fonksiyon seviyeleri arasında anlamlı bir ilişki bulunmazken(p>0,05), alıcı dil gelişimleri ile kognitif seviyeleri arasında anlamlı bir ilişki bulundu (p0,05). Tartışma: Motor sorunlar yanında özelikle bilişsel, konuşma ve dil bozukluklarının eşlik ettiği SP’li çocukların ayrıntılı olarak değerlendirilmesinin etkin rehabilitasyon hedeflerinin belirlenmesi açısından önemli olduğunu düşünmekteyiz.Objective: It is reported that from 33% to 88% of children with Cerebral Palsy (CP) have language and speech disorders. The present study aims to assess the relationship between vocabulary development and motor functions in children with CP. Materials and Method: The survey covered 54 children with CP and their mothers. Motor function levels of cases were determined through the Gross Motor Function Classification System (GMFSS) and Manual Ability Classification System (MACS); receptive language development through Peabody Picture Vocabulary Test; and estimated cognitive levels by questioning families with the Europe SPARCLE project cognitive impairment form. Data was analysed by using SPSS 18.0 statistics programme and p0.05 was accepted as statistically significant difference. Outcomes: While no significant relationship was found between CP children’s receptive language development and motor function levels (p>0.05), the relationship between receptive language development and cognitive levels was found as significant (p0.05). Discussion: We think detailed assessment of the state of children with CP characterized by cognitive, speech and language impairments besides motor problems is importan

Serebral Palsi’li Çocukların Dil Gelişimleri ile Motor Fonksiyonları Arasındaki İlişkinin İncelenmesi

Objective: It is reported that from 33% to 88% of children with Cerebral Palsy (CP) have language and speech disorders. the present study aims to assess the relationship between vocabulary development and motor functions in children with CP. Materials and Method: the survey covered 54 children with CP and their mothers. Motor function levels of cases were determined through the Gross Motor Function Classification System (GMFSS) and Manual Ability Classification System (MACS); receptive language development through Peabody Picture Vocabulary Test; and estimated cognitive levels by questioning families with the Europe SPARCLE project cognitive impairment form. Data was analysed by using SPSS 18.0 statistics programme and p0.05 was accepted as statistically significant difference. Outcomes: While no significant relationship was found between CP children’s receptive language development and motor function levels (p>0.05), the relationship between receptive language development and cognitive levels was found as significant (p0.05). Discussion: We think detailed assessment of the state of children with CP characterized by cognitive, speech and language impairments besides motor problems is importantAmaç: Serebral Palsi’li (SP) çocukların %31-88’inde dil ve konuşma bozukluğu bildirilmektedir. Bu çalışmada, SP’li çocukların kelime bilgisi gelişimi ile motor fonksiyonları arasındaki ilişkinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Bu çalışmaya 54 SP’li çocuk ve annesi dahil edildi. Olguların motor fonksiyon seviyeleri, Kaba Motor Fonksiyon Sınıflandırma Sistemi (Gross Motor Function Classification System- KMFSS) ve El Yetenek Sınıflandırma Sistemi (Manual Ability Classification System-MACS) ile, alıcı dil kelime bilgisi gelişimleri Peabody Resim-Kelime Testi ile, tahmini kognitif seviyeleri Avrupa SPARCLE projesi kognitif bozukluk formu ile ailelere sorularak belirlendi. Veriler SPSS 18,0 istatistik programı kullanılarak analiz edildi ve p0,05 istatistiksel anlamlı fark kabul edildi. Sonuçlar: SP’li çocukların alıcı dil gelişimleri ile motor fonksiyon seviyeleri arasında anlamlı bir ilişki bulunmazken(p>0,05), alıcı dil gelişimleri ile kognitif seviyeleri arasında anlamlı bir ilişki bulundu (p0,05). Tartışma: Motor sorunlar yanında özelikle bilişsel, konuşma ve dil bozukluklarının eşlik ettiği SP’li çocukların ayrıntılı olarak değerlendirilmesinin etkin rehabilitasyon hedeflerinin belirlenmesi açısından önemli olduğunu düşünmekteyiz

Levels of perception of family environment in mothers of children with Cerebral Palsy

Kayhan, Nilay (Aksaray, Yazar)Özürlü çocuğa sahip olmak anne ve babaları hem fiziksel hem de emosyonel olarak etkilemektedir. Bu çalışmada SP’li çocuğa sahip annelerin aile ortamını algılama düzeylerinin belirlenmesi amaçlanmıştır. Gereç ve Yöntem: SP’li çocuğa sahip annelerin aile ortamını algılama düzeylerinin belirlenmesi amacıyla yapılan bu çalışma, 66 SP’li çocuk ve annesi ile gerçekleştirilmiştir. Annelere Aile Ortamı Değerlendirme Ölçeği uygulanmıştır. Bulgular: SP’li çocukların yaş ortalaması 4.03±1.09 yıl idi ve 26’sında (%39,4) SP’ye ek olarak konuşma problemi vardı. SP’li çocukların annelerin tanı hakkında bilgilendirilme durumu ve çocuğun konuşma problemi ile aile ortamı değerlendirme ölçeğinin birlikberaberlik alt boyutu arasında istatistiksel olarak anlamlı ilişki bulunmuştur (p<0.05). Tartışma: Ailelere ilişkin daha ayrıntılı bilgi sahibi olunması, aileye sunulacak hizmetlerin belirlenmesine yardımcı olacaktır. Bu bakımdan önemli bir çalışmadır.Purpose: Having a disabled child effects mothers and fathers both in the physical and emotional aspect. This study aims to investigate levels of perception of family environment in mothers of children with CP. Material-Method: In order to determine the levels of perception of family environment in mothers of children with CP, this study in cluded 66 children with CP and their mothers. Family Environment Questionnaire was applied to mothers. Results: Mean age of the children was 4.03&plusmn;1.09 years. 26 (39.4%) of all children had speech disorder in addition to CP. Significant correlation was found between clinical type, information given to mothers about the diagnosis of their children, speech disorder of the children and between family environment concept unity-solidarity (p&lt;0.05). Conclusion: Detailed knowledge about families may help to determine the services which will be provided to families. This study therefore is important

Comparison Of The Family Environment Perception Levels Of The Mothers Who Have Physically Handicapped Children In Preschool And Primary School Period

Mothers and fathers are accepted as having major roles in the development and education period of the physically handicapped children. Most intensive periods of children to interest and care of their mothers are; preschool and primary school periods therefore these periods have great importance in physically handicapped children. This study aimed to compare the family environment perception levels of the mothers who have physically handicapped children in preschool (3-6 years) and primary school (7-10 years) period. This study included 84 physically handicapped children and their mothers. Perception of family environment of mothers were determined by Family Environment Questionnaire-FEQ. The results indicated that preschool or primary school period did not effect the family environment perception of the mothers of the physically handicapped children (p>0.05). Physically handicapped children requires different support servicesWoSScopu