Brunton, Laura

Scholtes, Cheryl

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Scholarship@Western

Western University Scholarship@Western Paediatrics Publications Paediatrics Department 1-1-2020 Commentary on "Longitudinal Change in Common Impairments in Children With Cerebral Palsy From Age 1.5 to 11 Years" Laura Brunton Western University, lbrunto3@uwo.ca Cheryl Scholtes Follow this and additional works at: https://ir.lib.uwo.ca/paedpub Citation of this paper: Brunton, Laura and Scholtes, Cheryl, "Commentary on "Longitudinal Change in Common Impairments in Children With Cerebral Palsy From Age 1.5 to 11 Years"" (2020). Paediatrics Publications. 867. https://ir.lib.uwo.ca/paedpub/867 C L I N I C A L B O T T O M L I N ECommentary on “Longitudinal Change in Common Impairments in Children WithCerebral Palsy From Age 1.5 to 11 Years”“How should I apply this information?”Young children with cerebral palsy (CP) may experience a mixture of improvements (balance, strength), stability(endurance), and/or progression of CP-related impairments. This research may help clinicians make decisions abouthow to use their resources to focus on areas that may be more impactful for children in specific Gross Motor FunctionClassification System (GMFCS) levels (ie, strengthening for GMFCS I, flexibility for GMFCS IV/V).Function and participation are the primary goals of therapy, with less priority given to monitoring of impairmentsor maintenance of abilities. This study supports the usefulness of impairment-based measures and may help clini-cians better understand the complexities of CP. Further this underscores the need to monitor children with valid andresponsive outcome measures to demonstrate value of interventions—regardless if they are actively targeting changeor focused on maintenance of function and/or the prevention or worsening of secondary impairments.“What should I be mindful about when applying this information?”The study may be underpowered to detect differences across GMFCS groups. The small sample size and the hetero-geneity associated with CP may have led to the premature conclusion that changes do not occur in some constructsovertime. This highlights the need to think critically about interventions and ongoing measurement of secondary con-ditions by GMFCS level. The relative distribution of children across the GMFCS levels and the numbers needed todetect small changes overtime often limit the documentation of clinically important changes in research evidence.Some of the outcome measures in this study are not familiar (though freely available on the CanChild website) andrequire judicious choice for implementation in clinical practice. For example, the Early Clinical Assessment of Balancemay have a ceiling effect whereby children score the maximum 100 points. This measure then will not adequatelycapture change to conclude stability or lack of improvement.Laura Brunton, PT, PhDSchool of Physical Therapy, Western UniversityLondon, Ontario, CanadaCheryl Scholtes, PTThames Valley Children’s CentreLondon, Ontario, CanadaThe authors declare no conflicts of interest.DOI: 10.1097/PEP.0000000000000677Copyright © 2020 Academy of Pediatric Physical Therapy of the American Physical Therapy Association.Unauthorized reproduction of this article is prohibited.Pediatric Physical Therapy Change in Impairments and Services 51

Commentary on  Longitudinal Change in Common Impairments in Children With Cerebral Palsy From Age 1.5 to 11 Years

https://ir.lib.uwo.ca/cgi/viewcontent.cgi?article=1875&context=paedpub

Commentary on Longitudinal Change in Common Impairments in Children With Cerebral Palsy From Age 1.5 to 11 Years

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