Functional independence measure (WeeFIM) reference values in Indian children aged 3-7 years: A cross-sectional study.

Background: . We sought to establish reference values of the functional independence measure (WeeFIM; Unified Data System for Medical Rehabilitation, Buffalo, NY, USA) for children aged 3-7 years in India using this cross-sectional study. Methods: . We obtained permission from the Unified Data System for Medical Rehabilitation, a non-profit organization to use the WeeFIM instrument. Participants were recruited randomly from schools. After obtaining written informed consent, direct interviews for WeeFIM II Clinical Guide (version 6.0) were conducted for parent/guardian/teacher of 182 typically developing children. Results: . There was a progressive increase of functional independence with increasing chronological age across all WeeFIM domains. Total score of the WeeFIM instrument showed a similar performance between boys and girls. At the beginning of 3 years, children were at WeeFIM level 3 that is moderate assistance stage in their functional independence, but by the age of 7 years, they became completely independent on all the three domains of WeeFIM functional scale. Conclusions: . We have provided reference values for WeeFIM in children of India aged 3-7 years (35-84 months). There were no differences between boys and girls regarding WeeFIM performance. Children in private schools showed better performance versus children in government schools in the early age ranges. We could not find any effect of socioeconomic status on WeeFIM raw rating or functional independence level.

Efficacy of Trunk Regimes on Balance, Mobility, Physical Function, and Community Reintegration in Chronic Stroke: A Parallel-Group Randomized Trial.

OBJECTIVE: The study objective was to examine the efficacy of plinth and Swiss ball-based trunk exercise regimes on balance, mobility, physical function, and community reintegration compared with standard physiotherapy in chronic stroke. SUBJECTS AND METHODS: This observer-blinded parallel-group randomized trial was conducted in outpatient stroke units. People with chronic stroke aged between 30 and 75 years, first onset of unilateral cortical lesion, poor trunk performance, 10 m independent walking ability with or without walking aids, and absence of pusher syndrome were included. Trunk Impairment Scale 2.0, Brunel Balance Assessment, Tinetti scale, gait speed, Stroke Impact Scale-16, and Reintegration to Normal Living Index were the measures. Experimental interventions involved the practice of selective upper and lower trunk movements using either plinth or Swiss ball. Control group received standard physiotherapy. All the patients practiced 1 hour exercise session, 3 sessions a week over a duration of 6 weeks and followed up after 3 and 12 months. RESULTS: Of 108 patients allocated into 3 groups, baseline characteristics were similar. Postintervention compared with control group, the plinth, and Swiss ball groups showed significant mean changes in the outcome measures: trunk impairment scale 2.0 (3.6;4.1 points), Brunel Balance Assessment (1-level), Tinetti scale (5;5.2 points), gait speed (.06;.08 m/s), Stroke Impact Scale-16 (8.7;7.2 points), and community reintegration (7.6;8.8 points). These improvements were retained during 3-12 months' follow-up. Statistical significant was set at P < .05. CONCLUSION: Plinth and Swiss ball-based trunk exercise regimes showed significant improvements in balance, mobility, physical function, and community reintegration in chronic stroke as against standard physiotherapy.

Lower Extremity Muscle Tendon Interaction Around Knee During Gait Among Adolescent Children with Cerebral Palsy with Varying Crouch Angle.

Background: Optimal management and surgical planning of severe bony deformities and muscle tendon unit contractures demands comprehensive evaluation of all structures including the dynamic muscle tendon length of all muscles around the joint during gait. Objectives: Present study aimed to explore dynamic muscle-tendon length for all muscles around the knee joint along with pelvis, hip, and ankle joint kinematics among adolescent children with varying crouch angle. Methods: Muscle-tendon length of 29 adolescent children with cerebral palsy with varying crouch angles was computed using a full-body musculo-skeletal model and expressed as a percentage of muscle-tendon length during walking compared to resting condition. Results: Children with knee flexion angle greater than 25° demonstrated lower anterior pelvic tilt and 11% greater muscle-tendon length of semimembranosus and biceps femoris during stance phase of gait compared to children with knee flexion angle less than 25° and typically developing children (p < 0.01). Conclusions: The findings of present study reported that routine bedside clinical evaluation in adolescent children with knee flexion angle greater than 25° revealed moderate shortening of hamstring muscle in supine position. Whereas instrumented objective evaluation of gait demonstrated lengthened hamstring muscle and reduced hip extension and relatively lower anterior pelvic tilt. Therefore, it may be valuable to add objective assessment of dynamic muscle-tendon length to kinematics of all lower-extremity joint motion during gait, in order to understand the muscle-joint interactions; particularly in children with severe crouch and plan specific, tailor-made surgical and non-surgical interventions.

Influence of Crouch Angle on Postural Stability in Quiet Stance and Functional Tasks Among Children with Cerebral Palsy.

The aim of this study is to investigate postural stability and function (functional tasks) in younger (<12 yr) and older (>12 yr) children with lesser (<25°) and greater crouch (>25°) during stance. Postural stability and functional tasks were assessed in 53 ambulatory children with spastic cerebral palsy (CP). Younger and older children with greater crouch angle demonstrated higher displacement of center of pressure compared to children with lesser crouch angle during gait (p < .01). All (younger and older) children with severe crouch angle demonstrated strong association of postural control with stair climb (r = 0.732; p < .05) and timed-up-and-go test (r = 0.84; p < .01). Greater crouch angle demonstrates a moderate association with postural stability (r = 0.528; p < .01) in quiet stance and a strong association with functional tasks in children with CP (r = 0.7-0.84; p < .05).

Gross motor function profile of children with cerebral palsy in a low-resource setting: A call for reflection on the model of care.

PURPOSE: The current study aimed to explore Gross Motor Function Measure (GMFM) profiles among children with cerebral palsy (CP) at various Gross Motor Function Classification System (GMFCS) levels in a low-resource setting. METHODS: Ambulatory capacity of children with CP was classified using GMFCS levels. Functional ability of all participants was measured using GMFM-88. Seventy-one ambulatory children with CP (61% males), were studied after signed informed consent was obtained from parents and assent from children older than 12 years. RESULTS: Children with CP in a low-resource setting had 12-44% lower GMFM scores in dimensions of standing, walking, running, and jumping with reference to children from high-resource settings with similar ambulatory capacity reported previously. The most affected components across various GMFCS levels were 'sitting on a large and small bench from floor,' 'arm-free squatting,' 'half-kneeling,' 'kneel-walking,' and 'single-limb hop'. CONCLUSION: Knowledge of GMFM profiles can guide clinicians and policymakers in low-resource settings for strategic rehabilitation planning and extend the focus of rehabilitation from restoration of body structure and function to the wider domain of social participation in leisure, sport, work, and the community at large. Additionally, providing tailored rehabilitation based on a profile of motor function can ensure an economically, environmentally, and socially sustainable future.

Core Stability Exercises Yield Multiple Benefits for Patients With Chronic Stroke: A Randomized Controlled Trial.

OBJECTIVE: This study examined the effect of core stability exercises on trunk control, core muscle strength, standing weight-bearing symmetry, and balance confidence of people with chronic stroke. DESIGN: This was an assessor-blinded randomized controlled trial involving 84 ambulatory patients with middle cerebral artery stroke, randomly assigned to three training groups. Two experimental groups practiced core stability exercises either on stable or on unstable support surfaces. In contrast, the control group received standard physiotherapy. All the participants underwent an hour-long training session a day, thrice a week over a 6-wk duration, and followed-up after 12 mos. Trunk Impairment Scale, core muscle strength, weight-bearing asymmetry in standing, and Activities-specific Balance Confidence scale were the outcome measures. RESULTS: Compared with the control group, the two experimental groups demonstrated a significant improvement on all the outcome measures from baseline to posttraining and from baseline to 12-mo follow-up (P < 0.001). The two experimental groups demonstrated no significant difference between them on all the measures (P > 0.05). CONCLUSIONS: Core stability exercises on stable and unstable support surfaces are equally beneficial in improving trunk control, core muscle strength, standing weight-bearing symmetry, and balance confidence of ambulatory patients with chronic stroke than the standard physiotherapy.

Comparison of physio ball and plinth trunk exercises regimens on trunk control and functional balance in patients with acute stroke: a pilot randomized controlled trial.

OBJECTIVE: To examine the effects of trunk exercises performed using the physio ball as against the plinth, on trunk control and functional balance in patients with acute stroke. DESIGN: An observer-blinded pilot randomized controlled trial. SUBJECTS: Thirty patients with acute stroke (mean post-stroke duration 12 (95% confidence interval (CI) 2-34) days) who had the first onset of unilateral haemorrhagic or ischaemic lesion and an independent ability to sit for 30 seconds. SETTING: Inpatient stroke rehabilitation centre. INTERVENTIONS: The experimental group performed task-specific trunk exercises on an unstable surface (physio ball) while the control group performed them on a stable surface (plinth). In addition to regular acute physiotherapy, both the groups underwent 1 hour of trunk exercises a day, four days a week for three weeks. MAIN MEASURES: Trunk Impairment Scale and Brunel Balance Assessment. RESULTS: The difference between the baseline characteristics of the patients belonging to both groups was not statistically significant. Post-intervention, both the groups improved on trunk control and functional balance but the experimental group improved more significantly than the control group (change scores of between-group comparison for the total Trunk Impairment Scale 3.06 (1.43), dynamic sitting balance 1.47 (1.36) and coordination 1.3 (0.67) subscales of Trunk Impairment Scale; the total Brunel Balance Assessment 1.8 (1.4) and stepping 1.87 (1.6) component of Brunel Balance Assessment). The level of significance was set at P < 0.05. CONCLUSIONS: The trunk exercises performed on the physio ball are more effective than those performed on the plinth in improving both trunk control and functional balance in acute stroke patients, suggesting a task-specific effect and also a carry-over effect.

Provocative poliomyelitis causing postpolio residual paralysis among select communities of two remote villages of North Karnataka in India: a community survey.

Intramuscular injections can provoke muscular paralysis especially, if the child has had exposure to polio virus. The purpose of the study was to determine the association with known risk factors for motor disabilities in two remote villages of North Karnataka (India), where an increased number of disabled people among select communities had been reported. A community based survey was conducted. The selection of study subjects was done through screening, history related with occurrence of musculoskeletal disability, screening and general examination of the affected joints and muscles. Data analysis was done by estimation of percentages. Among the physical disabilities identified, the most common was post-polio residual paralysis. 35.65% (n = 41) subjects had developed paralysis following the administration of an intramuscular injection when they had acute viremia in childhood, indicating that (probably) muscle paralysis would have been provoked by intramuscular injections, resulting in provocative poliomyelitis. Unnecessary injection must be avoided in children during acute viremia state and use of oral polio vaccine should be encouraged.

Inter-rater reliability of the Top Down Motor Milestone Test: a cross-sectional study.

OBJECTIVE: To assess the inter-rater reliability of the Top Down Motor Milestone Test, which is the first step of the Mobility Opportunities Via Education programme in children with motor disabilities. DESIGN: A cross-sectional study. SETTING: Neurosensory Developmental Unit of a tertiary hospital. SUBJECTS: Parents of 21 children with motor disabilities were interviewed and scored on the Top Down Motor Milestone Test. METHODS: The subjects were interviewed by one therapist while two other therapists observed the interview procedure. All three therapists were blinded to each other's scores. RESULTS: Inter-rater reliability was analysed for all the 16 subtests using the inter-rater kappa. The pooled kappa was done for the three raters. The standard error and the P-value were also calculated. The value of inter-rater kappa for individual subtests ranged from 0.74 to 0.96. Pooled kappa for the Top Down Motor Milestone Test was 0.88 with standard error 0.06 and P-value<0.01. CONCLUSION: The inter-rater reliability of the Top Down Motor Milestone Test proved to be good for each subtest and for the whole test.

Relationship between Pelvic Alignment and Weight-bearing Asymmetry in Community-dwelling Chronic Stroke Survivors.

BACKGROUND AND PURPOSE: Altered pelvic alignment and asymmetrical weight bearing on lower extremities are the most common findings observed in standing and walking after stroke. The purpose of this study was to find the relationship between pelvic alignment and weight-bearing asymmetry (WBA) in community-dwelling chronic stroke survivors. MATERIALS AND METHODS: This cross-sectional study was conducted in tertiary care rehabilitation centers. In standing, the lateral and anterior pelvic tilt angle of chronic stroke survivors was assessed using palpation (PALM™) meter device. The percentage of WBA was measured with two standard weighing scales. Pearson correlation coefficient (r) was used to study the correlation between pelvic tilt and WBA. RESULTS: Of 112 study participants, the mean (standard deviation) age was 54.7 (11.7) years and the poststroke duration was 14 (11) months. The lateral pelvic tilt on the most affected side and bilateral anterior pelvic tilt were 2.47 (1.8) and 4.4 (1.8) degree, respectively. The percentage of WBA was 23.2 (18.94). There was a high correlation of lateral pelvic tilt with WBA (r = 0.631; P < 0.001) than anterior pelvic tilt (r = 0.44; P < 0.001). CONCLUSION: Excessive lateral pelvic tilt toward the most affected side in standing may influence the weight-bearing ability of the ipsilateral lower extremity in community-dwelling chronic stroke survivors.