The Malay version of the caregiver assessment of function and upset instrument (Malay-CAFU): a translation and validation study among informal stroke caregivers.

BACKGROUND: Post-stroke complications affect the informal caregivers equally as the stroke survivors, especially those who have a moderate to worst prognosis in functional capacity recovery. Caregiver Assessment of Function and Upset (CAFU) is one of the common tools used in both research and clinical practice to measure the patient's dependency level and the stroke caregivers' upset level. OBJECTIVE: This study aimed to translate and validate the CAFU instrument into the Malay language and test the validity and reliability of the CAFU among informal stroke caregivers in Malaysia. METHODS: A standard forward-backward translation method was employed to translate CAFU. Subsequently, 10 expert panels were included in the validation process, and thereafter reliability testing was conducted among 51 stroke caregivers. The validation of the instrument was determined by computing the content validity indices (CVIs), and we used the Cronbach's alpha method to explore the internal consistency of the overall score and subscales scores of the Malay-CAFU. Finally, the explanatory factor analysis used principal component extraction and a varimax rotation to examine construct validity. RESULTS: All items of the Malay-CAFU had satisfactory item-level CVI (I-CVI), with values greater than 0.80, and the scale-level CVI (S-CVI) was 0.95. These results indicate that the Malay-CAFU had good relevancy. The internal consistency for the reliability test showed a Cronbach's alpha value of 0.95 for the overall score. The eigenvalues and scree plot supported a two-factor structural model of the instrument. From the explanatory factor analysis, the factor loadings ranged from 0.82 to 0.90 and 0.56 to 0.83, respectively. CONCLUSION: The Malay-CAFU questionnaire is a valid and reliable instrument to assess the dependence level of stroke survivors and the upset level of informal stroke caregivers in Malaysia.

Six Months Guided Exercise Therapy Improves Motor Abilities and White Matter Connectivity in Children with Cerebral Palsy.

BACKGROUND: Diffusion magnetic resonance imaging (dMRI) provides the state of putative connectivity from lesioned areas to other brain areas and is potentially beneficial to monitor intervention outcomes. This study assessed the effect of a 6 months guided exercise therapy on motor abilities and white matter diffusivity in the brains of cerebral palsy (CP) children. METHODS: This is a single arm pre-and post-test research design involving 10 spastic CP children, aged 8-18 years and whose Gross Motor Function Classification System Expanded and Revised (GMFCS-E & R) at least Level 21 with the ability to ambulate independently. They were recruited from Paediatric Neurology Clinic, Hospital Universiti Sains Malaysia (HUSM) from December 2015-December 2016. All participants underwent 6 months of therapist-guided exercise session comprising progressive strength training at a frequency of twice a week, 1 h duration per session. The effect of exercise on motor abilities was assessed using the Gross Motor Function Measures (GMFM)-88. Six out of the 10 children consented for dMRI. Probabilistic tractography of the corticospinal tract (CST) was performed to determine the connectivity index of the tracts pre-and post-intervention. RESULTS: All the participants displayed statistically significant increment in GMFM-88 scores pre-to post-exercise intervention. This improvement was concurrent with increased connectivity index in the CST of upper limbs and lower limbs in the brain of these children. CONCLUSION: Our findings demonstrated that 6 months guided exercise therapy improves motor abilities of CP children concurrent with strengthening the connectivities of the motor pathways in the brain.

Characterisation of the Corticospinal Tract Using Diffusion Magnetic Resonance Imaging in Unilateral and Bilateral Cerebral Palsy Patients.

BACKGROUND: Neuroimaging is increasingly used to locate the lesion that causes cerebral palsy (CP) and its extent in the brains of CP patients. Conventional structural magnetic resonance imaging (MRI) does not indicate the connectional pattern of white matter; however, with the help of diffusion MRI, fibre tracking of white matter can be done. METHODS: We used diffusion MRI and probabilistic tractography to identify the putative white matter connectivity in the brains of 10 CP patients. We tracked the corticospinal tract (CST) of the patients' upper and lower limbs and calculated the white matter connectivity, as indexed by streamlines representing the probability of connection of the CST. RESULTS: Our results show that diffusion MRI with probabilistic tractography, while having some relation with the clinical diagnosis of CP, reveals a high degree of individual variation in the streamlines representing the CST for upper and lower limbs. CONCLUSION: Diffusion MRI with probabilistic tractography provides the state of connectivity from lesioned areas to other parts of the brain and is potentially beneficial to be used as an adjunct to the clinical management of CP, providing a means to monitor intervention outcomes.