Validity and reliability of the Dynamic Gait Index in children with hemiplegic cerebral palsy.

BACKGROUND: Dynamic Gait Index (DGI) is a performance-based tool can be applied in a short time and evaluates dynamic balance and gait ability. RESEARCH QUESTION: Is the DGI valid and reliable for assessing gait and balance disorders in children with hemiplegic cerebral palsy (CP)? METHODS: Sixteen children with hemiplegic CP (5 females, 11 males; mean age 10y 3mo, SD 2y 7mo; range 6-14y; Gross Motor Function Classification System (GMFCS) levels I [n = 9], II [n = 7]) and 16 age-matched typically developing (TD) (8 females, 8 males; mean age 9y 9mo, SD 2y 6mo; range 6-14y) participated. The relationship between the DGI, Four-Square Step Test (FSST), Timed Up and Go Test (TUG) and Pediatric Berg Balance Scale (PBS) was analyzed. To determine the test-retest reliability, the DGI was performed twice and; for the inter-rater reliability, only DGI was reapplied by a different rater on the same day. Internal consistency was obtained by Cronbach-α value. Validity was tested by Spearman correlation coefficient and reliability was calculated by Intraclass correlation coefficient (ICC). RESULTS: There was a significant difference between hemiplegic CP and TD and between the children with GMFCS level I and II in the comparison of results of the DGI and other tests. All items on the DGI had appropriate internal consistency (Cronbach-α = 0.969). The test-retest (ICC = 0.970 CI(0.915- 0.990)) and inter-rater (ICC = 0.983 CI(0.882- 0.998)) reliabilities were found to be excellent. A negative, moderate correlation between FSST and DGI (rs = -0.673, p = 0.004); a positive, high correlation between PBS (rs = 0.724, p = 0.002) and DGI and a negative, high correlation between TUG and DGI (rs = -0.828, p < 0.001) was detected. SIGNIfiCANCE: DGI with features such as its feasibility in a short time, being simple but distinctive and not requiring heavy equipment is a valid and reliable method in children with hemiplegic CP.

Comparison of conventional chest physiotherapy and oscillatory positive expiratory pressure therapy in primary ciliary dyskinesia.

BACKGROUND: Chest physiotherapy (CP) is a recommended treatment modality in primary ciliary dyskinesia (PCD). OBJECTIVE: Primary aim was to compare the efficacy and safety of the conventional chest physiotherapy (CCP) and oscillatory positive expiratory pressure therapy (OPEPT). Secondary aims were to compare the exacerbation rate, time until the first exacerbation, patient compliance and comfort between the two CP methods. METHODS: This is a 6 month randomized, controlled crossover trial. Patients >6 years of age with PCD were randomized into two groups, first group was assigned to OPEPT (Acapella®) for 3 months while second group was assigned to CCP. Groups were crossed over to the other modality after a 15-day washout period. Pulmonary function tests (PFTs) and compliance were monitored by monthly clinic visits. RESULTS: There was a significant increase in FEV1 , FEF25-75 , and PEF values (p = .018, p = .020, and p = .016, respectively) in the OPEPT group and in FVC values (p = .007) in CCP group compared to baseline. However PFT increase at 3rd month was not superior to each other with both physiotherapy methods. Median acute pulmonary exacerbation rate and time period until the first exacerbation were similar in both groups (p = .821, p = .092, respectively). Comfort and effectiveness of OPEPT was higher than CCP according to patients (p = .029 and p = .042, respectively). There were no adverse effects with either therapy. CONCLUSIONS: OPEPT was as effective as CCP in PCD patients. OPEPT was more comfortable and effective than CCP according to patients. OPEPT might be an efficient alternative method for airway cleareance in PCD patients.