Clinical functional outcome measures for children with cerebral palsy after gait corrective orthopaedic surgery: A scoping review.

AIM: To identify the most frequently reported non-instrumented measures of gait, activity, and participation in children with cerebral palsy (CP) after undergoing gait corrective orthopaedic surgery. METHOD: Four databases were searched from database inception to the 9th December 2021 for studies that evaluated functional outcomes for children with CP under 18 years undergoing gait corrective orthopaedic surgery. RESULTS: Of 547 citations, 44 publications (n = 3535 participants, n = 1789 males, mean age 10 years 5 months [SD = 3 years 3 months], Gross Motor Function Classification System levels I-III at the time of surgery) were eligible for inclusion. Fourteen different outcome measures were used: one measure of gait, 10 measures of activity, and three measures of participation. Gait was measured with the Edinburgh Visual Gait Scale (EVGS; 4 out of 44). The most common activity and participation measures were the Functional Mobility Scale (FMS; 15 out of 44) and Pediatric Outcomes Data Collection Instrument (11 out of 44) respectively. No studies reported a combination of gait, activity, and participation measures. INTERPRETATION: The EVGS and FMS should be considered as core outcome measures in gait corrective orthopaedic surgery, while a measure of participation is unclear. Additional considerations for developing a comprehensive suite of outcomes include identifying a combination of clinical measures and performance-reflective questionnaires that are standardized for children with CP undergoing surgery and meaningful to clinicians and families.

Responsiveness of clinical and laboratory measures to intervention effects in children with developmental coordination disorder.

PURPOSE: To compare responsiveness of the Movement Assessment Battery for Children-2 (MABC-2) and segment kinematics and center of pressure measures in detecting intervention effects in children with developmental coordination disorder. METHODS: Motion Analysis Laboratory (MAL) data from 21 children with developmental coordination disorder (mean age 11.0 years) in a randomized control trial were analyzed using effect size, minimal detectable difference, and parent and child report of meaningfulness (χ2 tests). RESULTS: The MABC-2 and MAL data showed moderate-large effect sizes (0.7-1.8). The MABC-2 detected large portions of children whose change exceeded the minimal detectable difference (47.6%-71.4%); MAL data detected small portions (0%-19.0%). Neither tool correlated well with meaningfulness (χ2 = 0.186-5.724; P > .10). Both tools detected change in the overall group; however, only the MABC-2 detected individual change exceeding potential measurement error. CONCLUSIONS: Although both assessment tools are responsive, they may be responsive to different types of change. Therefore, assessment constructs should be matched to intervention goals.

A Comparison of Inertial Measurement Units and Overnight Videography to Assess Sleep Biomechanics.

PURPOSE: The assessment of sleep biomechanics (comprising movement and position during sleep) is of interest in a wide variety of clinical and research settings. However, there is no standard method by which sleep biomechanics are measured. This study aimed to (1) compare the intra- and inter-rater reliability of the current clinical standard, manually coded overnight videography, and (2) compare sleep position recorded using overnight videography to sleep position recorded using the XSENS DOT wearable sensor platform. METHODS: Ten healthy adult volunteers slept for one night with XSENS DOT units in situ (on their chest, pelvis, and left and right thighs), with three infrared video cameras recording concurrently. Ten clips per participant were edited from the video. Sleeping position in each clip was coded by six experienced allied health professionals using the novel Body Orientation During Sleep (BODS) Framework, comprising 12 sections in a 360-degree circle. Intra-rater reliability was assessed by calculating the differences between the BODS ratings from repeated clips and the percentage who were rated with a maximum of one section of the XSENS DOT value; the same methodology was used to establish the level of agreement between the XSENS DOT and allied health professional ratings of overnight videography. Bennett's S-Score was used to assess inter-rater reliability. RESULTS: High intra-rater reliability (90% of ratings with maximum difference of one section) and moderate inter-rater reliability (Bennett's S-Score 0.466 to 0.632) were demonstrated in the BODS ratings. The raters demonstrated high levels of agreement overall with the XSENS DOT platform, with 90% of ratings from allied health raters being within the range of at least 1 section of the BODS (as compared to the corresponding XSENS DOT produced rating). CONCLUSIONS: The current clinical standard for assessing sleep biomechanics, manually rated overnight videography (as rated using the BODS Framework) demonstrated acceptable intra- and inter-rater reliability. Further, the XSENS DOT platform demonstrated satisfactory levels of agreement as compared to the current clinical standard, providing confidence for its use in future studies of sleep biomechanics.

Can Wearable Inertial Measurement Units Be Used to Measure Sleep Biomechanics? Establishing Initial Feasibility and Validity.

Wearable motion sensors, specifically, Inertial Measurement Units, are useful tools for the assessment of orientation and movement during sleep. The DOTs platform (Xsens, Enschede, The Netherlands) has shown promise for this purpose. This pilot study aimed to assess its feasibility and validity for recording sleep biomechanics. Feasibility was assessed using four metrics: Drift, Battery Life, Reliability of Recording, and Participant Comfort. Each metric was rated as Stop (least successful), Continue But Modify Protocol, Continue But Monitor Closely, or Continue Without Modifications (most successful). A convenience sample of ten adults slept for one night with a DOT unit attached to their sternum, abdomen, and left and right legs. A survey was administered the following day to assess participant comfort wearing the DOTs. A subset of five participants underwent a single evaluation in a Vicon (Oxford Metrics, Oxford, UK) motion analysis lab to assess XSENS DOTs' validity. With the two systems recording simultaneously, participants were prompted through a series of movements intended to mimic typical sleep biomechanics (rolling over in lying), and the outputs of both systems were compared to assess the level of agreement. The DOT platform performed well on all metrics, with Drift, Battery Life, and Recording Reliability being rated as Continue Without Modifications. Participant Comfort was rated as Continue But Monitor Closely. The DOT Platform demonstrated an extremely high level of agreement with the Vicon motion analysis lab (difference of <0.025°). Using the Xsens DOT platform to assess sleep biomechanics is feasible and valid in adult populations. Future studies should further investigate the feasibility of using this data capture method for extended periods (e.g., multiple days) and in other groups (e.g., paediatric populations).

Early Moves: a protocol for a population-based prospective cohort study to establish general movements as an early biomarker of cognitive impairment in infants.

INTRODUCTION: The current diagnostic pathways for cognitive impairment rarely identify babies at risk before 2 years of age. Very early detection and timely targeted intervention has potential to improve outcomes for these children and support them to reach their full life potential. Early Moves aims to identify early biomarkers, including general movements (GMs), for babies at risk of cognitive impairment, allowing early intervention within critical developmental windows to enable these children to have the best possible start to life. METHOD AND ANALYSIS: Early Moves is a double-masked prospective cohort study that will recruit 3000 term and preterm babies from a secondary care setting. Early Moves will determine the diagnostic value of abnormal GMs (at writhing and fidgety age) for mild, moderate and severe cognitive delay at 2 years measured by the Bayley-4. Parents will use the Baby Moves smartphone application to video their babies' GMs. Trained GMs assessors will be masked to any risk factors and assessors of the primary outcome will be masked to the GMs result. Automated scoring of GMs will be developed through applying machine-based learning to the data and the predictive value for an abnormal GM will be investigated. Screening algorithms for identification of children at risk of cognitive impairment, using the GM assessment (GMA), and routinely collected social and environmental profile data will be developed to allow more accurate prediction of cognitive outcome at 2 years. A cost evaluation for GMA implementation in preparation for national implementation will be undertaken including exploring the relationship between cognitive status and healthcare utilisation, medical costs, health-related quality of life and caregiver burden. ETHICS AND DISSEMINATION: Ethics approval has been granted by the Medical Research Ethics Committee of Joondalup Health Services and the Health Service Human Research Ethics Committee (1902) of Curtin University (HRE2019-0739). TRIAL REGISTRATION NUMBER: ACTRN12619001422112.

Rationale, design and methods for a randomised and controlled trial to evaluate "Animal Fun"--a program designed to enhance physical and mental health in young children.

BACKGROUND: Children with poor motor ability have been found to engage less in physical activities than other children, and a lack of physical activity has been linked to problems such as obesity, lowered bone mineral density and cardiovascular risk factors. Furthermore, if children are confident with their fine and gross motor skills, they are more likely to engage in physical activities such as sports, crafts, dancing and other physical activity programs outside of the school curriculum which are important activities for psychosocial development. The primary objective of this project is to comprehensively evaluate a whole of class physical activity program called Animal Fun designed for Pre-Primary children. This program was designed to improve the child's movement skills, both fine and gross, and their perceptions of their movement ability, promote appropriate social skills and improve social-emotional development. METHODS: The proposed randomized and controlled trial uses a multivariate nested cohort design to examine the physical (motor coordination) and psychosocial (self perceptions, anxiety, social competence) outcomes of the program. The Animal Fun program is a teacher delivered universal program incorporating animal actions to facilitate motor skill and social skill acquisition and practice. Pre-intervention scores on motor and psychosocial variables for six control schools and six intervention schools will be compared with post-intervention scores (end of Pre-Primary year) and scores taken 12 months later after the children's transition to primary school Year 1. 520 children aged 4.5 to 6 years will be recruited and it is anticipated that 360 children will be retained to the 1 year follow-up. There will be equal numbers of boys and girls. DISCUSSION: If this program is found to improve the child's motor and psychosocial skills, this will assist in the child's transition into the first year of school. As a result of these changes, it is anticipated that children will have greater enjoyment participating in physical activities which will further promote long term physical and mental health. TRIAL REGISTRATION: This trial is registered in the Australian and New Zealand Clinical trials Registry (ACTRN12609000869279).

New pH-neutral peritoneal dialysis solution, low in glucose degradation products, in a double-chamber bag.

Fresenius Medical Care-North America has developed a neutral-pH version of its Delflex peritoneal dialysis (PD) solution with low glucose degradation products (GDPs): Delflex Neutral pH. The Delflex Neutral pH system stores the PD solution in a dual-chamber bag. The product is admixed by the patient before use. The new design facilitates GDP reduction in two ways. First, GDPs are reduced because the dextrose solution is stored at a pH that minimizes degradation during sterilization and that optimizes dextrose stability over time. Second, the design minimizes generation of acetaldehyde by separating dextrose from lactate during heat sterilization of the product. Mixing the contents of the two chambers before use produces a physiologically compatible pH of approximately 7.0, with minimal GDPs. Analysis of GDP content was conducted by high-performance liquid chromatography. The GDP reduction across all sizes and formulations of Delflex Neutral pH ranged between 74% and 93% as compared with conventional Delflex PD solution. Testing of the new delivery system by prevalent PD patients demonstrated that, with minimal training, patients can obtain a homogeneous PD solution low in GDPs with a physiologically compatible pH of approximately 7.0.

The contributions of fetal growth restriction and gestational age to developmental outcomes at 12 months of age: A cohort study.

BACKGROUND: Preterm birth is a known risk factor for infant development but it is less clear whether fetal growth restriction (FGR) and early term birth between 37 and 39 weeks gestation are associated with risks for infant development. AIMS: This study investigated risk factors for adverse developmental outcomes at 12 months of age in a population-based birth cohort. STUDY DESIGN: Cohort study. SUBJECTS: Participants in the Raine Study, which recruited 2900 women at 18 weeks of gestation (Gen1) and followed up infants longitudinally (Gen2). At 12 months, 1773 mothers provided developmental data for their infants. OUTCOME MEASURE: The Ages and Stages Questionnaire (ASQ) was used to measure gross and fine motor, communication, adaptability and personal social development. Multivariate logistic regression analyses were used to estimate associations between FGR, gestational age, sex, breast feeding, parental age, socioeconomic factors and developmental delay at 12 months of age as measured with the ASQ. RESULTS: The risk of any delay at 12 months of age, as well as gross motor, fine motor and adaptive delay, was slightly increased for infants born FGR. Preterm and early term birth and male sex were associated with poorer development at 12 months. Breast feeding was protective of developmental status. CONCLUSIONS: Developmental assessment using the ASQ of infants with FGR was mostly comparable to those born without FGR at 12 months, although finer-grained neurobehavioural assessments may yield capacity for earlier identification of developmental risk. Our data provide weight to the argument that surveillance of early term infants could enable earlier intervention for children at risk.

Children with developmental coordination disorder play active virtual reality games differently than children with typical development.

BACKGROUND: Active virtual reality gaming (AVG) may be useful for children with developmental coordination disorder (DCD) to practice motor skills if their movement patterns are of good quality while engaged in AVG. OBJECTIVE: This study aimed to examine: (1) the quality of motor patterns of children with DCD participating in AVG by comparing them with children with typical development (TD) and (2) whether differences existed in the motor patterns utilized with 2 AVG types: Sony PlayStation 3 Move and Microsoft Xbox 360 Kinect. DESIGN: This was a quasi-experimental, biomechanical laboratory-based study. METHODS: Twenty-one children with DCD, aged 10 to 12 years, and 19 age- and sex-matched children with TD played a match of table tennis on each AVG type. Hand path, wrist angle, and elbow angle were recorded using a motion analysis system. Linear mixed-model analyses were used to determine differences between DCD and TD groups and Move and Kinect AVG type for forehands and backhands. RESULTS: Children with DCD utilized a slower hand path speed (backhand mean difference [MD]=1.20 m/s; 95% confidence interval [95% CI]=0.41, 1.98); greater wrist extension (forehand MD=34.3°; 95% CI=22.6, 47.0); and greater elbow flexion (forehand MD=22.3°; 95% CI=7.4, 37.1) compared with children with TD when engaged in AVG. There also were differences in movement patterns utilized between AVG types. LIMITATIONS: Only simple kinematic measures were compared, and no data regarding movement outcome were assessed. CONCLUSIONS: If a therapeutic treatment goal is to promote movement quality in children with DCD, clinical judgment is required to select the most appropriate AVG type and determine whether movement quality is adequate for unsupervised practice.

Does the Animal Fun program improve social-emotional and behavioural outcomes in children aged 4-6 years?

Animal Fun was designed to enhance motor and social development in young children. Its efficacy in improving motor skills was presented previously using a randomised controlled trial and a multivariate nested cohort design. Based on the Environmental Stress Hypothesis, it was argued that the program would also result in positive mental health outcomes, investigated in the current study. Pre-intervention scores were recorded for 511 children aged 4.83-6.17 years (M=5.42, SD=.30). Intervention and control groups were compared 6 months following intervention, and again in their first school year. Changes in teacher-rated prosocial behaviour and total difficulties were assessed using the Strengths and Difficulties Questionnaire, and data analysed using Generalised Linear Mixed Models. There was a significant improvement in prosocial behaviour of children in the intervention group six months after initial testing, which remained at 18-month follow-up. Total difficulties decreased at 6 months for the intervention group, with no change at 18 months. This effect was present only for the hyperactivity/inattention subscale. The only significant change for the control group was an increase in hyperactivity/inattention scores from pre-intervention to 18-month follow-up. The Animal Fun program appears to be effective in improving social and behavioural outcomes.

A new neutral-pH low-GDP peritoneal dialysis fluid.

BACKGROUND: Conventional peritoneal dialysis fluids (PDFs) consist of ready-to-use solutions with an acidic pH. Sterilization of these fluids is known to generate high levels of glucose degradation products (GDPs). Although several neutral-pH, low-GDP PD solutions have been developed, none are commercially available in the United States. We analyzed pH and GDPs in Delflex Neutral pH (Fresenius Medical Care North America, Waltham, MA, USA), the first neutral-pH PDF to be approved by the US Food and Drug Administration. METHODS: We evaluated whether patients (n = 26; age range: 18 - 78 years) could properly mix the Delflex Neutral pH PDF after standardized initial training. We further analyzed the concentrations of 10 different glucose degradation products in Delflex Neutral pH PDF and compared the results with similar analyses in other commercially available biocompatible PDFs. RESULTS: All pH measurements (n = 288) in the delivered Delflex Neutral pH solution consistently fell within the labeled range of 7.0 ± 0.4. Analysis of mixing errors showed no significant impact on the pH results. Delflex Neutral pH, Balance (Fresenius Medical Care, Bad Homburg, Germany), BicaVera (Fresenius Medical Care), and Gambrosol Trio (Gambro Lundia AB, Lund, Sweden) exhibited similar low total GDP concentrations, with maximums in the 4.25% solutions of 88 µmol/L, 74 µmol/L, 74 µmol/L, and 79 µmol/L respectively; the concentration in Physioneal (Baxter Healthcare Corporation, Deerfield, IL, USA) was considerably higher at 263.26 µmol/L. The total GDP concentration in Extraneal (Baxter Healthcare Corporation) was 63 µmol/L, being thus slightly lower than the concentrations in the 4.25% glucose solutions, but higher than the concentrations in the 1.5% and 2.5% glucose solutions. CONCLUSIONS: The new Delflex Neutral pH PDF consistently delivers neutral pH with minimal GDPs.

Characteristics of chronic non-specific musculoskeletal pain in children and adolescents attending a rheumatology outpatients clinic: a cross-sectional study.

BACKGROUND: Chronic non-specific musculoskeletal pain (CNSMSP) may develop in childhood and adolescence, leading to disability and reduced quality of life that continues into adulthood. The purpose of the study was to build a biopsychosocial profile of children and adolescents with CNSMSP. METHODS: CNSMSP subjects (n = 30, 18 females, age 7-18) were compared with age matched pain free controls across a number of biopsychosocial domains. RESULTS: In the psychosocial domain CNSMSP subjects had increased levels of anxiety and depression, and had more somatic pain complaints. In the lifestyle domain CNSMSP subjects had lower physical activity levels, but no difference in television or computer use compared to pain free subjects. Physically, CNSMSP subjects tended to sit with a more slumped spinal posture, had reduced back muscle endurance, increased presence of joint hypermobility and poorer gross motor skills. CONCLUSION: These findings support the notion that CNSMSP is a multidimensional biopsychosocial disorder. Further research is needed to increase understanding of how the psychosocial, lifestyle and physical factors develop and interact in CNSMSP.