Gross Motor Family Report: Refinement and evaluation of psychometric properties.

AIM: To refine the Gross Motor Family Report (GM-FR) using parents' input and to evaluate its psychometric properties. METHOD: In this measurement study, 12 parents of children and adolescents with cerebral palsy (CP), aged 2 to 18 years, classified in all levels of the Gross Motor Function Classification System (GMFCS), were interviewed about their experience completing the GM-FR (content validity). Parents' feedback was used to refine the measure which was then completed by 146 families to evaluate internal consistency, and discriminative and concurrent validity. Forty-six parents completed the GM-FR again, 7 to 30 days later, to evaluate test-retest reliability. RESULTS: GM-FR scoring, pictures, descriptions, and the total number of items were revised based on parents' feedback. The GM-FR version 2.0 demonstrated high internal consistency (Cronbach's α = 0.99), no floor/ceiling effects, and excellent test-retest reliability (intraclass correlation coefficient = 0.99). GM-FR scores discriminated between GMFCS levels (p < 0.05) and were strongly negatively correlated with GMFCS level (r = -0.92; p < 0.001). GM-FR scores correlated positively and strongly with the Gross Motor Function Measure-66 (r = 0.94; p < 0.001) and the Pediatric Evaluation of Disability Inventory - Computer Adaptive Test mobility domain (r = 0.93; p < 0.001). INTERPRETATION: Active participation of families in the GM-FR's development facilitated creation of a family-friendly instrument. This study provides strong evidence of reliability and validity to support GM-FR use in clinical practice and research for assessing gross motor performance of children and adolescents with CP.

Feasibility of a home-based home videogaming intervention with a family-centered approach for children with cerebral palsy: a randomized multiple baseline single-case experimental design.

BACKGROUND: Worldwide, children with cerebral palsy (CP) living in underserved communities face barriers to accessing motor therapy services. This study assessed the implementation and effectiveness of an 8-week, upper limb (UL) home-based intervention with a movement-tracking videogame (Bootle Blast) in Costa Rican children with CP. METHODS: Children established a weekly playtime goal and two UL activities of daily living (ADLs) that they would like to improve on. A multiple-baseline, single-case experimental design, was used with the Performance Quality Rating Scale (PQRS) as the repeated measure to track changes in performance of the selected ADLs between the baseline (usual care) and intervention (Bootle Blast) phases. The Canadian Occupational Performance Measure (COPM), the Box and Blocks Test (BBT) and the Children's Hand-Use Experience Questionnaire (CHEQ) were collected before and after the intervention. Technical barriers were documented during weekly video calls with a monitoring therapist. Treatment effect size, slope changes and percentage of non-overlapping data were identified for the PQRS. Descriptive statistics summarized results for the BBT, CHEQ, videogame logs (e.g., playtime) and technical barriers. RESULTS: Fifteen children participated and 13 completed the intervention. Both participants who dropped out did so after completing baseline assessments, but before experiencing Bootle Blast. Children's mean active playtime (i.e., mini-games targeting the UL) across the 8-weeks was 377 min, while mean total time spent engaging with Bootle Blast (active + passive play time [e.g., time navigating menus, reviewing rewards]) was 728 min. In total, eight technical issues (from five children) were reported, and all but three were resolved within 48 h. Partial effectiveness was associated with the intervention. Specifically, 85% of participants improved on the PQRS and 69% achieved clinically important improvements ≥ 2 points in performance on the COPM. Children improved by 1.8 blocks on average on the BBT, while on the CHEQ, five children had a clinically important increase of 10% of the total number of UL activities performed with both hands. CONCLUSION: Bootle Blast is a feasible and effective option to facilitate access and engage children with cerebral palsy in UL home rehabilitation. Trial registration Trial registration number: NCT05403567.

Quick, Effective Screening Tasks Identify Children With Medical Conditions or Disabilities Needing Physical Literacy Support.

PURPOSE: This study evaluated screening tasks able to identify children with medical conditions or disabilities who may benefit from physical literacy. METHOD: Children completed ≤20 screening tasks during their clinic visit and then the Canadian Assessment of Physical Literacy (2nd edition) at a separate visit. Total Canadian Assessment of Physical Literacy scores <30th percentile were categorized as potentially needing physical literacy support. Receiver operator characteristic curves identified assessment cut points with 80% sensitivity and 40% specificity relative to total physical literacy scores. RESULTS: 223 children (97 girls; 10.1 [2.6] y) participated. Physical activity adequacy, predilection, and physical competence achieved ≥80% sensitivity and ≥40% specificity in both data sets. Adequacy ≤ 6.5 had 86% to 100% sensitivity and 48% to 49% specificity. Daily screen time >4.9 hours combined with Adequacy ≤6.15 had 88% to 10% sensitivity and 53% to 56% specificity. CONCLUSIONS: Activity adequacy, alone or with screen time, most effectively identified children likely to benefit from physical literacy support. Adequacy and screen time questionnaires are suitable for clinical use. Similar results regardless of diagnosis suggest physical competence deficits are not primary determinants of active lifestyles. Research to enhance screening specificity is required.

Development and evaluation of the Family Needs Questionnaire for Pediatric Rehabilitation.

PURPOSE: To develop the Family Needs Questionnaire-Pediatric Rehabilitation (FNQ-PR) version and evaluate the reliability and concurrent validity of this self-report measure for caregivers of children with disabilities who receive pediatric rehabilitation services. MATERIALS/METHODS: The 39-item FNQ-PR was developed through a modified Delphi Technique. For test-retest evaluation, parents completed the FNQ-PR twice through an online REDCap survey, 1-3 weeks apart. Concurrent validity data (parent-report Impact on Family Scale [IFS-15] and Measure of Processes of Care [MPOC-20]) were collected at baseline. Reliability analyses included ICCs (95%CI) and internal consistency evaluation. RESULTS: Twenty-five caregivers of children ages 2-18 years (mean age 12.2 years) with a disability completed the FNQ-PR at baseline, and 21 completed the retest. FNQ-PR total score demonstrated excellent test-retest reliability (ICC = 0.84); internal consistency was high. The FNQ-PR total score was strongly negatively associated with IFS-15 total score (r = -0.62) and showed fair to strong association with MPOC subscale scores (0.45 ≤ r ≤ 0.70). Participants did not identify issues with the online format or FNQ-PR item rating. CONCLUSIONS: The FNQ-PR demonstrated excellent overall reliability and strong evidence of validity. It fills a gap in clinical care of families of children with disabilities, providing a systematic way for families to identify the extent to which their needs are perceived to have been met. Clinicians can use this tool to target unmet needs that are most important to families. FNQ-PR use in future research will support exploration of the impact of specific child and family factors on family needs.

Gross motor change after inpatient rehabilitation for children with acquired brain injury: A 10-year retrospective review.

AIM: To estimate gross motor change in inpatient school-aged children with subacute acquired brain injury (ABI), identify factors associated with gross motor change, and describe inpatient physiotherapy focus. METHOD: This retrospective chart review involved inpatient children (5-18 years) with subacute ABI who had either two Gross Motor Function Measure (GMFM-88) assessments or one GMFM-88 with another pre/post gross motor outcome measure. Outcome change scores and Goal Attainment Scaling (GAS) T scores were calculated. Regression analyses examined factors predicting gross motor change. GAS goal areas were analysed to determine physiotherapy focus. RESULTS: Of the 546 charts screened, 266 (118 female) met study criteria. The GMFM-88 was generally administered first, followed by other measures. GMFM-88 (n = 202), Community Balance and Mobility Scale (n = 89), and Six-Minute Walk Test (6MWT) (n = 98) mean change scores were 18.03% (SD 19.34), 17.85% (SD 10.77), and 142.3 m (SD 101.8) respectively. The mean GAS T score was 55.06 (SD 11.50). Lower baseline scores and increased time between assessments were most predictive of greater GMFM-88 change (r ≥ 0.40). Twenty-five percent of GAS goals were ambulation-based. INTERPRETATION: Appropriate outcome measure selection is integral to detecting gross motor change in pediatric inpatient ABI rehabilitation. Mean change score estimates can be used to compare standard inpatient rehabilitation with new treatment approaches.

Integrating Transcranial Direct Current Stimulation into an Existing Inpatient Physiotherapy Program to Enhance Motor Learning in an Adolescent with Traumatic Brain Injury: A Case Report.

PURPOSE: Describe how transcranial direct current stimulation (tDCS) was incorporated into an inpatient physiotherapy program for an adolescent with severe traumatic brain injury (TBI), detail the motor learning focus of the physiotherapy sessions, and summarize gross motor progress. METHOD: This case report describes an adolescent who received 20 minutes of anodal tDCS immediately prior to 16 physiotherapy sessions over four weeks. Potential side effects were tracked pre/post tDCS. Gross motor outcomes were measured pre-intervention, post-intervention, and three months post-intervention. Physiotherapy session content was analyzed using therapist documentation and the Motor Learning Strategies Rating Instrument. RESULTS: The youth tolerated tDCS well. The primary side effect was itchiness under the electrodes during tDCS sessions. His mobility progressed from wheelchair use pre- 'tDCS + physiotherapy' to ambulation with a walker post-intervention. His Gross Motor Function Measure score increased 33.1% points pre/post intervention. Session tasks often had several foci (e.g., skill acquisition, strength, and balance) with task focus changing as the youth progressed. Various motor learning strategies were layered within tasks to support performance and learning. CONCLUSIONS: tDCS was successfully integrated into an existing inpatient physiotherapy program for an adolescent with TBI. This protocol provides a structure for implementing, monitoring, and measuring tDCS + physiotherapy in pediatric rehabilitation.

The Value of Incorporating Inclusive Sports in Schools: An Exploration of Unified Sport Experiences.

School sports programs intentionally created for students with and without disabilities may increase social participation of students with intellectual disabilities (IDs). Special Olympics Unified Sports is one program where students with and without ID participate on one team. Guided by a critical realist paradigm, this study explored the perceptions of students with and without ID and coaches of in-school Unified Sports. Interviews were conducted with 21 youths (12 with ID) and 14 coaches. Thematic analysis resulted in four developed themes (identified is outdated language): Inclusion-Is it a "we" or a "they?" Roles and Responsibilities, Educational Context for Inclusion, and Buy-In. Findings suggest students with and without ID and coaches value the inclusive nature of Unified Sports. Future research should explore training for coaches on inclusive practices (e.g., language), and optimal methods for consistent training (e.g., use of training manuals) to foster the philosophy of inclusion within school sports.

Use of Motor Learning Strategies in Occupational Therapy for Children and Youth with Acquired Brain Injury.

Motor learning strategies (MLS) can be used to promote motor skills acquisition in children and youth with acquired brain injury (ABI). While occupational therapists (OTs) likely use MLS in clinical practice, research has not investigated the extent and variety of their application.Aims: This study explored MLS use by OTs in pediatric ABI and factors influencing their application.Method: Individual video-recorded occupational therapy sessions for a sample of eight children/youth (ages 4-16) with ABI were evaluated via mixed methods approach. The Motor Learning Strategies Rating Instrument (MLSRI-22) quantified the extent of MLS use in each video. Directed content analysis of the videos explored the factors influencing how and when MLS were applied.Results: The most frequently used MLS were promoting problem solving, encouragement, directing attention to the body, permitting errors as part of learning, repetitive practice, and whole practice. Three themes described how and when the OTs used MLS: 1) Getting buy-in, 2) Going with the flow, and 3) Movement and thinking go hand-in-hand.Conclusions: The OTs frequently used MLS with children with ABI, appearing to select MLS based on factors related to the child, task, and environment. These findings are fundamental to future exploration of OT decision-making and evaluation of MLS effectiveness.

Development of the gait outcomes assessment list for lower-limb differences (GOAL-LD) questionnaire: a child and parent reported outcome measure.

BACKGROUND: To develop a priority-based patient/parent reported outcome measure for children with lower-limb differences (LD) by adapting the Gait Outcomes Assessment List (GOAL) questionnaire. METHODS: Guided by a conceptual framework of patient priorities, the GOAL questionnaire was iteratively modified and its sensibility evaluated by field-testing it on children with LD, and their parents. Cognitive interviews were conducted with a subgroup of these children, and an e-survey administered to a multidisciplinary group of health care professionals with expertise in paediatric LD. Findings were integrated to create the final version of the GOAL-LD. RESULTS: Twenty-five children (9-18 years), 20 parents, and 31 healthcare professionals evaluated the content and sensibility of the GOAL, with an emphasis on the relevance and importance of the items to patients' health related quality of life (HRQL). This resulted in the retention of 26 of the original 50 items, elimination of 12, modification of 12, and addition of seven new items. The new 45-item GOAL-LD questionnaire was shown to be sensible, and its content deemed important. CONCLUSIONS: The GOAL-LD questionnaire has a high level of face and content validity, and sensibility. It comprehensively captures the HRQL goals and outcomes that matter to children with LD and their parents. Following further psychometric evaluation, the GOAL-LD may serve as a much needed patient and parent reported outcome measure for this population.

Measurement Properties and Translation to Brazilian-Portuguese of the Challenge for Children and Adolescents with Cerebral Palsy.

Aims: Translate the Challenge assessment into Brazilian-Portuguese, determine its face validity, evaluate the reliability of the total score and score per item, investigate whether the child's gross motor level (classified by the Gross Motor Function Classification System-GMFCS) influences the reliability levels, and estimate responsiveness to change.Methods: The translation followed four stages: translation, synthesis, back-translation, and review. For face validity, ten physical therapists evaluated item relevance. Children and adolescents with cerebral palsy (n = 50, 5-18 years of age) GMFCS I and II were evaluated by two therapists for inter and intra-rater reliability. Thirty of these participants were recruited for the instrument's responsiveness evaluation and reassessed (n = 28) after three months of treatment. Minimal Detectable Change (MDC), and Minimal Clinically Important Difference (MCID) were estimated.Results: The back-translated version was similar to the English version. All test items were considered relevant by the physical therapists. Total score intra and inter-rater reliability were excellent for both GMFCS levels (ICC = 0.94-0.99). Items' intra- and inter- rater reliability varied from low to almost perfect (kw=-0.14-0.94). MDC90 and MDC95 values were 3.90-6.35 and 4.63-7.54, respectively. MCID values were 3.57-4.56.Conclusion: The translated version of the Challenge showed excellent face validity and reliability and was able to document longitudinal change.

First stage international validation of the pediatric family needs questionnaire (FNQ-P).

OBJECTIVES: 1. Evaluate reliability and construct validity of the newly-developed Family Needs Questionnaire - Pediatric (FNQ-P), a 40-item measure assessing the extent to which family's needs are met after a child has an acquired brain injury (ABI). 2. Explore the impact of selected child characteristics on FNQ-P scores. RESEARCH DESIGN: MEASUREMENT STUDY: Methods: Parents/caregivers of children with ABI (2-18 years) were recruited across four sites (Canada, Sweden, Lithuania, Australia) for FNQ-P test-retest evaluation. These sites plus a fifth (United Kingdom) completed construct validity evaluation with the Family Burden of Injury Inventory and Strengths and Difficulties Questionnaire. Associations between FNQ-P score and age, injury severity, time post-injury and site were evaluated via stepwise regression. RESULTS: FNQ-P mean scores (n=61) were 64.1% (SD 22.3) and 58.8% (SD 22.6) on test and retest, respectively. Test-retest reliability was good overall (ICC=0.78, 95% CI 0.65-0.86). There was a weak association between FNQ-P and FBII (r=-0.23, P=0.049, n=71), but no association between FNQ-P and SDQ scores (maximum r=0.16, P>0.15). None of the variables studied predicted FNQ-P scores. CONCLUSION: The FNQ-P demonstrated good test-retest reliability. Further validity assessment is recommended. Lack of relationship between FNQ-P and variables studied suggests independence of family needs.

Exploring Physiotherapists' Use of Motor Learning Strategies in Gait-Based Interventions for Children with Cerebral Palsy.

Aim: This study investigated physiotherapists' experiences using motor learning strategies (MLS) in gait-based interventions for children with cerebral palsy (CP). The objectives were to explore how child characteristics, physiotherapist decision-making, and treatment approach influenced intentional MLS use.Methods: Semi-structured interviews were conducted with eight physiotherapists who provided gym- and/or Lokomat-based treatment to children with CP. Interviews were analyzed using directed content analysis and a modified constant comparison method.Results: Three themes described their experiences: (1) MLS use is driven by the unique aspects of the child, physiotherapist, and intervention; (2) The use and description of motor learning content varies among physiotherapists; and (3) The Lokomat is "the same but different." Child characteristics were at the forefront of MLS selection in both interventions. The terminology used to describe MLS use varied considerably among therapists. They used similar clinical decision-making in gym- and Lokomat-based interventions.Conclusions: Conscious reflection on the factors affecting MLS use could facilitate related clinical decision-making in physiotherapy interventions for children with CP. Increased awareness of MLS and use of a structured framework for reporting MLS are required to promote intentional MLS use and generate CP-specific evidence-based MLS research.

Reliability of the Motor Learning Strategies Rating Instrument in physiotherapy intervention for children with cerebral palsy.

AIM: To evaluate the reliability of the Motor Learning Strategies Rating Instrument (MLSRI-20) in gait-based, video-recorded physiotherapy interventions for children with cerebral palsy (CP). METHOD: Thirty videos of 18 children with CP, aged 6 to 17 years, participating in either traditional or Lokomat-based physiotherapy interventions were rated using the MLSRI-20. Physiotherapist raters provided general and item-specific feedback after rating each video, which was used when interpreting reliability results. RESULTS: Both interrater and intrarater reliability of the MLSRI-20 total score was good. The interrater reliability intraclass correlation coefficient (ICC) was 0.78 with a 95% confidence interval (CI) of 0.53-0.89 and a coefficient of variation (CV) of 11.8%. The intrarater reliability ICC was 0.89 with a 95% CI of 0.76-0.95 and CV of 7.8%. Rater feedback identified task delineation and interpretation of therapist verbalizations as sources of interrater reliability-related scoring challenges. INTERPRETATION: The MLSRI-20 is a reliable tool for measuring the extent to which a physiotherapist uses motor learning strategies during a video-recorded intervention. These results have clinical and research implications for documenting and analyzing the motor learning content of physiotherapy interventions for children with CP. WHAT THIS PAPER ADDS: The Motor Learning Strategies Rating Instrument (MLSRI-20) is reliable for use by trained physiotherapist raters. Measuring motor learning strategies can identify active 'ingredients' in physiotherapy interventions for children with cerebral palsy. The MLSRI-20 promotes a common language in motor learning.

FIABILIDAD DEL INSTRUMENTO DE CLASIFICACIÓN DE LAS ESTRATEGIAS DE APRENDIZAJE MOTOR EN FISIOTERAPIA: OBJETIVO: Evaluar la fiabilidad del Instrumento de Clasificación de las Estrategias de Aprendizaje Motor (Motor Learning Strategies Rating Instrument, MLSRI-20, siglas en inglés,) en intervenciones fisioterapéuticas basadas en la marcha y grabadas en vídeo para niños con parálisis cerebral (PC). METODOLOGÍA: Se clasificaron 30 vídeos de 18 niños y niñas con PC, de edades comprendidas entre los 6 y 17 años y participando en intervenciones de Fisioterapia tradicionales o basadas en el Lokomat, usando el MLRSI-20. Los evaluadores fisioterapeutas proporcionaron retroalimentación general y específica de los ítems después de clasificar cada vídeo, el cual fue usado al interpretar los resultados de fiabilidad. RESULTADOS: Tanto la fiabilidad inter-observador de la puntuación total del MLSRI-20 como la fiabilidad intra-observador fueron buenas. El coeficiente de correlación intraclase (CCI) de la fiabilidad inter-observador fue de 0,78 con un intervalo de confianza del 95% (IC) de 0,53-0,89 y la variación del coeficiente (VC) del 11,8%. EL CCI de la fiabilidad intra-observador fue 0,89 con un IC95% de 0,76-0-95 y un CV de 7,8%. La retroalimentación del evaluador identificó la delineación de la tarea y la interpretación de las verbalizaciones del terapeuta como fuentes de desafío para puntuar la fiabilidad inter-observador. INTERPRETACIÓN: El MLSRI-20 es una herramienta fiable para medir en qué grado los fisioterapeutas usan estrategias de aprendizaje motor durante una intervención grabada en vídeo. Estos resultados tienen implicaciones clínicas y de investigación para documentar y analizar el contenido de aprendizaje motor en las intervenciones fisioterapéuticas en niños con PC.

CONFIABILIDADE DO INSTRUMENTO DE PONTUAÇÃO DAS ESTRATÉGIAS DE APRENDIZAGEM MOTORA NA INTERVENÇÃO DE FISIOTERAPIA PARA CRIANÇAS COM PARALISIA CEREBRAL: OBJETIVO: Avaliar a confiabilidade do Instrumento de Pontuação das Estratégias de Aprendizagem Motora (Motor Learning Strategies Rating Instrument, MLSRI-20) em intervenções de fisioterapia para crianças com paralisia cerebral (PC) baseadas na marcha e registradas por vídeo. MÉTODO: Trinta videos de 18 crianças com PC, com idades de 6 a 17 anos, participando ou em intervenções de fisioterapia baseada no Lokomat foram pontuadas usando o MLSRI-20. Os examinadores fisioterapeutas forneceram uma avaliação geral e item-específica após pontuar cada vídeo, o que foi usado para interpretar os resultados de confiabilidade. RESULTADOS: Tanto a confiabilidade inter-examinador quanto intra-examinador do MLSRI-20 foi boa. O coeficiente de correlação intraclasse (CCI) da confiabilidade inter-foi 0,78 com intervalo de confiança (IC) a 95% de 0,53-0,89 e coeficiente de variação (CV) de 11,8%. O CII da confiabilidade intra-examinador foi 0,89 com CI a 95% de 0,76-0,95 e CV de 7,8%. A avaliação dos examinadores identificou o delineamento da tarefa e as verbalizações dos terapeutas para interpretação como fontes de desafios na pontuação da confiabilidade inter-examinadores. INTERPRETAÇÃO: O MLSRI-20 é uma ferramenta confiável para mensurar a extensão em que um fisioterapeuta usa estratégias de aprendizagem motora durante uma intervenção gravada em video. Os resultados têm implicações clínicas e científicas para a documentação e análise do conteúdo de aprendizagem motora em crianças com PC.

Relato Familiar da Motricidade Grossa: Refinamento e avaliação das propriedades psicométricas.

OBJETIVO: Refinar o Relato Familiar da Motricidade Grossa (GM­FR) utilizando a contribuição dos pais e avaliar as suas propriedades psicométricas. MÉTODO: Neste estudo metodológico, 12 pais de crianças e adolescentes com paralisia cerebral (PC), com idade entre 2 e 18 anos, classificados em todos os níveis do Sistema de Classificação da Função Motora Grossa (GMFCS), foram entrevistados sobre sua experiência na conclusão do GM­FR (validade de conteúdo). O feedback dos pais foi usado para refinar o instrumento que foi então preenchida por 146 famílias para avaliar a consistência interna, e a validade discriminativa e concorrente. 46 pais completaram o GM­FR novamente, 7 a 30 dias depois, para avaliar a confiabilidade teste­reteste. RESULTADOS: A pontuação do GM­FR, as imagens, as descrições e o número total de itens foram revisados com base no feedback dos pais. O GM­FR versão 2.0 demonstrou alta consistência interna (α de Cronbach = 0,99), ausência de efeitos piso/teto e excelente confiabilidade teste­reteste (coeficiente de correlação intraclasse = 0,99). Os escores do GM­FR discriminaram entre os níveis do GMFCS (p < 0,05) e foram fortemente correlacionados negativamente com o nível do GMFCS (r = −0,92; p < 0,001). Os escores do GM­FR correlacionaram­se de forma positiva e forte com o Gross Motor Function Measure­66 (r = 0,94; p < 0,001) e com o domínio de mobilidade do Pediatric Evaluation of Disability Inventory ­ Computer Adaptive Test (r = 0,93; p < 0,001). INTERPRETAÇÃO: A participação ativa das famílias no desenvolvimento do GM­FR facilitou a criação de um instrumento amigável à família. Este estudo fornece fortes evidências de confiabilidade e validade para apoiar o uso do GM­FR na prática clínica e em pesquisas para avaliar o desempenho motor grosso de crianças e adolescentes com PC.

Development of the family needs questionnaire - pediatric version [FNQ-P] - phase I.

OBJECTIVE: To adapt the well-validated 37-item adult Family Needs Questionnaire to make it suitable for families of children and youth with acquired brain injury (ABI). METHODS: Measurement construction employed a modified Delphi technique to identify the most relevant content items for the pediatric Family Needs Questionnaire (FNQ-P). The Delphi process involved a panel of 11 ABI-team clinicians and seven family caregivers of children/youth with an ABI and four rounds of anonymous voting on each item's importance. Qualitative responses related to each item's review were incorporated into item content and wording decisions. Cognitive interviews were conducted with three parents after the Delphi to evaluate face and content validity. RESULTS: The outcome of the final Delphi round was a set of 40 items within the original FNQ's original six categories: Health Information (n = 10), Emotional Support (n = 6), Instrumental Support (n = 4), Professional Support (n = 6), Community Support (n = 6), and Involvement with Care (n = 8). Cognitive interviews resulted in changes to formatting, rating scale, and item wording, and culminated in overall consensus about the FNQ-P's face/content validity. CONCLUSIONS: Use of the Delphi process with family and clinical partners resulted in content-endorsed pediatric FNQ that is ready for validation work prior to transfer to clinical practice.

Opening the Door to Physical Activity for Children With Cerebral Palsy: Experiences of Participants in the BeFAST or BeSTRONG Program.

This study explored children's experiences of participating in one-to-one physical training programs to identify how programs can best promote physical activity participation for children with cerebral palsy. A qualitative descriptive design with self-determination theory was used. Semistructured interviews were conducted with 6 children with cerebral palsy, age 8-14 years, who participated in a fundamental-movement-skills or lower-limb strength-training program. A hybrid approach of deductive and inductive analysis was used. Four themes developed: World around me (i.e., social/physical environments), Made for me (i.e., individualizing programs), Teach me how (i.e., teaching strategies facilitated skill learning), and I know me (i.e., sense of self). Results include recommendations for delivery of physical training programs. Using an individualized approach in a structured one-to-one program that employs skill-teaching strategies and self-reflection opportunities may provide a foundation to increase physical activity participation, related self-confidence, and desire to participate.

Should the Gross Motor Function Classification System be used for children who do not have cerebral palsy?

This literature review addressed four questions. (1) In which populations other than cerebral palsy (CP) has the Gross Motor Function Classification System (GMFCS) been applied? (2) In what types of study, and why was it used? (3) How was it modified to facilitate these applications? (4) What justifications and evidence of psychometric adequacy were used to support its application? A search of PubMed, MEDLINE, and Embase databases (January 1997 to April 2017) using the terms: 'GMFCS' OR 'Gross Motor Function Classification System' yielded 2499 articles. 118 met inclusion criteria and reported children/adults with 133 health conditions/clinical descriptions other than CP. Three broad GMFCS applications were observed: as a categorization tool, independent variable, or outcome measure. While the GMFCS is widely used for children with health conditions/clinical description other than CP, researchers rarely provided adequate justification for these uses. We offer recommendations for development/validation of other condition-specific classification systems and discuss the potential need for a generic gross motor function classification system. WHAT THIS PAPER ADDS: The Gross Motor Function Classification System should not be used outside cerebral palsy or as an outcome measure. The authors provide recommendations for development and validation of condition-specific or generic classification systems.

Development of Child and Family-Centered Engagement Guidelines for Clinical Administration of the Challenge to Measure Advanced Gross Motor Skills: A Qualitative Study.

AIMS: This article describes a qualitative study aimed at producing child-centered guidelines for the administration of a measure of children's advanced gross motor skills, the Challenge. The purpose of the guidelines is to promote collaborative interpretation and application of results. METHODS: The study was conducted in three Canadian cities and included 31 children with cerebral palsy (GMFCS Level I or II) ages 8 to 18 and one parent/caregiver per child (N = 62 participants). Following Challenge administration, each child and one of their caregivers took part in separate qualitative interviews. Analyses were oriented to exploring understandings of the purposes of testing, impressions of the child's performance, and perceptions of how results might inform activity choices and interventions. RESULTS: Three themes were generated: investments in doing well; I know my child/myself; and caregivers' interpretations of child's performance. Themes were then integrated with principles of child and family-centered care to develop The Challenge Engagement Guidelines directed at reducing test anxiety and enhancing shared decision making. CONCLUSIONS: The Guidelines are the first of their kind to integrate child and family-centered principles into the administration protocol of a motor measure. Although developed for the Challenge, the principles have applicability to other rehabilitation measures.

Evaluation of the Reliability of the Challenge when used to Measure Advanced Motor Skills of Children with Cerebral Palsy.

AIMS: The Challenge was designed as an extension to the GMFM-66 to assess advanced motor skills of children with cerebral palsy (CP) who walk/run independently. This study evaluated the Challenge's inter-rater and test-retest reliability. METHODS: Thirty children with CP (GMFCS level I [n = 24] and II [n = 6]) completed the Challenge, with re-testing one to two weeks later. Seven physiotherapist assessors passed the Challenge criterion test pre-administration. A single assessor administered and scored test and retest sessions (test-retest reliability). A second assessor independently scored one of these sessions (inter-rater reliability). RESULTS: Inter-rater reliability was excellent (ICC = 0.97, 95%CI 0.94-0.99, CoV < 10%), with no bias (Bland-Altman plot). Test-retest ICC was excellent (ICC = 0.94, 95% CI 0.88-0.97. CoV < 10%, and Minimum Detectable Change (MDC90) was 4.47 points. Many participants indicated practising at home pre-retest session. CONCLUSIONS: There was strong rating consistency between assessors. While test-retest ICC estimates were also high, Challenge scores were higher at retest. The MDC90 was still in a range (>4.5 points) that seems clinically viable for change detection. Test-retest reliability could be reassessed with children instructed not to practice between assessments to determine the extent to which between-session practice influenced scores.

A Scoping Review of Inclusive Out-of-School Time Physical Activity Programs for Children and Youth With Physical Disabilities.

The objective of this study was to comprehensively evaluate inclusive out-of-school time physical activity programs for children/youth with physical disabilities. A search of the published literature was conducted and augmented by international expertise. A quality appraisal was conducted; only studies with quality ratings ≥60% informed our best practice recommendations. Seventeen studies were included using qualitative (n = 9), quantitative (n = 5), or mixed (n = 3) designs. Programs had a diversity of age groups, group sizes, and durations. Most programs were recreational level, involving both genders. Rehabilitation staff were the most common leaders. Outcomes focused on social skills/relationships, physical skill development, and psychological well-being, with overall positive effects shown in these areas. The best practice recommendations are consistent with an abilities-based approach emphasizing common group goals and interests; cooperative activities; mastery-oriented, individualized instruction; and developmentally appropriate, challenging activities. Results indicate that inclusive out-of-school time physical activity programs are important for positive psychosocial and physical skill development of children/youth with physical disabilities.