The prevalence and clustering of alcohol consumption, gambling, smoking, and excess weight in an English adult population.

BACKGROUND: The aim of this study was to examine the prevalence and clustering of four health risks (increasing-/higher-risk drinking, current smoking, overweight/obesity, and at-risk gambling), and to examine variation across sociodemographic groups in the English adult population. METHODS: We analysed data from the 2012, 2015, 2016, and 2018 Health Survey for England (n = 20,698). Prevalence odds ratios (POR) were calculated to examine the clustering of risks. We undertook a multinomial multilevel regression model to examine sociodemographic variation in the clustering of health risks. RESULTS: Overall, 23.8% of the adult English population had two or more co-occurring health risks. The most prevalent was increasing-/higher-risk drinking and overweight/obesity (17.2%). Alcohol consumption and smoking were strongly clustered, particularly higher-risk drinking and smoking (POR = 2.68; 95% CI = 2.31, 3.11; prevalence = 1.7%). Higher-risk drinking and at-risk gambling were also clustered (POR = 2.66; 95% CI = 1.76, 4.01), albeit with a very low prevalence (0.2%). Prevalence of multiple risks was higher among men for all risk combinations except smoking and obesity. The odds of multiple risks were highest for men and women aged 35-64 years. Unemployed men and women with lower educational qualifications had a higher odds of multiple risks. The relationship between deprivation and multiple risks depended on the definition of multiple risks, with the clearest socioeconomic gradients seen for the highest risk health behaviours. CONCLUSION: An understanding of the prevalence, clustering, and risk factors for multiple health risks can help inform effective prevention and treatment approaches and may support the design and use of multiple behaviour change interventions.

Quality of Participation Experiences in Special Olympics Sports Programs.

This cross-sectional study examined experiential elements facilitating quality sport experiences for youth (ages 12-24 years) in Special Olympics, and the associated influences of sport program and sociodemographic characteristics. A total of 451 athletes involved in the 2019 Special Olympics Youth Games completed a survey assessing elements of quality participation (autonomy, belongingness, challenge, engagement, mastery, and meaning). The t tests investigated whether athletes with intellectual and developmental disabilities rated elements differently across Traditional and Unified Sport programs. Regression analyses explored whether sport program and sociodemographic characteristics were predictors of these elements. Youth reported high mean scores across the elements, with no significant differences between athletes with intellectual and developmental disabilities in Traditional or Unified Sport. Athletes with no reported disability rated higher autonomy than those who reported disability (p = .01). Women tended to report greater engagement in sport than men (p = .07). Findings provide theoretical and practical insights into quality sport participation among youth in Special Olympics.

Mothers' experiences with the Pediatric Evaluation of Disability Inventory (PEDI).

Parents of a child with a disability are often asked about their child's functioning in daily activities. One way to gather this information is through parent-report functional questionnaires such as the Pediatric Evaluation of Disability Inventory (PEDI). The purpose of this study was to explore parental experiences associated with completion of the PEDI before and after a functional therapy intervention. Semi-structured interviews were conducted with 12 mothers of children with cerebral palsy (CP) or developmental delay (DD) who had completed the PEDI within a larger study. A content analysis approach was used to code and organize the data into five themes. PEDI completion was associated with increased parental awareness of developmental patterns, and greater insight into levels of assistance they give to their child. Parents described various challenges and concerns with the PEDI that have implications for test administration processes. The findings have potential to enable more sensitive and focused PEDI use.

Further development of the response scales of the Acquired Brain Injury Challenge Assessment (ABI-CA).

PRIMARY OBJECTIVE: To revise the scaling of the response sets of the Acquired Brain Injury Challenge Assessment (ABI-CA) through expert input and determination of empirically based cut-points. RESEARCH DESIGN: A measurement development study with a content validity focus. METHODS: Response option wording was revised through consultation with six physiotherapists with paediatric ABI expertise. Twenty-nine typically-developing children performed the ABI-CA and empirically-based cut-points for item-specific response options were derived from their time/distance/repetition results (SD values) as benchmark values. Movement quality considerations (compensatory movements) were identified from expert consultation/ABI-CA video observation and built into revised response options. The revised ABI-CA was pilot-tested with four children with ABI, aged 7-15 years, for a feasibility check. RESULTS: Nineteen of the 23 items' response scales were revised based on experts' feedback and empirically-based cut-points replaced the previous arbitrarily-determined cut-points. Compensatory movement considerations were re-defined in nine items. The mean score of the refined ABI-CA was 70.0% (SD = 18.5) with four children with ABI. CONCLUSION: The new response options in the ABI-CA appeared suitable for testing high-functioning children with ABI and the mid-range mean score in this pilot sample indicates its potential to measure change. Recommendations are outlined for final ABI-CA amendments before large-scale validation.

The motor learning strategy instrument: interrater reliability within usual and virtual reality physical therapy interventions.

PURPOSE: To evaluate and compare the interrater reliability of the Motor Learning Strategy Rating Instrument (MLSRI) within usual and virtual reality (VR) interventions for children with acquired brain injury. METHODS: Two intervention sessions for each of 11 children (total, 22) were videotaped; sessions were provided by 4 physical therapists. Videotapes were divided into usual and VR components and rated by 2 observers using the MLSRI. A generalizability theory approach was used to determine interrater reliability for each intervention. RESULTS: Interrater reliability for usual interventions was high for the MLSRI total score (g-coefficient, 0.81), whereas it was low for the VR total score (g-coefficient, 0.28); MLSRI category g-coefficients varied from 0.35 to 0.65 for usual and from 0.17 to 0.72 for VR interventions. CONCLUSION: Adequate reliability was achieved within ratings of usual interventions; however, challenges related to MLSRI use to rate VR-based interventions require further evaluation.

Development of expert consensus to guide physical rehabilitation in children and adolescents with acquired brain injury during the subacute phase.

OBJECTIVE: To develop consensus among experts to guide physical rehabilitation in children and adolescents with acquired brain injury during the subacute phase. DESIGN: International Delphi study. METHODS: A 3-round online Delphi study was conducted with 11 international experts in rehabilitation for children and adolescents with acquired brain injury. The first round consisted of open-ended questions; the second and third round consisted of ranking 139 statements on a 5-point Likert scale. RESULTS: The panel reached consensus on 116/139 statements. Consensus was reached on the importance of age, pre-injury developmental stage and the clinical presentation of the child when determining content and focus of physical rehabilitation. In addition, consensus was reached on the importance of participation-focused interventions, and involvement of family members in goal-setting and therapeutic activities. Although dosage was deemed very important, no consensus was reached for determination of dose-response variables to suit and influence the child's needs. CONCLUSION: This study provides a framework for clinicians to design physical rehabilitation interventions in children with acquired brain injury in the sub-acute recovery phase. The promotion of physical activity in meaningful contexts and involvement of family members are considered as important components to optimize recovery.

Active video game play in children with cerebral palsy: potential for physical activity promotion and rehabilitation therapies.

OBJECTIVE: To evaluate the potential of active video game (AVG) play for physical activity promotion and rehabilitation therapies in children with cerebral palsy (CP) through a quantitative exploration of energy expenditure, muscle activation, and quality of movement. DESIGN: Single-group, experimental study. SETTING: Human movement laboratory in an urban rehabilitation hospital. PARTICIPANTS: Children (N=17; mean age ± SD, 9.43±1.51y) with CP. INTERVENTION: Participants played 4 AVGs (bowling, tennis, boxing, and a dance game). MAIN OUTCOME MEASURES: Energy expenditure via a portable cardiopulmonary testing unit; upper limb muscle activations via single differential surface electrodes; upper limb kinematics via an optical motion capture system; and self-reported enjoyment via the Physical Activity Enjoyment Scale (PACES). RESULTS: Moderate levels of physical activity were achieved during the dance (metabolic equivalent for task [MET]=3.20±1.04) and boxing (MET=3.36±1.50) games. Muscle activations did not exceed maximum voluntary exertions and were greatest for the boxing AVG and for the wrist extensor bundle. Angular velocities and accelerations were significantly larger in the dominant arm than in the hemiplegic arm during bilateral play. A high level of enjoyment was reported on the PACES (4.5±0.3 out of 5). CONCLUSIONS: AVG play via a low-cost, commercially available system can offer an enjoyable opportunity for light to moderate physical activity in children with CP. While all games may encourage motor learning to some extent, AVGs can be strategically selected to address specific therapeutic goals (eg, targeted joints, bilateral limb use). Future research is needed to address the challenge of individual variability in movement patterns/play styles. Likewise, further study exploring home use of AVGs for physical activity promotion and rehabilitation therapies, and its functional outcomes, is warranted.

Reliability of the motor learning strategy rating instrument for children and youth with acquired brain injury.

PURPOSE: To evaluate reliability and feasibility of the Motor Learning Strategy Rating Instrument (MLSRI) in children with acquired brain injury (ABI). The MLSRI quantifies the extent to which motor learning strategies (MLS) are used within physiotherapy (PT) interventions. METHODS: PT sessions conducted by ABI team physiotherapists with a convenience sample of children with ABI (4-18 years) were videotaped and independently scored later by two raters trained in MLSRI use. Intraclass correlation coefficients (ICCs) and 95% confidence intervals (CIs) estimated intra- and inter-rater reliability. RESULTS: Eighteen PT sessions were evaluated. Intra- and inter-rater reliability ICCs for total score were 0.86 (95% CI: 0.66-0.94) and 0.50 (95% CI: 0.08-0.78), respectively. MLSRI category ICCs were 0.56-0.86 (intra-rater) and 0.16-0.84 (inter-rater). CONCLUSIONS: Intra-rater reliability of MSLRI total score was excellent. Moderate inter-rater reliability may partially be due to inconsistent item interpretation between raters. Revisions and further reliability testing are required before recommending the MLSRI for clinical and research use.

Is Physical Activity-Related Self-Efficacy Associated with Moderate to Vigorous Physical Activity and Sedentary Behaviour among Ambulatory Children with Cerebral Palsy?

Purpose: To determine how physical activity-related self-efficacy is associated with physical activity and sedentary behaviour time among ambulatory children with cerebral palsy (CP). Method: Children with CP, Gross Motor Function Classification System (GMFCS) Levels I-III (N = 26; aged 9-18 y), completed the task self-efficacy component of a self-efficacy scale and wore Actigraph GT3X+ accelerometers for 5 days. Correlations (Pearson and Spearman's rank-order; α = 0.050) were conducted to evaluate the relationships among age, GMFCS level, self-efficacy, and both daily moderate-to-vigorous physical activity (MVPA) and sedentary time. Linear regression models were used to determine the relationships among the independent variables and MVPA and sedentary time. Results: Self-efficacy was positively associated with MVPA time (r = 0.428, p = 0.015) and negatively correlated with sedentary time (r = -0.332, p = 0.049). In our linear regression models, gross motor function (ß = -0.462, p = 0.006), age (ß = -0.344, p = 0.033), and self-efficacy (ß = 0.281, p = 0.080) were associated with MVPA time (R2 = 0.508), while GMFCS level (ß = 0.439, p = 0.003) and age (ß = 0.605, p < 0.001) were associated with sedentary time (R2 = 0.584). Conclusions: This research suggests that self-efficacy, age, and gross motor function are associated with MVPA in children with CP. Additional research is needed to confirm these findings and further explore the influence of self-efficacy on sedentary behaviour.

Objectif : déterminer l'association entre l'autoefficacité liée à l'activité physique et la durée de l'activité et du comportement sédentaire chez les enfants ambulatoires ayant la paralysie cérébrale (PC). Méthodologie : des enfants ayant la PC âgés de 9 à 18 ans (N = 26) présentant les niveaux I à III du système de classification de la fonction motrice globale (GMFCS) ont effectué l'élément d'autoefficacité de l'échelle d'autoévaluation et ont porté des accéléromètres Actigraph GT3X+ pendant cinq jours. Les chercheurs ont établi des corrélations (hiérarchie de Pearson et Spearman; α = 0,050) pour évaluer les relations entre l'âge, le niveau de GMFCS, l'autoefficacité et à la fois l'activité physique modérée à vigoureuse (APMV) et à la durée de la sédentarité. Ils ont utilisé les modèles de régression linéaire pour déterminer la relation entre, d'une part, les variables indépendantes et, d'autre part, l'APMV et la sédentarité. Résultats : l'autoefficacité était associée de manière positive au temps d'APMV (r = 0,428, p = 0,015) et de manière négative avec la durée de sédentarité (r = ­0,332, p = 0,049). Dans les modèles de régression linéaire des chercheurs, la fonction motrice globale (ß = ­0,462, p = 0,006), l'âge (ß = ­0,344, p = 0,033) et l'autoefficacité (ß = 0,281, p = 0,080) étaient associés à la durée de l'APMV (R2 = 0,508), mais le niveau du GMFCS (ß = 0,439, p = 0,003) et l'âge (ß = 0,605, p < 0,001) étaient corrélés avec la durée de sédentarité (R2 = 0,584). Conclusions : selon la présente recherche, l'autoefficacité, l'âge et la fonction motrice globale sont liées à l'APMV chez les enfants ayant la PC. D'autres recherches devront être réalisées pour confirmer ces observations et explorer plus à fond l'influence de l'autoefficacité sur le comportement sédentaire.

Identification of a core set of exercise tests for children and adolescents with cerebral palsy: a Delphi survey of researchers and clinicians.

AIM: Evidence-based recommendations regarding which exercise tests to use in children and adolescents with cerebral palsy (CP) are lacking. This makes it very difficult for therapists and researchers to choose the appropriate exercise-related outcome measures for this group. This study aimed to identify a core set of exercise tests for children and adolescents with CP. METHOD: Fifteen experts (10 physical therapists/researchers and five exercise physiologists; three from the Netherlands, two from the USA, one from the UK, five from Canada, and four from Australia) participated in a Delphi survey which took four stages to achieve a consensus. Based on the information that was collected during the survey, a core set of measures was identified for levels I to IV of the Gross Motor Function Classification System (GMFCS). RESULTS: For children with CP classified at GMFCS levels I and II, tests were identified for two motor skills (walking and cycling). For the subgroup of children with CP classified at GMFCS level III, the tests that were identified related to walking, cycling, and arm cranking. For children with CP classified at GMFCS level IV, the tests included in the core set were related to cycling and arm cranking. INTERPRETATION: The core set will help physical therapists, exercise physiologists, and other health professionals who work with children and adolescents with CP to decide which test(s) to use in clinical practice or research. This will facilitate comparability of results across studies and clinical programmes.

Test-retest reliability of discrete gait parameters in children with cerebral palsy.

OBJECTIVES: To examine the test-retest reliability of discrete gait parameters in children with cerebral palsy (CP) in Gross Motor Function Classification System (GMFCS) levels I, II, and III; to calculate the measurement error between testing sessions of these parameters in the total sample and within GMFCS subgroups using the standard error of measurement; and to evaluate the minimal detectable change (MDC) to identify discrete gait parameters that are most sensitive to change in children with CP. DESIGN: Test-retest reliability study. SETTING: Rehabilitation facility with human movement laboratory. PARTICIPANTS: Ambulatory children with CP (N=28). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Intraclass correlation coefficients (ICCs), standard error of measurement, and MDC of discrete gait parameters. RESULTS: Parameters measured in the sagittal plane and temporal-spatial parameters were highly reliable across all GMFCS levels (ICC range, .84-.97), while test-retest reliability in the frontal and transverse planes varied from poor to excellent (ICC range, .46-.91). Using MDC as a guide, hip and pelvis parameters in the transverse and frontal planes were least responsive for GMFCS levels I and III (MDC ranges, 8.3 degrees -18.0 degrees and 2.7 degrees -23.4 degrees , respectively), whereas ankle kinematics were the least responsive for level II (MDC range, 8.2 degrees -11.9 degrees ). Reliability was dependent on mobility level, with children in GMFCS level III exhibiting greater test-retest variability overall. CONCLUSIONS: Our findings suggest that select discrete gait parameters measured using computerized gait analysis are reliable and potentially responsive measures of performance and can be used as outcome measures in intervention studies.

Development of a challenge assessment tool for high-functioning children with an acquired brain injury.

PURPOSE: To develop a performance-based challenge assessment to evaluate gross motor abilities of high-functioning youth with an acquired brain injury (ABI). METHODS: Potential items were identified from the literature. A panel of 4 expert physical therapists selected items on the basis of 3 criteria: safety to test, feasibility to administer, and importance to perform. Item reduction was completed using ratings from a physical therapist web survey. The Acquired Brain Injury-Challenge Assessment (ABI-CA) was created and pilot tested with youth with an ABI. RESULTS: Seventy-eight items were identified and reduced to 47 items following expert panel discussion. Web-survey item reduction by 75 pediatric physical therapists yielded a 24-item ABI-CA that was administered to 6 youth with an ABI, aged 8 to 17 years. The ABI-CA mean score was 50.7/81.0 (SD = 17.4). CONCLUSION: The ABI-CA was feasible to administer and demonstrated gross motor activity challenges beyond the Gross Motor Function Measure. Response option refinement and measure validation are required prior to clinical/research use.

Protocol for a multi-centre, definitive randomised controlled trial of the effectiveness of Individual Placement and Support for employment support among people with alcohol and drug dependence.

BACKGROUND: Unemployment is highly prevalent in populations with alcohol and drug dependence and the employment support offered in addiction-treatment programmes is ineffective. Individual Placement and Support (IPS) is an evidence-based intervention for competitive employment. IPS has been extensively studied in severe mental illness and physical disabilities, but there have been no formal randomised controlled trials (RCTs) in alcohol and drug dependence. The Individual Placement and Support for Alcohol and Drug Dependence (IPS-AD) study should determine whether IPS for patients with alcohol use disorder (AUD), opioid use disorder (OUD) and other drug use disorder is effective. DESIGN/METHODS: The IPS-AD study is a seven-site, pragmatic, two-arm, parallel-group, superiority RCT. IPS-AD includes a realist process evaluation. Eligible patients (adult, unemployed or economically inactive for at least 6 months and wishing to obtain open job market employment and enrolled in ongoing community treatment-as-usual (TAU; the control condition) in England for AUD, OUD and other drug use disorders) will be randomised (1:1) to receive TAU and any standard employment support, or TAU plus IPS (the experimental condition) for 9 months with up to 4 months of in-work support. The primary outcome measure will be competitive employment status (at least 1 day (7 h)) during an 18-month follow-up, determined by patient-level, trial-data-linkage with national tax and state benefit databases. From meta-analysis, an 18% target difference on this measure of vocational effectiveness (for the experimental intervention) and a two-sided 5% level of statistical significance, will require a minimum target sample of 832 participants to achieve 90% power for a pre-registered, mixed-effects, multi-variable logistic regression model. A maximum-likelihood multiple-imputation approach will manage missing outcome data. IPS-AD has six vocational secondary outcome measures during the 18-month follow-up: (1) total time in competitive employment (and corresponding National Insurance contributions and tax paid); (2) time from randomisation to first competitive employment; (3) number of competitive job appointments; (4) job tenure (length of longest held competitive employment); (5) sustained employment (tenure in a single appointment for at least 13 weeks); and (6) job search self-efficacy. A primary cost-benefit analysis and a secondary cost-effectiveness analysis will be done using the primary outcome and secondary vocational outcomes, respectively and will include addiction treatment and social and health outcomes and their associated reference costs. The process evaluation will address IPS implementation and delivery. DISCUSSION: The IPS-AD study is the first large-scale, multi-site, definitive, superiority RCT of IPS for people with alcohol and drug dependence. Findings from the study will have substantial implications for service delivery. TRIAL REGISTRATION: ISRCTN Registry, ID: ISRCTN24159790. Registered on 1 February 2018.

The ICF-CY and Goal Attainment Scaling: benefits of their combined use for pediatric practice.

PURPOSE: There is much heterogeneity and disconnect in the approaches used by service providers to conduct needs assessments, set goals and evaluate outcomes for clients receiving pediatric rehabilitation services. The purpose of this article is to describe how the International Classification of Functioning, Disability and Health-Child and Youth (ICF-CY) can be used in combination with Goal Attainment Scaling (GAS), an individualised measure of change, to connect the various phases of the therapeutic process to provide consistent clinical care that is family-centred, collaborative, well directed and accountable. METHOD: A brief description of both the ICF-CY and GAS as they pertain to pediatric rehabilitation is provided as background. An explanation is given of how the ICF-CY offers a framework through which clients, families and service providers can together identify the areas of clients' needs. In addition, the article discusses how the use of GAS facilitates translation of clients' identified needs into distinct, measurable goals set collaboratively by clients, their families and service providers. Examples of integrated GAS goals set for the various components of the ICF-CY are provided. The utility of GAS as a measure of clinical outcomes for individual clients is also discussed. CONCLUSIONS: Used in combination, the ICF-CY and GAS can serve to coordinate, simplify and standardise assessment and outcome evaluation practices for individual clients receiving pediatric rehabilitation services.

The application of motor learning strategies within functionally based interventions for children with neuromotor conditions.

PURPOSE: To identify and describe the application of 3 motor learning strategies (verbal instructions, practice, and verbal feedback) within 4 intervention approaches (cognitive orientation to daily occupational performance, neuromotor task training, family-centered functional therapy, and activity-focused motor interventions). METHODS: A scoping review of the literature was conducted. Two themes characterizing the application of motor learning strategies within the approaches are identified and described. RESULTS: Application of a motor learning strategy can be a defining component of the intervention or a means of enhancing generalization and transfer of learning beyond the intervention. Often, insufficient information limits full understanding of strategy application within the approach. CONCLUSIONS: A greater understanding of the application, and perceived nonapplication, of motor learning strategies within intervention approaches has important clinical and research implications.

Single-session reliability of discrete gait parameters in ambulatory children with cerebral palsy based on GMFCS level.

The single-session reliability of 28 discrete spatiotemporal and kinematic variables was evaluated from computerized gait analysis (CGA) in 33 ambulatory children with cerebral palsy (CP), subcategorized according to Gross Motor Function Classification System (GMFCS) Levels I (n=11), II (n=12) and III (n=10). Nineteen boys and 14 girls participated, mean age=8 years 1 month (S.D.=3 years 0 month). Intraclass correlation coefficients (ICCs) estimated reliability, and the number of strides required to obtain an ICC of at least 0.90 was determined. The reliability of discrete gait parameters was dependent upon GMFCS level, with children in GMFCS Level I exhibiting the highest reliability (ICC range=0.70-0.96). GMFCS Levels II and III had lower levels of reliability with ICC values varying from 0.54 to 0.95 and 0.45 to 0.98, respectively. With the exclusion of pelvis range of motion (ROM), an average of four strides provided a reliability estimate of at least 0.90 for GMFCS Level I, while six strides were needed for children in Levels II and III. On the basis of the intrasession reliability results from the present study, further work is recommended to examine the test-retest reliability of these gait parameters in children with CP.

Individualized outcome measures for evaluating life skill groups for children with disabilities.

BACKGROUND: The challenge of evaluating life skill groups is the need to assess skills reflecting the priorities and abilities of the individuals as well as the program focus. PURPOSE: This study describes the feasibility and utility of goal menus and individualized outcome measures in two life skill groups for children with disabilities. METHODS: Eleven children were evaluated at baseline and 5 weeks post-program using a modified Canadian Occupational Performance Measure (COPM) and modified Goal Attainment Scaling (mod-GAS). FINDINGS: COPM satisfaction median scores across all goals increased post-program by 3.0 points (P=0.001) and performance scores by 1.0 point (P=0.002). Mod-GAS scores for all participants were at least -1 (partial achievement), and 55% of participants achieved their functional goal (Mod-GAS = 0) with carryover into their community environments. IMPLICATIONS: This study supports the positive contribution of individualized measures to evaluate outcomes within life skill programs for children with disabilities.

Focus on Function - a randomized controlled trial comparing two rehabilitation interventions for young children with cerebral palsy.

BACKGROUND: Children with cerebral palsy receive a variety of long-term physical and occupational therapy interventions to facilitate development and to enhance functional independence in movement, self-care, play, school activities and leisure. Considerable human and financial resources are directed at the "intervention" of the problems of cerebral palsy, although the available evidence supporting current interventions is inconclusive. A considerable degree of uncertainty remains about the appropriate therapeutic approaches to manage the habilitation of children with cerebral palsy. The primary objective of this project is to conduct a multi-site randomized clinical trial to evaluate the efficacy of a task/context-focused approach compared to a child-focused remediation approach in improving performance of functional tasks and mobility, increasing participation in everyday activities, and improving quality of life in children 12 months to 5 years of age who have cerebral palsy. METHOD/DESIGN: A multi-centred randomized controlled trial research design will be used. Children will be recruited from a representative sample of children attending publicly-funded regional children's rehabilitation centers serving children with disabilities in Ontario and Alberta in Canada. Target sample size is 220 children with cerebral palsy aged 12 months to 5 years at recruitment date. Therapists are randomly assigned to deliver either a context-focused approach or a child-focused approach. Children follow their therapist into their treatment arm. Outcomes will be evaluated at baseline, after 6 months of treatment and at a 3-month follow-up period. Outcomes represent the components of the International Classification of Functioning, Disability and Health, including body function and structure (range of motion), activities (performance of functional tasks, motor function), participation (involvement in formal and informal activities), and environment (parent perceptions of care, parental empowerment). DISCUSSION: This paper presents the background information, design and protocol for a randomized controlled trial comparing a task/context-focused approach to a child-focused remediation approach in improving functional outcomes for young children with cerebral palsy. TRIAL REGISTRATION: [clinical trial registration #: NCT00469872].

Reliability and validity of the Lower Limb Function Questionnaire when completed by young adult orthotic and prosthetic device users.

Purpose The Lower Limb Function Questionnaire (LLFQ) was developed as a self-report assessment of lower-limb functional ability for orthotic and prosthetic (O&P) device users to be suitable for a wide range of conditions, cultures, and ages. The measure aims to address an existing gap in tools for the assessment of functional ability in this population. The purpose of this study is to evaluate LLFQ reliability and validity in a sample of young adult O&P users. Methods Adolescents from a secondary school in Kenya completed the LLFQ twice, 6 d apart, and test-retest reliability was assessed using intra-class correlation coefficients. Validity evaluations involved Timed Up-and-Go, 6-min walk, 6-min obstacle course, and/or spatiotemporal gait assessments. Oxygen consumption was measured during walk tests. Associations between the LLFQ and each measure were evaluated using Pearson correlation coefficients for construct validity. Results LLFQ reliability was acceptable (ICC = 0.79, 95% CIs 0.64-0.89). Construct validity was demonstrated via moderate correlation (r > 0.60) with obstacle course distance, gait velocity, stride length, and stance/single support/double support percent of gait cycle. Conclusions Both LLFQ reliability and validity were acceptable in the sample of youth in Kenya. Further testing is required to determine applicability in other cultural contexts. Implications for Rehabilitation The LLFQ may be clinically useful across a variety of cultures and conditions to provide feedback on the effectiveness of rehabilitative treatment or assistive devices for youth with lower limb impairments. The LLFQ may enable specific strengths and challenges to lower limb function to be identified to enable planning of well-targeted rehabilitation.

Maternal factors and the emotional and behavioural functioning of adolescents with chronic health conditions.

PURPOSE: This study investigated the association between mothers' mental health and education and the emotional and behavioural functioning of adolescents with chronic health conditions over time. METHODS: Data were drawn from an ongoing study. Study participants (N = 363) were recruited through eight children's rehabilitation centres. Logistic regression models were estimated. RESULTS: There were significantly reduced odds that girls would display clinical signs of hyperactivity/inattention one year later compared to boys when a maternal mental health condition was present (OR = 0.10; p < 0.01). Where low maternal education was present, girls were more likely to display peer relationship problems one year later (OR = 3.72; p < 0.01). For both genders, having a mother with less than a high school education was also associated with conduct problems one year later (OR = 2.89; p < 0.01). CONCLUSIONS: Findings support a link between maternal factors and emotional and behavioural functioning in adolescents with chronic conditions. A holistic and family-centred approach to assessment and service delivery is indicated. Implications for Rehabilitation When conducting clinical assessments, service providers should consider associations between maternal education and mental health and the emotional and behavioural functioning of adolescents with chronic health conditions. A holistic and family-centred approach to assessment and service delivery is indicated to ensure adolescents with chronic conditions and their families receive support for interrelated needs.