Reliability and Validity of the Turkish Version of the Gross Motor Function Measurement (GMFM-88&66) in Children with Cerebral Palsy.

BACKGROUND: The gross motor function measurement is considered as the gold standard for the motor assessment of children with cerebral palsy. The aim was to carry out the cross-cultural adaptation and investigate psychometric properties. METHODS: A total of 150 children with cerebral palsy aged 2-16 (mean 8.82 ± 3.78 years; 54.7% male) included. The Gross Motor Function Measurement was adapted into Turkish. Two physiotherapies independently administered the gross motor function measurement. Internal consistency and intra/inter-rater reliability were assessed using Cronbach's alpha, intraclass-correlation-coefficient. Standard-error-of-measurement, minimal-detectible-change calculated. The Bland-Altman method was applied to estimate the measurement bias in reliability analysis. Construct validity assessed with Spearman's correlation coefficient between the gross motor function measurement and the gross motor function classification system, pediatric-evaluation-of-disability-inventory-mobility; confirmatory-factor-analysis was carried. RESULTS: Internal-consistency (α: 0.997-1.00); reliability indices were excellent for total scale (intraclass-correlation-coefficient for intra-rater reliability 0.994-0.999, inter-rater reliability 0.997-0.999) and for each sub-dimension and total score. Standard-error-of-measurement was ranging 1.044-1.677, minimal-detectible-change was 2.435-5.520. Construct validity was supported by strong to excellent negative significant correlations (p < 0.05).

Young Children's Participation and Environment Measure (YC-PEM): Cross-Cultural Adaptation, Reliability, and Validity of Turkish Version.

We investigated the psychometric properties of a Turkish version of the Young Children's Participation and Environment Measure (YC-PEM-T). Our participants were 367 children (212 children with disabilities and 155 children without disabilities; M age = 40.76 months, SD = 20.33; range 0-71 months) and their parents, who were selected by a convenience sampling method. We translated and cross-culturally adapted the original YC-PEM from English to Turkish (YC-PEM-T). We found the internal consistency and test-retest reliability of the YC-PEM-T to be good with a Croanbach's alpha ranging from .68 to .94, and intraclass correlation coefficients ranging from .69 to .89 after the YC-PEM-T was administered twice to 100 parents within a three week period. In a two-way analysis of variance (ANOVA) we compared YC-PEM-T scores between children with and without the presence of a disability and found significant differences (p < .05). While we found significant differences between three different age groups, they did not follow consistently. To evaluate discriminant validity, we followed up these ANOVAs with post-hoc analyses when results were statistically significant. Regarding concurrent validity, there were strong to very strong relationships between scores on the participation part of the YC-PEM-T and both the Pediatric Evaluation of Disability Inventory (PEDI; .701 < r < .854, p < .001), and the European Child Environment Questionnaire (ECEQ; - .632 < r < - .690, p < .001). We concluded that the YC-PEM-T is a valid, reliable, and culturally adapted tool for evaluating daily life participation and adaptation to environmental factors in young Turkish children. We can recommend the YC-PEM-T for use in clinical settings and for epidemiological research to assess young children's participation in activities in the home, preschool and community. We also recommend that future investigators examine other psychometric properties of this scale, including its interpretation and capacity to differentiate varied diagnostic and disability groups.

The effects of myofascial release in combined with task-oriented circuit training on balance in people with Parkinson's disease: a randomized pilot trial.

OBJECTIVES: Task-oriented circuit training (TOCT) has been used to improve balance in people with Parkinson's disease (pwPD). To investigate the effectiveness of TOCT on balance, quality of life, and disease symptoms when combined with myofascial release in pwPD. METHODS: Twenty-six pwPD were randomized into two groups for this randomized controlled study. The groups received TOCT three days a week for eight weeks. At the end of each session, the myofascial release was applied to the neck, trunk, and lumbar region with three sets of 60-s foam rolling body weight (Intervention group-IG) and perceived discomfort level 0/10 (Control group-CG) using a numeric rating scale. Primary outcome measures were measured by the Berg Balance Scale (BBS), Parkinson's Disease Questionnaire (PDQ-8), and Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Secondary outcome measures included posturographic assessment, timed-up and go test (TUG), Trunk Impairment Scale (TIS), and rolling time. RESULTS: Data obtained from 26 pwPDs in equal numbers in both groups were analyzed. All groups reported a significant change in MDS-UPDRS, MDS-UPDRS-III, PDQ-8, TIS, and rolling time after treatment compared to pretreatment. Post-hoc analyses showed that IG significantly improved motor symptoms, TUG, and TIS dynamics compared to CG. The mediolateral limits of stability and anterioposterior limits of stability distances of IG increased (p < 0.05). DISCUSSION: Myofascial release, when combined with TOCT, may help to reduce disease-related motor symptoms and improve dynamic balance in pwPD. These findings suggest that myofascial release can be a beneficial addition to TOCT programs for pwPD.Clinical Trial Number: NCT05900934 (ClinicalTrials.gov).

Interrater reliability of face-to-face, tele- and video-based assessments with the modified Mallet classification in brachial plexus birth injuries.

The modified Mallet classification is widely used to measure motor function in brachial plexus birth injuries. The aim of the study was to investigate agreement and reliability of this classification under three different evaluation conditions: face-to-face; live tele-assessment; and delayed video-based assessment. A total of 100 children aged 4-15 years were included. Children were assessed by two raters except for live tele-assessment, which was performed by four raters. Agreement between the three different assessment conditions for the same rater were between strong and excellent for both raters 1 and 2. The interrater reliability for raters 1 and 2 under different assessment conditions was strong to excellent. Interrater reliability among the four raters was moderate to strong in tele-assessment. The modified Mallet classification may have appropriate reliability to be used in remote medical follow-up.Level of evidence: III.

Asymmetric involvement of hands: Psychometric properties of the Turkish version of the Bimanual Fine Motor Function 2.0 classification in children with cerebral palsy.

BACKGROUND: Manual functions affect more than a half of children with Cerebral palsy (CP). Asymmetric involvement of hands may also affect unilateral and bilateral activities of daily life. The Bimanual Fine Motor Function version 2.0 (BFMF-2.0) is a unique functional classification that categorizes the capacity of each hand (what the child can do) during bimanual functions. PURPOSE: The aim of this study was to investigate the validity and reliability of the Turkish version of the BFMF-2.0 in children with CP. STUDY DESIGN: Clinical measurement and cross-sectional study. METHODS: The study included 91 children with CP (56 girls, mean age; 7.41 ± 4.23 years [4-18 years]) and their parents. The Manual Ability Classification System (MACS), the Quality of Upper Extremity Skills Test (QUEST), and the Box and Block Test (BBT) were used for construct and concurrent validity. Experienced/inexperienced therapists and parents classified fine motor capacities of the children via live or video-based observation to assess inter-rater reliability. Three weeks later, the children were reclassified for intra-rater reliability. RESULTS: The Turkish version of the BFMF-2.0 classification was strongly correlated with the MACS (rho = -0.88, p < 0.001), the QUEST (rho = 0.80, p < 0.001), and the BBT (rho = -0.77, p < 0.001). The inter-rater reliability scores were weak to excellent between the parents and the therapists (via live observation, κw = 0.57) and also between experienced/inexperienced therapists (via live or video-based observation, κw = 0.66-0.79). Intra-rater reliability scores were good to excellent (Intraclass Correlation Coefficient [ICC] = 0.87-0.95). CONCLUSIONS: The Turkish version of the BFMF-2.0 classification is valid and reliable and could be applied by experienced and inexperienced therapists via live or video-based observation and by parents via live observation.

Evaluation of daily and social participation of children with Cerebral Palsy across different age groups with a focus on the 'F'-words: Function, family, fitness, fun, friends and future.

BACKGROUND: The impact of disability differs across cultures. This study aimed to determine the predictors of participation in children with cerebral palsy (CP) in Turkey, based on the six F-words. METHODS: Cross-sectional study exploring participation profiles of 450 children with CP, aged between 2 and 18 years. Pediatric Evaluation of Disability Inventory (PEDI) evaluated functional skills, and Assessment of Life Habits (LIFE-H) version 3.0 assessed daily and social participation. Hierarchical linear regression models were done to determine the predictors of participation in daily activities (PDA) and social roles (PSR) in three age groups (2-4, 5-13 and 14-18 years) based on the 6 F-words (mobility of PEDI for 'fitness'; four classification systems and self-care of PEDI for 'functioning'; social functions of PEDI for 'friends'; demographic information by parents for 'family'; the recreation of LIFE-H for 'fun'; and different stages of development for 'future'). RESULTS: The most important predictors for total PDA by age group were: self-care (p = 0.012) of PEDI in 2-4 y; self-care (p = 0.001) and mobility (p = 0.005) of PEDI in 5-13 y; GMFCS (p = 0.006) and mobility (p = 0.002) of PEDI in 14-18 y. Significant predictors for PSR differed by age group: self-care (p = 0.001) of PEDI in 2-4 y; self-care (p = 0.023) and mobility (p = 0.006) of PEDI in 5-13 y; and GMFCS (p = 0.004) and MACS (p = 0.003) in 14-18 y. CONCLUSIONS: Six F-words of function and fitness focussed on self-care in younger children with an increasing emphasis on mobility and ability levels according to age. Therefore, rehabilitation for different aspects of the functional levels is needed to improve participation in life across the six F-words framework; plus take into consideration context, age-differences, family's expectations, life requirements, environmental needs, and cultural differences.

Measure of Processes of Care (MPOC-56 and 20): Turkish adaptation, reliability, and validity study.

BACKGROUND: The purpose of this study was to investigate the validity and reliability of the Turkish versions of the Measure of Processes of Care, MPOC-56 and MPOC-20, in children with disability aged 5-17 years. METHODS: A total of 290 parents of children with disability due to various disorders were evaluated with the MPOC-56 and MPOC-20. Internal consistency was determined with Cronbach`s alpha, and test-retest reliability with the intraclass correlation coefficient (ICC). Confirmatory factor analysis was performed to investigate the factor structure of the Turkish MPOC-56 and -20. RESULTS: Cronbach`s alpha values for the MPOC-56 and MPOC-20 ranged between 0.84-0.97 and 0.87-0.92, respectively. Test-retest ICC values were 0.96-0.99 for MPOC-56 and 0.94-0.98 for MPOC-20. The correlations of the subscale scores of MPOC- 56 and MPOC-20 were shown to be at very good to excellent levels for reliability. Factor structure for MPOC-20 and MPOC-56 were found to be acceptable. CONCLUSIONS: This study has shown that the Turkish versions of MPOC-56 and MPOC-20 are valid, reliable, and applicable for the evaluation of parents` experiences of processes of care for children with disability aged 5-17 years.

Cut-off values of internal rotation in the glenohumeral joint for functional tasks in children with brachial plexus birth injury.

The aim of this study was to determine the cut-off values of the range of internal rotation motion in the isolated glenohumeral joint that is required for functional tasks in children with an upper root injury of the brachial plexus. Internal rotation motion was measured using a universal goniometer in 97 participants. The Mallet Hand to Spine and Mallet Hand to Belly tasks were assessed as functional tasks that require internal rotation of the shoulder. For the Hand to Spine task, 41° passive and 30° active internal rotation were necessary to reach the S1 level. For the Hand to Belly task, 42° passive and 29° active internal rotation were required to place the palm on the belly without wrist flexion. Of our participants, 97% could touch the belly with or without wrist flexion, but 28% could not reach S1 in the Hand to Spine task. The results of this study show the necessary amount of internal rotation of the shoulder that should be considered in treatment strategies.Level of evidence: III.

Postural Control Alterations in Children with Mild Forms of Spastic Cerebral Palsy.

Purpose: To determine the postural control responses' differences between children with mild spastic Cerebral Palsy (CP) and children who are typically developing (TD). Patients and Methods: Children with spastic CP, Level I-II (n=20, mean age=9.42±4.59 years, 50% girls, 50% boys) and children with TD (N=20, mean age=9.65±3.03, 55% girls, 45% boys) were included in the study. All participants were evaluated with Computerized Dynamic Posturography, Sensory Organization Test (SOT). Results: There were differences between children with spastic CP and children with TD in visual and composite balance score of SOT significantly (p<0.05); there were no differences at vestibular and somatosensory scores of SOT. Children with CP had more postural sway than children with TD (p<0.05). Conclusion: There were differences between children with mild CP and TD in terms of postural control responses.

The effects of fatigue, gross motor function, and gender on participation in life situations of school-aged children with cerebral palsy: A parental perspective.

OBJECTIVE: To investigate the effects of fatigue, gross motor function, and gender on participation in life situations of school-aged children with cerebral palsy (CP) from a parental perspective. METHODS: The study included 209 children with CP aged between 5 and 13 years (mean age, 8.06 ± 2.41 years; girls, 45.5%) and their parents. Fatigue, gross motor function, and participation status were evaluated with the Pediatric Quality of Life (PedsQL), Gross Motor Function Classification System (GMFCS), and the Assessment of Life Habits (Life-H) questionnaire, respectively. The effects of fatigue, gross motor function, and gender on participation were investigated with linear regression analysis. RESULTS: According to parental reports, 79.9% of the children had fatigue. Children in all GMFCS levels experienced fatigue. Fatigue and GMFCS levels were dependent variables, and therefore only simple linear regression analyses were performed. Fatigue explained 38-43% of the variances in daily activities, social roles, and total Life-H scores, while gross motor function explained 48-65% of the variances in scores (p < 0.001). Gender had no effect on participation scores (p > 0.05). CONCLUSION: More than two thirds of the school-aged children with CP had fatigue. Fatigue and poor gross motor function had a negative effect on participation in daily activities and social roles.

Relationship among four functional classification systems and parent interpredicted intelligence level in children with different clinical types of cerebral palsy.

OBJECTIVE: To investigate the relationships between four functional classification systems in children with cerebral palsy (CP) and parent-interpredicted intelligence level, and the functional status in clinical types of CP. METHODS: Two hundred and twenty-five children with CP ages between 2 and 18 (mean age 6.5 ± 4.4) years included using the Surveillance of CP in Europe (SCPE) database in Turkey. Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Communication Function Classification System (CFCS) and Eating and Drinking Classification System (EDACS) levels were classified by clinical observation, and intelligence quotient (IQ) was determined by parent reports. RESULTS: Correlations were found between all functional levels; the strongest were between GMFCS-MACS (r = 0.784, p < .001), CFCS-EDACS (r = 0.772, p < .001). Strong correlations were found for the IQ-CFCS (r = 0.762, p < .001) and IQ-EDACS (r = 0.634, p < .001). Correlations were stronger in children with bilateral CP and IQ level <70. CONCLUSIONS: Taken together, these four classification systems and reported IQ levels can adequately describe overall functioning for children with CP. Our results can guide clinicians in the rehabilitation of children with CP.

The functional health status of children with cerebral palsy during the COVID-19 pandemic stay-at-home period: a parental perspective.

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic was effective all over the world. The stay-athome period was proposed to protect against the pandemic. The aim of this study was to investigate the effects of the COVID-19 pandemic stay-at-home period on body structures and functions, activity and participation levels, and environmental factors of children with cerebral palsy (CP) from the parental perspective in Turkey. METHODS: A twenty-question survey, using the International Classification of Functioning, Disability and Health for Children and Youth set to understand the functional changes of children with CP during the stay-athome period, was sent to parents in this prospective study. Motor function levels of children were determined by the Gross Motor Function Classification System parent report. The structural equation model was used for statistical analysis. RESULTS: One hundred and three parents of children with CP participated. At least one of four children with CP had increased levels of anxiety (41.8%), and increased level of a sensation of pain (34%) and sleep problems (25.2%). More than half of the children had increased tonus (67%), decreased range of motion (60.2%), decreased physical activity level (55.3%), and decreased support level of rehabilitation services (82.6%). During the stayat- home period activity and participation levels and environmental factors of children explained the changes of body functions as 70% and 33% (RMSEA=0.077, p < 0.05). CONCLUSIONS: This study is the first study to examine the functional health of children with CP biopsychosocially during the COVID-19 stay-at-home period. According to the parents, the functional health of children with CP was affected at different levels during the COVID-19 pandemic. Body functions may also be affected positively if physical activity level, home program and environmental supports increase.

Gross motor development of preschool children: effects of socioeconomic status and maternal education.

Motor development reflects the general health status of the child and affects other areas of development. It is influenced by biological and family characteristics especially in infancy and early childhood, and by environmental conditions in preschool age. We assessed the effect of several family and environment characteristics on gross motor developmental items included in the Denver-II test on 2,042 healthy children. Increasing maternal age and education were associated with later achievement in several items after age 12 months while socioeconomic status, sex and birth rank did not show a clear effect. Our observations suggest in a relatively homogenous urban population, few external factors affect gross motor development in preschool children.

Inter-intra observer reliability and validity of the Turkish version of Trunk Control Measurement Scale in children with cerebral palsy.

OBJECTIVE: The aim of this study was to demonstrate the inter and intra rater reliability and validity of the Turkish version of the Trunk Control Measurement Scale (TCMS) for children with CP. METHODS: Fifty children (21 girls and 29 boys; mean age 6.6 ± 2.3 years) with spastic, dyskinetic and ataxic types of CP were participated in the study. Children with Level I-II and III according to Gross Motor Function Classification System (GMFCS) were included into the study. All children were evaluated separately by two physiotherapists for interrater reliability and they re-evaluated for intra rater reliability. Gross Motor Function Measurement total score and B part were used for construct validity. RESULTS: The intraclass correlation coefficient (ICC) value of the inter-rater reliability for the Turkish TCMS was 95% CI (0.823-886), and the intra-rater reliability was 95% CI (0.986-0.992). The Spearman rank correlation coefficient between the Turkish TCMS and the Gross Motor Function Measure total score r: 0.827; p < 0.05 Part B was r: 0.863; p < 0.05. CONCLUSION: The results of the study support that the Turkish TCMS has a high inter and intra rater reliability and validity similar to the original version. Thus, the Turkish TCMS appears to be a suitable evaluation tool to assess the qualitative performance of trunk control and sitting balance for children with CP and it gives opportunity to use clinically and research purposes. LEVEL OF EVIDENCE: Level III, Diagnostic Study.