Psychometric Evaluation of the Polish Version of the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD).

Purpose: The assessment of the quality of life is an important element of the clinical examination of the patient. The aim of this study was translation and cross-cultural adaptation of the "Caregiver Priorities and Child Health Index of Life with Disabilities" (CPCHILD) questionnaire into Polish language, and testing of reliability and validity of the CPCHILD-PL for children with cerebral palsy (CP). Material and Methods: A Polish version of CPCHILD was created according to internationally accepted guidelines. Parents (n=77) of 51 boys/26 girls between 3 and 17 years with CP with Gross Motor Function Classification System I-V (GMFCS I-V) participated. To assess the reliability each domain and the total measure was tested for internal consistency and test-retest reliability. Convergent validity was evaluated by correlating the CPCHILD-PL with the CHAQ (Childhood Health Assessment Questionnaire) questionnaire. Results: Test-retest reliability assessed by Spearman correlation coefficient for the final result of CPCHILD-PL and for most of domains were above 0.90. The values of Cronbach's-α coefficient (measuring internal consistency) were high for all domains (except for domain 5: Health) and the entire CPCHILD-PL, with the range 0.88-0.96. The comparison between CPCHILD-PL and the Disability Index (DI) of the CHAQ showed a negative correlation. The higher the DI, the lower the CPCHILD result. The Spearman's rank coefficient was -0.75. Conclusion: The Polish version for the CPCHILD for children with CP seems to be reliable and valid tool for assessing health-related quality of life from the caregiver perspective. It can be used in research and clinical practice for evaluation and comparison of health-related quality of life in children with CP in different countries.

Effects of Robot-Assisted Therapy on Gait Parameters in Pediatric Patients With Spastic Cerebral Palsy.

Background: Gait dysfunction is a crucial factor that restricts independence and quality of life in children with cerebral palsy (CP). Gait training based on robotic-assisted therapy (RAT) is widely used, but information about effectiveness and ideal patient profile is not sufficient. Aim of this study was to assess the effect of RAT on gait parameters in spastic children with CP, and to determine whether changes in gait parameters are different among patients on different ambulatory levels. Method: A total of 26 children with bilateral spastic CP were divided into two groups based on their functional ability: non-assisted ambulator (NAS) or assisted ambulator (AS); and underwent a RAT program (30 training sessions of RAT during 10 weeks). Gait analysis was performed: before the therapy (t1), right after (t2), and 6 weeks later (t3). Results: No significant changes in spatiotemporal parameters or gait deviation index at t2 or t3. Double support symmetry significantly improved (t1 vs. t3, p = 0.03) for the whole group (NAS + AS). Walking speed symmetry significantly improved (t2 vs. t3, p = 0.02) for group AS. Conclusion: RAT based on our protocol did not change spatiotemporal parameters and kinematics of walking except limited improvement in some aspects of gait symmetry. We did not find differences in changes in selected objective gait parameters among children with CP in different ambulatory levels.

Baseline Gross Motor Function Affects the Outcome of Robot-Assisted Therapy in Ambulatory Individuals with Spastic Cerebral Palsy.

Robotic-assisted therapy (RAT) is a task-specific approach for treating gait disorders in individuals with neurological impairments. However, the effectiveness of RAT is not clear for different severities of involvement, pathologies, and ages. This study aimed to assess the functional and clinical status outcomes after RAT in individuals with cerebral palsy (CP). Twenty-eight individuals with bilateral spastic CP were enrolled (female = 10; male = 18; age = 15.2 ± 2.0 years). The RAT program consisted of 30 sessions: five sessions weekly for six weeks. Gross Motor Function Measure (GMFM) and clinical physical examinations were evaluated before and after RAT. Our results suggested that the RAT program with the described protocol can improve the general gross motor functions of individuals with CP in Gross Motor Function Classification System (GMFCS) levels I and II, and primarily improves performance on less complex GMFM items for those in GMFCS levels III and IV. The lower baseline functional level was related to a greater functional improvement. Older individuals were noticed to improve more in GMFM dimension D. Regarding impairments evaluated by clinical examinations, no change was found after RAT intervention. It is worth mentioning that the strength of knee muscles was not affected either.