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.

Lower extremity proprioception and its association with activity and participation in children with unilateral spastic cerebral palsy.

OBJECTIVE: This cross-sectional study aimed to assess lower extremity proprioception and investigate its relationship to activity and participation levels in children with unilateral spastic cerebral palsy (USCP). METHODS: A total of 22 children with USCP between the ages of 5 and 16 years participated in this study. Lower extremity proprioception was evaluated with a protocol that consisted of verbal and location identification, unilateral and contralateral limb matching, and static and dynamic balance tests performed with the impaired and less impaired lower extremities under eyes-open and eyes-closed conditions. Furthermore, the Functional Independence Measure (WeeFIM) and Pediatric Outcomes Data Collection Instrument (PODCI) were used to evaluate the independence levels in daily living activities and participation levels. RESULTS: Children demonstrated proprioceptive loss, as evidenced by an increase in matching errors under the eyes-closed condition compared to the eyes-open condition (p<0.05). Also, the impaired extremity had greater proprioceptive loss than the less impaired extremity (p<0.05). The 5-6-year age group experienced greater proprioceptive deficits than did the 7-11 and 12-16 age groups (p<0.05). Children's lower extremity proprioceptive deficit was moderately associated with their activity and participation levels (p<0.05). CONCLUSIONS: Our findings suggest that treatment programs based on comprehensive assessments, including proprioception, may be more effective in these children.

Effects of Telerehabilitation-Based Structured Home Program on Activity, Participation and Goal Achievement in Preschool Children with Cerebral Palsy: A Triple-Blinded Randomized Controlled Trial.

A home program is implemented as an evidence-based mode of delivering services for physiotherapy and rehabilitation. Telerehabilitation is a method applied in physiotherapy modalities for children. This study aims to determine the effectiveness of usual care plus a Telerehabilitation-Based Structured Home Program on preschool children with cerebral palsy (CP) compared to usual care. Forty-three children aged 3-6 years (mean age 4.66 ± 1.08 years) with CP were randomly assigned to the Telerehabilitation-Based Structured Home Program and usual care groups. Their motor function was assessed with the Gross Motor Function Measure (GMFM); performance and satisfaction were evaluated with the Canadian Occupational Performance Measure (COPM); goal achievement was assessed with the Goal Attainment Scale (GAS); and activity and participation were evaluated with Pediatric Evaluation of Disability Inventory (PEDI). Participants were evaluated at baseline, immediately post-intervention (12 weeks) and at follow-up (24 weeks). There was a statistically significant difference between pre- and post-test GMFM, COPM, GAS and PEDI scores in the intervention and control groups (p < 0.001). The Telerehabilitation-Based Structured Home Program showed statistically significant changes in activity, participation and goal achievement after 12 weeks of intervention (p < 0.001). However, significant results were not obtained in the usual care group. The Telerehabilitation-Based Structured Home Program may be an effective method for preschool children with CP. (Registration number: NCT04807790; no = KA-20124/26.01.2021).

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.

How does treadmill training contribute to botulinum toxin application plus routine physical therapy in ambulatory children with spastic bilateral cerebral palsy? A randomized controlled trial.

BACKGROUND: In spite of treadmill training and multilevel botulinum toxin (BoNT-A) injection being the two most commonly used treatment methods in pediatric rehabilitation management, there was no study investigating the effect of treadmill training after BoNT-A injection in children with cerebral palsy (CP). AIM: The aim of this study was to investigate the effect of treadmill training in addition to routine physical therapy after BoNT-A injection in ambulatory children with spastic bilateral CP on lower extremity muscle strength, selective motor control, and mobility. METHODS: A total of 30 spastic bilateral children with CP classified level II-III by the Gross Motor Function Classification System were randomly assigned the study and control groups. Both groups continued routine physical therapy treatments after multilevel BoNT-A injection into lower extremities, while the study group additionally underwent 8 weeks of treadmill training (20 min, two sessions per week). Handheld dynamometer, selective control assessment of lower extremity, temporospatial evaluation of gait, and Pediatric Evaluation of Disability Inventory were assessed before and after 8 weeks. RESULTS: In both groups, hip, knee, and ankle muscle strength increased at the end of 8 weeks (p < 0.05); however, in the study group, hip flexor/extensor muscle strength (p < 0.05, ES ≥ 0.50), selective motor control of ankle (p < 0.01, ES = 1.17), walking speed (p < 0.01, ES = 2.60), step lengths (p < 0.01, ES = 1.32), and mobility (p < 0.01, ES = 1.37) increased significantly compared to those of the control group. CONCLUSIONS: Treadmill training in addition to routine physical therapy after BoNT-A injection is beneficial for hip muscle strength, ankle selective motor control, walking quality, and functional mobility in the short term. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03580174.

Validity and Reliability of the Turkish Version of the KIDSCREEN-27 for Individuals With Cerebral Palsy.

Our aims in this study were to examine the construct/concurrent validity and internal/test-re-test reliabilities of both the self-report and parent-report questionnaires of a Turkish version of the KIDSCREEN-27 for adolescents with cerebral palsy (CP). We used a convenience sample of 135 children and adolescents with CP aged 8-18 years (65 males, 70 females; M age = 12.39, SD = 3.57) and their parents/caregivers (123 mothers, seven fathers, and five grandmothers). We explored structural construct validity via confirmatory factor analysis (CFA). Concurrent validity was examined via Spearman's correlations between the KIDSCREEN-27 questionnaires and the self-report and primary caregiver report forms of the Cerebral Palsy Quality of Life for Children (CP QOL-Child) and adolescents (CP QOL-Teen). We explored test-retest and internal consistency reliabilities utilizing intraclass correlation coefficients (ICC) and Cronbach's alpha (α), respectively. CFA goodness-of fit indices verified that the predefined model of the KIDSCREEN-27 was a good fit for data from the CP population (X2/df<5, GFI >0.90, AGFI >0.90, RMSEA<0.80). Results showed the subdomains of both KIDSCREEN-27 forms to be significantly correlated with the matched subdomains of the CP QOL-Child and CP QOL-Teen questionnaires (ranges of r = 0.62-0.94). Overall, α and ICC coefficients for all subdomains of both KIDSCREEN-27 versions were acceptable (α and ICC >0.70). Both versions of the KIDSCREEN-27 have satisfactory psychometric properties for use in evaluating health-related quality of life (HRQOL) outcomes in children and adolescents with CP.

Dual-task training effect on gait parameters in children with spastic diplegic cerebral palsy: Preliminary results of a self-controlled study.

BACKGROUND: Children with cerebral palsy (CP) may have difficulties under dual-task conditions. Spatiotemporal gait parameters have deteriorated with concurrent tasks in children with CP. However, how dual-task training affects gait parameters in children with spastic diplegic CP has not been clarified. RESEARCH QUESTION: How does dual-task training program effect gait, functional skills, and health-related quality of life in children with spastic diplegic CP? METHODS: Eleven children with spastic diplegic CP (median age 11 y, range 7-16 y; 4 female; 7 male) Gross Motor Function Classification System level 1-2 and obtained 27 and higher scores from Modified Mini Mental Test included in the study. The study was planned as a self-controlled clinical research design. Children were recruited to conventional physiotherapy program for 8 weeks and dual-task training program added to conventional physiotherapy program for following 8 weeks. Children were evaluated at baseline, after conventional physiotherapy program, and after dual-task training program. Children's gait was evaluated with Zebris™ FDM-2 device and Edinburgh Visual Gait Score, functional mobility skills with 1 min Walk Test (1MWT), and health-related quality of life with the Pediatric Quality of Life Inventory (PedsQL) - CP module. RESULTS: The difference in step length, step time, stride time, cadence and gait speed of spatiotemporal parameters of gait during dual-task performance were found statistically significant in children with spastic diplegic CP, after dual-task training program (p < 0,05). After dual-task training, statistically significant gains were found in 1MWT, movement and balance subtitle of PedsQL-CP module Parent Form (p < 0,05). SIGNIFICANCE: Dual-task training program added to a conventional physiotherapy program provides more gains in terms of functionality of children with spastic diplegic CP will contribute to the improvement of the motor functional level.

Comparing the effects of modified constraint-induced movement therapy and bimanual training in children with hemiplegic cerebral palsy mainstreamed in regular school: A randomized controlled study.

PURPOSE: The aim of this study was to compare the effects of modified constraint-induced movement therapy (mCIMT) and bimanual training (BIT) based on the International Classification of Functioning, Disability, and Health, Children and Youth (ICF-CY) conceptual framework. RESEARCH METHOD: A total of 32 children (mean age 10.43 years [SD 2.9 years]; 15 girls, 17 boys) whose functional motor and communication levels, according to the Manual Ability Classification System, Gross Motor Function Classification System, and Communication Function Classification System, changed between level I and III were randomly distributed to one of the mCIMT or BIT groups with equivalent dosing frequencies and intensities (10 weeks, 3 days/week, 2.5 h/day). Upper extremity body function outcomes (handheld dynamometer), activity outcomes (Quality of Upper Extremity Skills Test, The Children's Hand-use Experience Questionnaire, ABILHAND-Kids, Pediatric Upper Extremity Motor Activity Log), and participation outcomes (Child and Adolescent Scale of Participation) were assessed before and after treatment, and at 16 weeks postintervention. The clinical trial number of the study is NCT04577391. RESULTS: mCIMT resulted in more significant improvements in all outcomes than BIT at the immediate postintervention period (T2), which were maintained in the mCIMT group throughout the 16-week postintervention period (p<0.001; dmCIMT > dBIT). CONCLUSION: The potential advantage of mCIMT versus BIT is the larger short-term effect sizes (ESs) and the more sustainable improvements.

Validity and reliability of the Turkish version of the pediatric motor activity log-revised (PMAL-R) for 2-17 year old children with hemiparetic cerebral palsy.

PURPOSE: The Pediatric Upper-extremity Motor Activity Log-Revised (PMAL-R) is a structured interview that measures use of the more-affected arm in daily life in children with cerebral palsy (CP). This study investigated the concurrent validity and test-retest reliability of a Turkish version of the PMAL-R. MATERIALS AND METHODS: The PMAL-R was translated and cross-culturally adapted to Turkish and administered to parents of eighty children with hemiplegic CP between 2-17 years. Its concurrent validity was examined by correlating scores on the PMAL-R How Well and How Often scales with ABILHAND-Kids scores. Fifty parents were re-interviewed after three weeks to establish test-retest reliability. RESULTS: PMAL-R scores were strongly correlated with ABILHAND-Kids scores (How Well scale, r = 0.78, p < 0.001; How Often scale, r = 0.59, p < 0.001). PMAL-R test-retest reliability (Intraclass correlation; How Often = 0.98, How Well = 0.99) and internal consistency (Cronbach's α; How Often = 0.96, How Well = 0.97) were high. CONCLUSIONS: This translation of the PMAL-R has good reliability and validity for measuring everyday use of the more-affected arm in Turkish children with hemiparesis due to CP between 2-17 years. Implications for rehabilitationAn instrument that evaluates real-world arm use in Turkish children with CP.Reliability and concurrent validity of the Turkish PMAL-R is established in 2-17-year old with upper-extremity hemiparesis.Systematic replication of the clinimetric properties of the English PMAL-R is demonstrated in a wider age range than previously, 2-17 years vs. 2-8 years.Reliability and concurrent validity of the PMAL-R is shown in both children with right and left hemiparesis.

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.

Is there any difference between high-risk infants with different birth weight and gestational age in neurodevelopmental characters?

AIM: This study is aimed to investigate differences between cognitive, language and motor development of high-risk infants related to birth weight and gestational age. MATERIAL AND METHODS: One hundred sixty high-risk infants who were born 32 weeks, 1 500 gr and below included in this study. According to corrected age, 58 infants were 1 month, 72 were at 4 months, 82 were at 8 months and 65 were 12 months old. Infants were seperated two groups according to gestational age <30 weeks and 30-32 weeks and birth weight ≤1 000 gr and 1 001-1 500 gr. Infants motor development were assessed with Bayley-III Infant and Toddler Development Motor Scale (Bayley-III) and Neuro Sensory Motor Developmental Scale (NSMDA), cognitif and lanuage development were Bayley-III cognitive and Language scales. Assessments were applied by the same physiotherapist at 1 month, 4 months, 8 months and 12 months old infants in corrected age. Mann-Whitney U Test, 2 x 2 Chi-Square test ve Fisher's exact tests were used to compare group data. Statistical significance was determined p<0.05. RESULTS: Cognitive, motor and language developments were in normal ranges in all infants. There were no statistical differences in cognitive, language and motor development between groups (p>0.05). CONCLUSION: Results of this study showed that the motor, cognitive and language development were normal in all high risk infants and power gestational age and birth weight did not affect these parametes.

The effects of Kinesio Taping on body functions and activity in unilateral spastic cerebral palsy: a single-blind randomized controlled trial.

AIM: The aim of this study was to investigate the effects of Kinesio Taping (KT) on the body functions and activity of children with unilateral spastic cerebral palsy (CP). METHOD: This study was designed as a single-blind, randomized, controlled trial. Thirty children with unilateral spastic CP were randomized and split equally between the KT group (eight males, seven females; mean age 9y [SD 2y 3mo] range 7-12y) and the control group (seven males, eight females; mean age 9y 7mo [SD 3y 4mo] range 7-14y) receiving usual care. All participants were evaluated with the Functional Independence Measure for Children (WeeFIM), the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP), the Gross Motor Function Measure (GMFM), short-term muscle power, agility and functional muscle strength tests. Wilcoxon signed-rank and Mann-Whitney U tests were used to evaluate within and between-group differences respectively. The level of significance was accepted as p<0.05. RESULTS: There were significant differences in muscle power sprint (p=0.003), lateral step-up test right (p=0.016), sit to stand (p=0.018), attain stand through half knee right (p=0.003), BOTMP Gross scores (p=0.019), and WeeFIM total (p=0.003) and self-care scores (p=0.022) between the groups (p<0.05). INTERPRETATION: Kinesio Taping is a promising additional approach to increase proprioceptive feedback and improve physical fitness, gross motor function, and activities of daily living in children with CP.

Intraobserver reliability of modified Ashworth scale and modified Tardieu scale in the assessment of spasticity in children with cerebral palsy.

OBJECTIVE: The aim of this study was to analyze the intraobserver reliability of the Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS) in the assessment of spasticity in children with cerebral palsy (CP). METHODS: Elbow flexor muscles, wrist flexor muscles, hip adductors, hamstrings, gastrocnemius and soleus muscles of 37 children (mean age: 8.97±4.41) with spastic CP were evaluated using the MAS and MTS according to the severity of spasticity. RESULTS: Intraobserver reliability of MAS was significant for all assessments (p<0.01) and reliability ranged from 'low' to 'average'. The reliability of MTS was significant for all assessments (p<0.01) and intraobserver reliability ranged among 'average', 'good' and 'excellent'. CONCLUSION: Although the high intraobserver reliability for MTS to assess spasticity level in muscles of children with CP will improve usage of this scale, new research testing the intraobserver reliability of this scale is needed.

The cross-cultural adaptation, reliability, and validity of the Copenhagen Neck Functional Disability Scale in patients with chronic neck pain: Turkish version study.

STUDY DESIGN: The study design was cross-cultural adaptation and investigation of reliability and validity of the Copenhagen Neck Functional Disability Scale (CNFDS). OBJECTIVE: The aim of this study was to translate the CNFDS into Turkish language and assess its reliability and validity among patients with neck pain in Turkish population. SUMMARY OF BACKGROUND DATA: The CNFDS is a reliable and valid evaluation instrument for disability, but there is no published the Turkish version of the CNFDS. METHODS: One hundred one subjects who had chronic neck pain were included in this study. The CNFDS, Neck Pain and Disability Scale, and visual analogue scale were administered to all subjects. RESULTS: For investigating test-retest reliability, correlation between CNFDS scores, applied at 1-week interval, intraclass correlation coefficient score for test-retest reliability was 0.86 (95% confidence interval = 0.679-0.935). There was no difference between test-retest scores (P < 0.001). For investigating concurrent validity, correlation between total score of the CNFDS and the mean visual analogue scale was r = 0.73 (P < 0.001). Concurrent validity of the CNFDS was very good. For investigating construct validity, correlation between total score of the CNFDS and the Neck Pain and Disability Scale was r = 0.78 (P < 0.001). Construct validity of the CNFDS was also very good. CONCLUSION: Our results suggest that the Turkish version of the CNFDS is a reliable and valid instrument for Turkish people.

Agreement between parents and clinicians for the motor functional classification systems of children with cerebral palsy.

PURPOSE: This study aimed to evaluate whether parental ratings of expanded and revised Gross Motor Function Classification System (GMFCS E&R) and Manual Ability Classification System (MACS) had agreement with clinicians' ratings when classifying children with CP to these two well-known classifications of motor functioning and hereby to evaluate intertester reliability of the classification systems between clinicians and parents. METHOD: The process of study was designed to collect data from parents using the GMFCS E&R and MACS. The total participants consisted of 100 children with CP and their parents. The overall agreement between the parents and physiotherapist GMFCS and MACS scores was analysed using intraclass correlation coefficient (ICC). RESULTS: The ICC value between parents and physiotherapist was 0.96 (95% confidence interval [CI] 0.95-0.97) for GMFCS and 0.96 (95% CI 0.94-0.97) for MACS and indicated excellent agreement. CONCLUSIONS: The excellent agreement between parents and clinicians indicated that parents and clinicians can talk in the same language for the motor functional classification systems of children with CP if careful administrations are provided.

Investigation of interobserver reliability of the Gillette Functional Assessment Questionnaire in children with spastic diparetic cerebral palsy.

OBJECTIVES: Information obtained from families is of particular importance in the evaluation of functional mobility skills of children with cerebral palsy (CP) after orthopedic interventions and long-term rehabilitation applications. This study was designed to evaluate the interobserver reliability of the Gillette Functional Assessment Questionnaire (FAQ) which was administered to the mothers and the physiotherapist for children with CP. METHODS: The study included 52 spastic diparetic children with CP (22 girls, 30 boys; mean age 7.8+/-4.4 years; range 4 to 12 years) and their mothers. According to the Gross Motor Function Classification System (GMFCS), all the children were in level 1 to 3. The Gillette FAQ was administered to the mother and physiotherapist to determine the functional walking level of the child and the interobserver reliability of the FAQ was calculated. In addition, gross motor performance was evaluated by the standing and walking-running-jumping dimensions of the Gross Motor Performance Measure (GMPM), and functional independence level was evaluated by the transfer and locomotion dimensions of the Functional Independence Measure for Children (WeeFIM). Correlations were sought between the FAQ results of the physiotherapist and mothers and the GMFCS, GMPM, and WeeFIM. RESULTS: The intraclass correlation coefficient for interobserver reliability of the Gillette FAQ was 0.94 (95% CI 0.898-0.966). A highly significant correlation was found between the responses of the mother and physiotherapist to the Gillette FAQ (r=0.882, p<0.01). The responses of the mother and physiotherapist to the Gillette FAQ showed a negative correlation with the GMFCS level, and positive correlations with the dimensions of the GMPM and WeeFIM studied (p<0.01). CONCLUSION: The Gillette FAQ can be used by the physiotherapists to determine the functional changes in spastic diparetic children with CP and can help clinicians derive important information from the families about functional walking of their children.

The importance of motor functional levels from the activity limitation perspective of ICF in children with cerebral palsy.

Our purpose in this study was to evaluate performance and capacity as defined by Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) from the 'activity limitation' perspective of International Classification of Functioning,Disability, and Health (ICF) and to investigate the relationship between the two classification systems in different subtypes of cerebral palsy (CP). This prospective cross-sectional study was performed on 448 children with CP ranging from 4 to 15 years of age. Activity limitations were studied with the GMFCS for gross motor function and MACS for manual ability. The Spearman's correlation coefficient, contingency coefficient, and Cramer's V coefficient were used to assess the strength and significance of the association betweenGMFCS and MACS. The overall agreement between GMFCS and MACS was found to be 41%. The agreement was 42% in spastic children, 40% in dyskinetic children, 50% in ataxic children, and 28% in mixed type children. The overall j value was j=0.235 (P<0.001). The κ coefficient was 0.252 in spastic children, 0.245 in dyskinetic children, 0.318 in ataxic children, and 0.023 in mixed type children. All the κ coefficients except the value for the mixed type were found to be significant. The usage of two different classification systems, GMFCS and MACS, to describe the capacity and performance in children with CP as defined by the ICF provides an easy and quick classification tool for indicating 'activity limitations' of ICF in children with CP. The next step in research should be to highlight the other domains such as participation restrictions in these children.

The results of early physiotherapy on a child with incontinentia pigmenti with encephalocele.

This study aimed to exhibit the effects of early physiotherapy and discusses post-treatment results on a patient with incontinentia pigmenti (IP) with encephalocele. Physiotherapy evaluations of the child included cognitive, fine and gross motor development assessed with the Bayley Scales of Infant and Toddler Development - Third Edition (Bayley-III), disability level with the gross motor function classification system, gross motor function with the gross motor function measurement (GMFM), and tonus evaluation with the Modified Ashworth Scale. The child was included in a physiotherapy and rehabilitation programme based on neurodevelopmental treatment three times a week. Although cognitive and motor development according to Bayley-III improved in the present case, motor and cognitive retardation became more apparent with growth. GMFM results indicated a large improvement from 5.88% to 47.73%. Presentation of this case shows the significance of early physiotherapy in this first study on physiotherapy for IP during the early rehabilitation process.