Validación al idioma español de Venezuela de los índices de actividad de enfermedad y el índice funcional para espondilitis anquilosante / Validity of a Venezuelan version of the bath ankylosing spondylitis functional index and bath ankylosing spondylitis disease activity index

Introducción: Las espondiloartritis (EsA) son enfermedades discapacitantes, con una prevalencia del 1,9% en la población general; los índices diseñados para su seguimiento deben ser válidos, confiables y adaptados transculturalmente para decidir el tratamiento y la vigilancia adecuada. El cambiar un adjetivo o un pronombre en un cuestionario autoadministrado puede ser la gran diferencia cuando se quiere investigar el estado actual de la enfermedad. Objetivos: Desarrollar una versión venezolana de la versión original en inglés de BASDAI/BASFI, para evaluar su confiabilidad y validez en pacientes venezolanos con EsA. Métodos: Se necesitaron lingüistas certificados para la traducción de una versión venezolana de BASDAI/BASFI. La evaluación de la confiabilidad y la validez se realizó mediante el cálculo de coeficientes de correlación, además de la correlación α de Cronbach, entre la puntuación de BASDAI y los parámetros clínicos (p. ej., ESR, CRP, índice de prueba de Schöber modificado, distancia occipucio-pared y recuento de entesis). Resultados: Cuarenta pacientes, 31 hombres (77,5%) y 9 mujeres (22,5%), con una edad promedio ± desviación estándar 35,9 ± 12,0 años. Duración de la enfermedad fue de 11,5 ± 9,5 años. El 45% presentaba EsA indiferenciada, el 27,5% espondilitis anquilosante y el 20,0% artritis psoriásica. La artritis reactiva, la espondilitis anquilosante juvenil y la artritis enteropática representaron el 2,5% cada una. La confiabilidad test-retest del BASDAI y del BASFI fueron ambas de 0,99 (p < 0,0001). La consistencia interna para el BASDAI fue de 0,88 (p = 0,002), coeficiente de correlación intraclase para consistencia interna: 0,9867 (p = 0,001). Consistencia interna para el BASFI: α de Cronbach: 0,7985 (p = 0,002), coeficiente de correlación intraclase para consistencia interna: 0,9055 (p = 0,001). La validez de constructo del BASDAI fue de 0,84 para estado de bienestar general del paciente y 0,84 para el recuento de entesis (p < 0,0001). Conclusión: La versión venezolana del BASDAI/BASFI podría utilizarse en la investigación clínica para evaluar el curso de la actividad de la enfermedad en pacientes venezolanos con EsA

Introduction: Spondyloarthropathies (SpA) are disabling diseases with a prevalence of 1.9% in the general population. The indices designed for monitoring the disease should be valid, reliable and cross-culturally adapted for decision-making concerning the appropriate treatment. Changing an adjective or pronoun in a self-administered questionnaire could be the big difference in condensing an idea in a few words and transmitting that concept to all those who share the same language. Objectives: To develop a Venezuelan version of the original English version of the BASDAI/BASFI and to evaluate its reliability and validity in Venezuelan patients with SpA. Methods: Certified linguists were needed for the translation of a Venezuelan version of the BASDAI/BASFI. The evaluation of reliability and validity was performed by calculating correlation coefficients in addition to Cronbach's alpha correlation between the BASDAI score and the clinical parameters (for example: erythrocyte sedimentation rate, C-reactive protein, modified Schöber test, occiput-to-wall distance and enthesis count). Results: We studied 40 patients including 31 men (77.5%) and 9 women (22.5%). The mean age was 35.9 years ± standard deviation (SD) 12.01 and the disease duration was 11.5 years (± SD 9.5). The most common diagnoses were undifferentiated spondyloarthritis (45%), ankylosing spondylitis (27.5%) and psoriatic arthritis (20%). The incidences of reactive arthritis, ankylosing spondylitis and juvenile Reiter's syndrome were 2.5% each. The test-retest reliability of the BASDAI and BASFI was high (R = 0.99 and 0.99, respectively; P<.0001). The internal consistency for the BASDAI was high (Cronbach's alpha = 0.88; P=.002) and the intraclass correlation coefficient for internal consistency: 0.9867 (P=.001). Internal consistency for the BASFI: Cronbach's alpha = 0.7985 (P=.002), intraclass correlation coefficient for internal consistency: 0.9055 (P=.001). Construct validity of the BASDAI was high for general well-being of the patient (R = 0.84) and for enthesis count (R = 0.84). Low back pain showed moderate correlation with BASDAI (R = 0.69; P<.0001) and the erythrocyte sedimentation rate showed a low correlation (R = 0.39683; P=.0112). Conclusion: The Venezuelan version of the BASDAI/BASFI could be used in clinical research to assess and evaluate the course of disease activity in Venezuelan SpA patients

Is the motor skills checklist appropriate for assessing children in Japan?

PURPOSE: Motor skill screening tools are essential for the early detection of developmental coordination disorder (DCD). The present study aimed to examine any cultural and rater effects on these tools. This then enabled us to judge the validity of the original cut-off values for identifying diagnosable children. METHODS: A community sample survey was performed in Japan; 3852 children aged 6-9 years were recruited. Both parents and teachers evaluated the motor skills of their children using the Movement Assessment Battery for Children - Second Edition Checklist. The psychometric properties were evaluated and the scoring characteristics examined based on the type of rater and country of origin, as compared to data originally sampled in the UK. RESULTS: High reliability and validity of the Japanese samples were confirmed. The Japanese adults evaluated their children's motor skills more rigorously than the Europeans. Additionally, there was a large disagreement between parent and teacher rating scores; the degree of agreement varied depending on the severity of motor deficits in the child. CONCLUSION: The first findings from a Japanese sample suggest that the assessment of motor skills in children is significantly affected by culture and rater. These cultural characteristics and rater biases strongly suggest that new cut-off values, reflecting country and rater type, be introduced for identifying children at risk of DCD.

Instrumented finger-to-nose test classification in children with ataxia or developmental coordination disorder and controls.

BACKGROUND: During childhood, many conditions may impact coordination. Examples are physiological age-related development and pathological conditions, such as early onset ataxia and developmental coordination disorder. These conditions are generally diagnosed by clinical specialists. However, in absence of a gold phenotypic standard, objective reproducibility among specialists appears limited. METHODS: We investigated whether quantitative analysis of an upper limb coordination task (the finger-to-nose test) could discriminate between physiological and pathological conditions impacting coordination. We used inertial measurement units to estimate movement trajectories of the participants while they executed the finger-to-nose test. We employed random forests to classify each participant in one category. FINDINGS: On average, 87.4% of controls, 74.4% of early onset ataxia and 24.8% of developmental coordination disorder patients were correctly classified. The relatively good classification of early onset ataxia patients and controls contrasts with the poor classification of developmental coordination disorder patients. INTERPRETATION: In absence of a gold phenotypic standard for developmental coordination disorder recognition, it remains elusive whether the finger-to-nose test in these patients represents a sufficiently accurate entity to reflect symptoms distinctive of this disorder. Based on the relatively good results in early onset ataxia patients and controls, we conclude that quantitative analysis of the finger-to-nose test can provide a reliable support tool during the assessment of phenotypic early onset ataxia.

Subtyping children with developmental coordination disorder based on physical fitness outcomes.

PURPOSE: Children with Developmental Coordination Disorder (DCD) are known to have poor physical fitness. However, differentiating homogenous subgroups of DCD using fitness performance has not yet been established. Therefore the purpose of this study was to identify subtypes in children with and without DCD using measures of physical fitness. METHOD: Children (aged 6-10 years, n = 217) constituted the sample for this study. They were assessed on 1) aerobic fitness (20m Shuttle Run test), 2) anaerobic fitness (Muscle Power Sprint Test), 3) isometric muscle strength (handheld dynamometry) 4) functional upper and lower body strength (Functional Strength Measurement) and 5) motor coordination [Movement Assessment Battery for Children-2nd edition (MABC-2) test]. The Ward method was used to identify the various clusters. RESULTS: Five subtypes emerged in the entire sample. In the typically developing (TD) children mainly 2 subtypes (number 5 and 2) were found containing 89% of the TD children (n = 55), with the largest group demonstrating above average performance on all measures (cluster 5). Children in subtype 2 had just above average motor coordination and good aerobic fitness but lower muscle strength. Subtypes 1, 3 and 4 were clearly "DCD" clusters, however they showed difference in fitness performance. Subtype 1 contained children with DCD who showed poor performance on all fitness outcomes (n = 45). Children with DCD in subtype 3 had poor aerobic but average strength and anaerobic fitness (n = 48). Subtype 4 contained children with DCD (n = 45) who had good muscle strength and anaerobic fitness. Of these, 36% were at risk of DCD while 24% had definite motor coordination problems. CONCLUSION: Our findings indicate that children with and without DCD demonstrate heterogeneous physical fitness profiles. The majority of the children (66%) with DCD belonged to subtypes with lower fitness performance. Further studies are needed to confirm these findings in other samples of DCD children.

Clinical characteristics and functional status of children with different subtypes of dyskinetic cerebral palsy.

Dyskinetic cerebral palsy (CP) is the second major subtype of CP. Dyskinetic CP can be classified into different subtypes, but the exact clinical characteristics of these subtypes have been poorly studied. To investigate the clinical characteristics and functional classification of dyskinetic CP from the perspective of neurologic subtypes in a hospital-based follow-up study.This was an observational study of consecutive children with dyskinetic CP treated at The Affiliated Women & Children Hospital of Qingdao University (China) from October 2005 to February 2015. The children were stratified according to their neurologic subtype and assessed with the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS). MRI scanning was conducted at 1 year of age for most children.Twenty-six participants (28.0%) had dystonic CP, 26 (28.0%) had choreoathetotic CP, and 41 (44.1%) had mixed CP. Auditory impairment and basal ganglion lesions occurred more frequently in the dystonia group (n = 8, 31%; and n = 16, 67%), while seizures, microcephaly, white matter lesions, and mixed lesions were more frequent in the mixed type (n = 14, 34%; n = 10, 24%; n = 15, 41%; n = 12, 32%). Functional classification levels were distributed unequally among the 3 subgroups (P < .01). No significant difference between GMFCS and MACS was found among the 3 subgroups (P > .05).Different subtypes of dyskinetic CP have specific comorbidities, radiological characteristics, and functional attributes according to their etiological factors and brain lesions. Children with dystonic CP have more limited functional status than children with choreoathetotic CP.

The Spanish version of the Alberta Infant Motor Scale: Validity and reliability analysis.

OBJECTIVES: Validity and reliability of the cross-cultural adaptive translation of the Alberta Infant Motor Scale (AIMS), to monitor gross motor development in infants from 0 to 18 months of age, were evaluated. METHODS: A cross-cultural translation was used to generate a Spanish version of the AIMS. Fifty infants at risk or with diagnosis of motor delay, 0-18 months of age, participated in this study. Two independent physical therapists scored infants on the AIMS. Concurrent validity was tested using the AIMS and the Bayley Scales of Infant and Toddler Development - III (Bayley - III). RESULTS: Reliability and the internal consistency were high (ICCs ranged from 0.94 to 1.00 and KR-20 ranged from 0.90 to 0.98, respectively). AIMS and Bayley - III scores correlated strongly (r = 0.97). CONCLUSION: The Spanish version of the AIMS presented excellent validity and reliability. Further studies are suggested in order to assess the AIMS in preterm babies.

Perspectives on classification of selected childhood neurodisabilities based on a review of literature.

PURPOSE: Classifying children with heterogeneous health conditions is challenging. The purposes of this perspective are to explore the prevailing classifications in children with the three selected neurodisabilities using the underlying framework of ICF/ICF-CY, explore the utility of the identified classifications, and make recommendations aimed at improving classifications. METHODS: A literature search on six databases and Google was conducted. Articles published between the years 2000 and 2013 were included if they provided information on classification of cerebral palsy (CP), and/or developmental coordination disorder (DCD) and/or autism spectrum disorders (ASD). RESULTS: Children with DCD and ASD are classified using combinations of multiple measures. The classifications in CP meet more of the proposed criteria for utility than those in DCD and ASD. CONCLUSION: None of the existing classifications addressed all the criteria. The heterogeneity associated with the selected neurodisabilities poses major challenges. Further work is required to establish improved classifications.

Cognitive process-based subtypes of developmental coordination disorder (DCD).

The purpose of the study was to identify the cognitive subtypes demonstrated by children with developmental coordination disorder (DCD) using the Planning-Attention-Simultaneous-Successive Processing (PASS) theory and the Cognitive Assessment System (D-N CAS). Participants were 108 children aged 5- and 6-years old, 54 with DCD and 54 without DCD, all attending typical kindergartens. They were examined on 31 cognitive-motor variables. Hierarchical-agglomerative and iterative partitioning cluster analyses including 9 motor and 7 cognitive variables revealed the following six subtypes: o C1 = children at risk (having considerable difficulty with jumping and minor difficulty with manual dexterity and simultaneous coding); o C2 = children on the mean (all cognitive-motor scores close to the mean); o C3 = free from cognitive-motor problems (all scores above average); o C4 = manual dexterity, planning and simultaneous coding difficulties; o C5 = manual dexterity, dynamic balance, and planning difficulties; o C6 = generalized cognitive-motor dysfunction (all scores considerably below average). It is well known that DCD is a heterogeneous condition. However, whenever cognitive processes were lower than average, cognitive-motor relationship was evident in subgroups C1, C4, C5 and C6. Early identification of task-specific cognitive-motor difficulties may be essential for early educational intervention practices in order to anticipate and improve learning, academic and performing difficulties.

Study of clinical characteristics in young subjects with Developmental coordination disorder.

BACKGROUND: Developmental Coordination Disorder (DCD) is a chronic neurological disorder observed in children. DCD is characterized by slowness in activities and motor impairment that affects the children's daily living and academic achievements, and later their professional and social behavior. Our aim in this work was to report characteristics frequencies in a group of children with DCD and to propose a subtyping of DCD characteristics. METHODS: Thirty three clinical DCD characteristics, the mostly reported in the literature, were assessed in 129 patients, boys and girls aged from 4years to 18years, and their subtyping was proposed. The statistical analyses were carried out with the Chi square, the t-test and the correlation for the statistical differences, and with the Ward clustering method for subtyping. RESULTS: We found that there were 3.17 boys for one girl, all patients were characterized as slow, 47% were left-handers or ambidextrous, 36% and 26% had orofacial and verbal dyspraxia, respectively, 83% were found anxious, and 84% were described as being clumsy. CONCLUSIONS: It appears from these results that a child with DCD expresses more than a single difficulty. Three subtypes emerged from the statistical analysis in this study: (1) clumsiness and other characteristics except language difficulties; (2) self-esteem and peer relation without clumsiness and language difficulties; (3) language difficulties and orofacial dyspraxia.

Non motor subtypes and Parkinson's disease.

Non motor symptoms (NMS) represent a significant burden in Parkinson's disease (PD) with numerous studies highlighting the importance of NMS both in "pre-motor" phase of PD as well as throughout the course of disease. In part this has led the international Parkinson and Movement Disorder Society (IPMDS) task force to attempt a re-definition of PD incorporating NMS and not base the diagnosis solely on motor symptoms. While motor subtypes within PD have been recognized and researched, recent clinical and neurobiological research suggests the existence of discrete non motor subtypes in PD, particularly in untreated (drug naïve) and early PD patients. Several independent observers have reported specific "clusters of NMS dominant PD" using a data driven approach in early and untreated PD patients while others have reported on the burden of NMS in untreated PD and specific NMS dominant phenotypes in untreated or treated PD using observational case series based data. In this review we report on specific NMS dominant phenotypes of PD as described in the literature using clinical observational studies and address pathophysiological concepts. A proposal for several NMS subtypes are reported combining clinical reports with, where possible, evidence base supporting probable biomarkers.

Teorías y modelos de control y aprendizaje motor. Aplicaciones clínicas en neurorrehabilitación / Theories and control models and motor learning: clinical applications in neuro-rehabilitation

Introducción: En las últimas décadas ha existido un especial interés por las teorías que podrían xplicar el gobierno del control motor y sus aplicaciones. Estas teorías suelen basarse en modelos de función cerebral, reflejando criterios filosóficamente diferentes sobre la forma en la que el movimiento es controlado por el cerebro, enfatizando cada una de ellas en los distintos componentes neurales del movimiento. Asimismo, en el contexto de las neurociencias, toma relevancia el concepto de aprendizaje motor, considerado como el conjunto de procesos internos asociados a la práctica, y la experiencia, que producen cambios relativamente permanentes en la capacidad de producir actividades motoras, a través de una habilidad específica. Por lo que ambos, control y aprendizaje motor, se posicionan como campos de estudio fundamentales para los profesionales sanitarios en el campo de la neurorrehabilitación. Desarrollo: Se describen las principales teorías de control motor como la teoría de la programación motora, la teoría de sistemas, la teoría de la acción dinámica o la teoría del procesamiento de distribución en paralelo, así como los factores que influyen en el aprendizaje motor y sus aplicaciones en neurorrehabilitación. Conclusiones: En la actualidad no existe un consenso sobre qué teoría o modelo es definitorio en dar explicación al gobierno del control motor. Las teorías sobre el aprendizaje motor deben ser la base para la rehabilitación motora. Las nuevas líneas de investigación deben aplicar los conocimientos generados en los campos del control y aprendizaje motor en neurorrehabilitación

Introduction: In recent decades there has been a special interest in theories that could explain the regulation of motor control, and their applications. These theories are often based on models of brain function, philosophically reflecting different criteria on how movement is controlled by the brain, each being emphasised in different neural components of the movement. The concept of motor learning, regarded as the set of internal processes associated with practice and experience that produce relatively permanent changes in the ability to produce motor activities through a specific skill, is also relevant in the context of neuroscience. Thus, both motor control and learning are seen as key fields of study for health professionals in the field of neuro-rehabilitation. Development: The major theories of motor control are described, which include, motor programming theory, systems theory, the theory of dynamic action, and the theory of parallel distributed processing, as well as the factors that influence motor learning and its applications in neuro-rehabilitation. Conclusions: At present there is no consensus on which theory or model defines the regulations to explain motor control. Theories of motor learning should be the basis for motor rehabilitation. The new research should apply the knowledge generated in the fields of control and motor learning in neuro-rehabilitation

Identifying subtypes among children with developmental coordination disorder and mathematical learning disabilities, using model-based clustering.

A relationship between motor and mathematical skills has been shown by previous research. However, the question of whether subtypes can be differentiated within developmental coordination disorder (DCD) and/or mathematical learning disability (MLD) remains unresolved. In a sample of children with and without DCD and/or MLD, a data-driven model-based clustering was used to identify subgroups of individuals with relatively homogeneous profiles on measures associated with motor and mathematical skills. One subgroup of children with motor problems was found based on motor variables. Based on mathematical variables, two clinical clusters were found: a subtype with number fact retrieval problems and a subtype with procedural calculation problems. Clustering with motor and mathematical skills revealed two clinical clusters: a cluster with number fact retrieval as well as procedural calculation problems and below average motor and visual-motor integration skills. A second cluster of children had only procedural calculation and visual-motor problems. Our results raise questions about the usefulness of placing children who have below average mathematical skills into a single diagnostic category. Furthermore, we inform ongoing debates about the overlap between DCD and MLD, as below average motor skills were found in both MLD subgroups, although a different motor profile is linked to a different mathematical profile.

What do parents need to enhance participation of their school-aged child with a physical disability? A cross-sectional study in the Netherlands.

BACKGROUND: The aim was to provide an overview of the number, domains and priority of needs as expressed by parents in supporting participation of their school-aged child with a physical disability. Additionally, this study investigated whether the number of needs within each domain is related to the child's gross motor function level, parent's perceived own general health, family socio-economic status and family type. METHOD: A cross-sectional study with a total of 146 participants (84.9% mothers) who completed a survey including the Family Needs Inventory - Paediatric Rehabilitation, the Gross Motor Function Classification System Family Report Questionnaire, the General Health Questionnaire and a demographic questionnaire. A need has been operationalized as 'a family's, parent's or other family member's expressed desire for information, services and supports related to their family'. Descriptive statistics and correlation analysis were applied. RESULTS: Parents (n = 146; response rate 27%) varied in the number of expressed needs (range 0-124; mean = 35.9; median = 30; SD = 25.6). Highest mean percentage scores were found for the domains 'Laws, regulations and fees' (36%), 'Leisure time' (35.6%) and 'Aids, adaptations, facilities and resources' (33.8%). Seven single needs were expressed by 50% or more of the parents. All domains of needs showed a positive correlation with perceived parental general health. The domains 'Laws, regulations and fees', 'Day care & school', 'Emotional and mental support' and 'Raising my child' correlated negatively with family socio-economic status; and child's gross motor function level correlated positively with the domains 'Aids, adaptations, facilities and resources', 'Practical support at home' and 'Leisure time'. CONCLUSIONS: As parents have a major influence on participation of children with a physical disability, meeting their individual needs should become an objective for service providers and policy makers. Family-centred service might be more effective by putting a greater emphasis on changing the environment.

[ESSENCE gathers the diagnoses into a whole]. / ESSENCE samlar diagnoserna till en helhet.

Co-existence of attention-deficit/hyperactivity disorder, oppositional defiant disorder, tic disorders, developmental coordination disorder, language disorder, learning problems, and autism spectrum disorder and sharing of symptoms across disorders, contribute to the typical clinical presentation in child psychiatry as well as in developmental medicine. The acronym ESSENCE refers to Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations. Affected children are brought for clinical assessment because of impairing symptoms that raise concern before the age of about 5 years in general development, communication and language, social inter-relatedness, motor coordination, attention, activity, behaviour, mood, and/or sleep. Such children are usually in need of a range of expert assessments, but a holistic approach is rarely taken from the start. Major problems in at least one ESSENCE domain before 5 years of age predict poor mental health later in life. Expert ESSENCE centres for assessment, habilitation and treatment of these children are needed.

Variability explained by strength, body composition and gait impairment in activity and participation measures for children with cerebral palsy: a multicentre study.

OBJECTIVE: To determine the amount of variability in scores on activity and participation measures used to assess ambulatory individuals with cerebral palsy explained by strength, body composition, gait impairment and participant characteristics. DESIGN: Multicentre prospective cross-sectional study. SETTING: Seven paediatric-orthopaedic specialty hospitals. PARTICIPANTS: Three hundred and seventy-seven ambulatory individuals (241 males, 136 females) with cerebral palsy, Gross Motor Function Classification System (GMFCS) levels I-III (I = 148, II = 153, III = 76), ages 8-18 years (mean 12 years 9 months, SD 2 years 8 months). METHODS: Participants completed assessments of GMFCS level, patient history, lower extremity muscle strength, Gross Motor Function Measure (GMFM-66), Pediatric Outcomes Data Collection Instrument (PODCI), instrumented gait analysis, 1 minute walk test, Timed Up-and-Go and body composition. Multiple linear regression and bootstrap analyses were performed for each outcome measure, stratified by GMFCS level. RESULTS: The amount of variability in outcome measures explained by participant characteristics, strength, and gait impairment ranged from 11% to 50%. Gait impairment was the most common predictor variable and frequently explained the greatest variance across all outcome measures and GMFCS levels. As gait impairment increased, scores on outcome measures decreased. Strength findings were inconsistent and not a primary factor. Body composition contributed minimally (<4%) in explaining variability. Participant characteristics (cerebral palsy type, gestational age and age at walking onset), were significant predictor variables in several models. CONCLUSIONS: Variability in outcome measure scores is multifaceted and only partially explained by strength and gait impairment illustrating the challenges of attempting to explain variation within this heterogeneous population. Clinicians treating individuals with cerebral palsy should consider this when developing treatment paradigms.

Assessment of upper limb capacity in children with unilateral cerebral palsy: construct validity of a Rasch-reduced Modified House Classification.

AIM: The aim of this study was to test and improve the unidimensionality and item hierarchy of the Modified House Classification (MHC) for the assessment of upper limb capacity in children with unilateral cerebral palsy (CP) using Rasch analysis. The construct validity of the Rasch-reduced item set was evaluated. METHOD: Modified House Classification items were scored from 369 videotaped assessments of 159 children with unilateral CP (98 males, 61 females; median age 6y 6mo, range 2y 1mo-17y 5mo). Construct validity was tested in 40 other children with unilateral CP (21 males, 19 females; median age 8y 2mo, range 3y 3mo-17y 6mo) by comparing total scores with the Manual Ability Classification System (MACS) and the ABILHAND-Kids scale. RESULTS: Fifteen MHC items could be included in the Rasch analysis. The excluded items were either too easy or too difficult. Fourteen items fitted the unidimensional model (χ(2) =41.3, df=39, p=0.37). The hierarchy of these items was different from the original MHC. There was a significant correlation with the MACS (r=-0.901, p<0.001) and the ABILHAND-Kids scale (r=0.558, p<0.001). INTERPRETATION: The original item hierarchy of the MHC can be improved in order to use its sum score for the assessment of upper limb capacity in children with unilateral CP. The Rasch-reduced 14-item MHC with weighted sum score shows good construct validity to measure functional capacity of the affected hand in children with unilateral CP.

Trastornos motores en los trastornos del neurodesarrollo. Tics y estereotipias / Motor disorders in neurodevelopmental disorders. Tics and stereotypies

Los tics son movimientos o vocalizaciones repetitivos, bruscos, rápidos y no rítmicos, resultantes de contracciones musculares súbitas, abruptas e involuntarias. Las estereotipias son movimientos repetitivos, aparentemente impulsivos, rítmicos y carentes de propositividad, que siguen un repertorio individual propio de cada individuo y que se presentan bajo un patrón temporal variable, bien transitorio o persistente. Ambos se incluyen en el Manual diagnóstico y estadístico de los trastornos mentales, quinta edición (DSM-5), en los trastornos del neurodesarrollo, y conforman, junto con el trastorno del desarrollo de la coordinación, el grupo de trastornos motores. Para los tics se han mantenido las categorías de ‘trastorno de Tourette’, ‘trastorno de tics motor o vocal crónico’ y ‘trastorno de tics no especificado’; desaparece la categoría de ‘tics transitorios’ y se incorporan el ‘trastorno de tics provisional’ y ‘otros trastornos de tics especificados’. En el trastorno de movimientos estereotipado, el DSM-5 sustituye ‘no funcional’ por ‘aparentemente carente de sentido’, se retiran los umbrales de necesidad de atención médica y se sustituyen por el criterio de afectación estándar del manual, se omite la alusión al retraso mental para matizar la gravedad del movimiento estereotipado, y se añaden un criterio de inicio de síntomas y especificadores de existencia o no de comportamientos autolesivos, así como de asociación a enfermedades genéticas, médicas generales o factores extrínsecos. Se incluye, además, una categorización en función de la gravedad (AU)

Tics are repetitive, sharp, rapid, non-rhythmic movements or utterances that are the result of sudden, abrupt and involuntary muscular contractions. Stereotypies are repetitive, apparently impulsive, rhythmic, purposeless movements that follow an individual repertoire that is specific to each individual and that occur under a variable time pattern, which may be either transient or persistent. Both are included in the Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5), among the eurodevelopmental disorders, and together with coordination development disorder go to make up the group of motor disorders. For tics, the categories of ‘Tourette’s disorder’, ‘chronic motor or vocal tic disorder’ and ‘unspecified tic disorder’ have been maintained, whereas the category ‘transient tics’ has disappeared and ‘provisional tic disorder’ and ‘other specified tic disorders’ have been incorporated. Within stereotypic movement disorder, the DSM-5 replaces ‘non-functional’ by ‘apparently purposeless’; the thresholds of the need for medical care are withdrawn and replaced with the manual’s standard involvement criterion; mental retardation is no longer mentioned and emphasis is placed on the severity of the stereotypic movement; and a criterion concerning the onset of symptoms and specifiers of the existence or not of self-injurious behaviours have been added, together with the association with genetic or general medical diseases or extrinsic factors. Moreover, a categorisation depending on severity has also been included (AU)

The stability of the Manual Ability Classification System over time.

AIM: To evaluate the stability over time of the Manual Ability Classification System (MACS) levels. METHOD: The study group comprised 1267 children with cerebral palsy (746 males, 521 females) who were followed from 2005 to 2010 with two or more registered MACS classifications rated at least 1 year apart. Thirty-five percent of the children (n=445) had four MACS registrations. The children were between 4 and 17 years old at their first rating, The stability over time was also compared between children who were younger (4y of age) or older (≥10y) at the time of their first classification. RESULTS: An excellent stability was found between two ratings at 1-year intervals with an intraclass correlation coefficient (ICC) of 0.97 (95% CI 0.97-0.97) and 82% agreement (n=1267). The stability was also excellent for two ratings performed 3 to 5 years apart (ICC 0.96; 95% CI 0.95-0.97) with an agreement of 78% (n=445). Across four ratings, 70% of the children remained at the same level. The results were similar for younger and older children, indicating that stability was not influenced by age. INTERPRETATION: This study provides evidence that MACS levels are stable over time and that the classification has predictive value.

Linkage of ICF-CY codes with environmental factors in studies of developmental outcomes of infants and toddlers with or at risk for motor delays.

PURPOSE: Environmental variables have been explored in studies of the development of young children with motor delays. Linking environmental variables to the International Classification of Functioning, Disability and Health - Children and Youth (ICF-CY), environmental factors (EFs) categories can provide a common language for documenting their contribution to developmental outcomes. This review of studies aimed to (1) link EFs for developmental outcomes in infants with or at risk for motor delays to ICF-CY categories and (2) synthesize the influences of EFs (with ICF-CY linkage) on developmental outcomes. METHOD: A systematic literature search was performed of multiple databases. After applying selection criteria, environmental variables in 28 articles were linked to ICF-CY categories and underwent qualitative synthesis. RESULTS: Results indicated that physical environmental variables could be linked successfully to ICF-CY EFs categories, but not social environmental variables. Multiple environmental variables were associated with motor and other developmental outcomes. CONCLUSION: Difficulties in linking social factors to ICF-CY categories indicate that additional EFs codes may need to be considered in the ICF-CY revision processes. The review provides empirical data on relationships between EFs and developmental outcomes in children with or at risk for motor delay.