Advertisement

Validity and Clinical Utility of Functional Assessments in Children With Cerebral Palsy

  • Nikolaos Chrysagis
    Affiliations
    Department of Physical Therapy, Technological Educational Institute of Athens, Athens, Greece

    Laboratory of Adapted Physical Activity/Developmental and Physical Disabilities, Athens, Greece
    Search for articles by this author
  • Emmanouil K. Skordilis
    Correspondence
    Corresponding author Emmanouil K. Skordilis, PhD, Department of Physical Education and Sport Sciences, National and Kapodistrian University of Athens, Ethnikis Antistaseos 21, Daphni 17237 Athens, Greece.
    Affiliations
    Department of Physical Education and Sport Sciences, National and Kapodistrian University of Athens, Athens, Greece
    Search for articles by this author
  • Dimitra Koutsouki
    Affiliations
    Laboratory of Adapted Physical Activity/Developmental and Physical Disabilities, Athens, Greece

    Department of Physical Education and Sport Sciences, National and Kapodistrian University of Athens, Athens, Greece
    Search for articles by this author
Published:November 14, 2013DOI:https://doi.org/10.1016/j.apmr.2013.10.025

      Abstract

      Objective

      To examine the validity and clinical utility of functional assessments (1-minute walk test, 10-meter walk test, Timed Up & Go [TUG] test, Timed Up and Down Stairs [TUDS] test, sit-to-stand [STS] test, and lateral step-up [LSU] test).

      Design

      Cross-sectional study.

      Setting

      Four special schools for adolescents with physical disabilities.

      Participants

      Adolescents with spastic tetraplegia and diplegia (at levels I–III) were selected through convenience sampling (N=35; mean age, 14.97±2.03y).

      Interventions

      Not applicable.

      Main Outcome Measures

      GMFM-88 (dimensions D and E), 1-minute walk, 10-meter walk, TUG, TUDS, STS, and LSU tests. Data were analyzed using Pearson intercorrelations, multiple regression analysis, and multivariate analysis of variance (MANOVA).

      Results

      Significant moderate to high intercorrelations were found. Three significant positive predictors emerged (1-minute walk, 10-meter walk, and LSU) with the following regression equation: YGMFM-88 (dimensions D and E) = 5.708 + .402 × X1-minute walk + .920 × XLSU + .404 × X10-meter walk The MANOVA was significant (Λ=.163, F=14.732, P<.001, η2=.596), and post hoc comparisons revealed significant differences across Gross Motor Function Classification System Expanded and Revised levels in all paired comparisons for the 1-minute walk and LSU tests. For the 10-meter walk test, significant differences were evident in the level I versus level III and level II versus level III comparisons. No significant differences were found in the 10-meter walk test between levels I and II.

      Conclusions

      These functional assessments (1-minute walk, LSU, and 10-meter walk tests) are simple to administer, quick, low cost, and user-friendly. Although these assessments are not a substitute for the criterion standard (GMFM-88), they may be used for a quick assessment in adolescents with cerebral palsy (levels I–III) either at school or during rehabilitation, especially when time is limited.

      Keywords

      List of abbreviations:

      CP (cerebral palsy), GMFCS E&R (Gross Motor Function Classification System Expanded and Revised), GMFM-66 (Gross Motor Function Measure-66), GMFM-88 (Gross Motor Function Measure-88), LSU (lateral step-up), MANOVA (multivariate analysis of variance), STS (sit-to-stand), TUDS (Timed Up and Down Stairs), TUG (Timed Up & Go)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. World Health Organization. International Classification of Functioning, Disability and Health (IFC). 2001. Available at: http://www.who.int/classifications/icf/en/. Accessed November 18, 2011.

        • Russell D.J.
        • Rosenbaum P.L.
        • Cadman D.T.
        • Gowland C.
        • Hardy S.
        • Jarvis S.
        The gross motor function measure: a means to evaluate the effects of physical therapy.
        Dev Med Child Neurol. 1989; 31: 341-352
        • Williams E.
        • Carroll S.
        • Reddihough D.
        • Phillips B.
        • Galea M.
        Investigation of the timed ‘up & go’ test in children.
        Dev Med Child Neurol. 2005; 47: 518-524
        • Bjornson K.F.
        • Graubert C.S.
        • Buford V.L.
        • McLaughlin J.
        Validity of the gross motor function measure.
        Pediatr Phys Ther. 1998; 10: 43-47
        • Lundkvist Josenby A.
        • Jarnlo G.B.
        • Gummesson C.
        • Normark E.
        Longitudinal construct validity of the GMFM-88 total score and the GMFM-66 score in a 5-year follow-up study.
        Phys Ther. 2009; 89: 342-350
        • Russell D.
        • Rosenbaum P.
        • Avery L.
        • Lane M.
        Gross motor function measure (GMFM-66 & GMFM-88) user's manual.
        Mac Keith Pr, London2002
        • Russell D.
        • Avery L.
        • Rosenbaum P.
        • Raina P.
        • Walter S.
        • Palisiano R.
        Improved scaling of the gross motor function measure for children with cerebral palsy: evidence of reliability and validity.
        Phys Ther. 2000; 80: 873-885
        • Bagley A.M.
        • Gorton G.
        • Oeffinger D.
        • et al.
        Outcome assessments in children with cerebral palsy, part II: discriminatory ability of outcome tools.
        Dev Med Child Neurol. 2007; 49: 181-186
        • Oeffinger D.
        • Tylkowski C.
        • Rayens M.
        • et al.
        Gross motor classification system and outcome tools for assessing ambulatory cerebral palsy: a multicenter study.
        Dev Med Child Neurol. 2004; 46: 311-319
        • Vos-Vromans D.C.
        • Ketelaar M.
        • Gorter J.W.
        Responsiveness of evaluative measures for children with cerebral palsy: the gross motor function measure and the pediatric evaluation of disability inventory.
        Disabil Rehabil. 2005; 27: 1245-1252
        • Declerck M.
        Benefits of swimming for children with cerebral palsy. A pilot study.
        Serbian Journal of Sports Sciences. 2013; 7: 57-69
        • Knox V.
        • Lloyd-Evans A.
        Pilot study to evaluate the functional effects of a block of Bobath therapy in children with cerebral palsy.
        Dev Med Child Neurol. 2002; 44: 447-460
        • Wilson A.
        • Kavanaugh A.
        • Moher R.
        • et al.
        Development and pilot testing of the challenge module: a proposed adjunct to the Gross Motor Function Measure for high-functioning children with cerebral palsy.
        Phys Occup Ther Pediatr. 2011; 31: 135-149
        • Liao H.F.
        • Liu Y.C.
        • Liu W.Y.
        • Lin Y.T.
        Effectiveness of loaded sit to stand resistance exercise for children with mild spastic diplegia: a randomized clinical trial.
        Arch Phys Med Rehabil. 2007; 88: 25-31
        • Dodd K.
        • Taylor N.
        • Graham K.
        A randomized clinical trial of strength training in young people with cerebral palsy.
        Dev Med Child Neurol. 2003; 45: 652-657
        • Unnithan V.
        • Katsimanis G.
        • Evangelinou C.
        • Kosmas C.
        • Kandrali I.
        • Kellis E.
        Effect of strength and aerobic training in children with cerebral palsy.
        Med Sci Sports Exerc. 2007; 39: 1902-1909
        • Lee J.
        • Sung I.
        • Yoo J.
        Therapeutic effects of strengthening exercise on gait function of cerebral palsy.
        Disabil Rehabil. 2008; 30: 1439-1444
        • Fowler E.
        • Knutson L.
        • De Muth S.
        • et al.
        Pediatric endurance and limb strengthening (pedals) for children with cerebral palsy using stationary cycling: a randomized controlled trial.
        Phys Ther. 2012; 90: 367-381
        • Johnston J.E.
        • Watson K.E.
        • Ross S.A.
        • et al.
        Effects of a supported speed treadmill training exercise program on impairment and function for children with cerebral palsy.
        Dev Med Child Neurol. 2011; 53: 742-750
        • Scholtes V.A.
        • Becher B.J.
        • Comuth A.
        • Dekkers H.
        • Van Dijk L.
        • Dallmeijer J.A.
        Effectiveness of functional progressive resistance exercise strength training on muscle strength and mobility in children with cerebral palsy: a randomized controlled trial.
        Dev Med Child Neurol. 2010; 52: 107-113
        • Damiano D.L.
        • Abel M.F.
        Functional outcomes of strength training in spastic cerebral palsy.
        Arch Phys Med Rehabil. 1998; 79: 119-125
        • Verschuren O.
        • Ketelaar M.
        • Gorter J.W.
        • Helders P.J.
        • Takken T.
        Relation between physical fitness and gross motor capacity in children and adolescents with cerebral palsy.
        Dev Med Child Neurol. 2009; 43: 866-871
        • McDowell B.
        • Kerr C.
        • Parkes J.
        • Cosgrove A.
        Validity of 1 minute walk test for cerebral palsy.
        Dev Med Child Neurol. 2005; 47: 744-748
        • Drouin L.M.
        • Malouin F.
        • Richards C.L.
        • Marcoux S.
        Correlation between the gross motor function measure scores and gait spatiotemporal measures in children with neurological impairments.
        Dev Med Child Neurol. 1996; 38: 1007-1019
        • Zaino C.A.
        • Marchese V.G.
        • Westcott S.L.
        Timed up and down stairs test: preliminary reliability and validity of a new measure of functional mobility.
        Pediatr Phys Ther. 2004; 16: 90-98
        • Wang T.H.
        • Liao H.F.
        • Peng Y.C.
        Reliability and validity of the five-repetition sit-to-stand test for children with cerebral palsy.
        Clin Rehabil. 2011; 26: 664-671
        • Chrysagis N.
        • Skordilis E.
        • Tsiganos G.
        • Koutsouki D.
        Validity evidence of the Lateral Step Up (LSU) test for adolescents with spastic cerebral palsy.
        Disabil Rehabil. 2012; 35: 875-880
        • Gan S.M.
        • Tung C.L.
        • Tang H.Y.
        • Wang C.H.
        Psychometric properties of functional balance assessment in children with cerebral palsy.
        Neurorehabil Neural Repair. 2008; 22: 745-753
        • Verschuren O.
        • Ketelaar M.
        • Gorter J.
        • Helders P.
        • Uiterwaal C.
        • Takken T.
        Exercise training program in children and adolescents with cerebral palsy.
        Arch Pediatr Adolesc. 2007; 161: 1075-1081
        • Sullivan E.
        • Barnes D.
        • Linton J.
        • et al.
        Relationships among functional outcome measures used for assessing children with ambulatory CP.
        Dev Med Child Neurol. 2007; 49: 338-344
        • Marchionni L.
        • Wilson R.F.
        • Wolff A.C.
        • et al.
        Systematic review: gene expression profiling assays in early-stage breast cancer.
        Ann Intern Med. 2008; 148: 358-369
        • Palisano R.J.
        • Rosenbaum P.
        • Bartlett D.
        • Livingston M.H.
        Content validity of the expanded and revised gross motor function classification system.
        Dev Med Child Neurol. 2008; 50: 744-750
        • Verschuren O.
        • Ketelaar M.
        • Takken T.
        • Van Brussel M.
        • Helders P.J.
        • Gorter J.W.
        Reliability of hand-held dynamometry and functional strength tests for the lower extremity in children with cerebral palsy.
        Disabil Rehabil. 2008; 30: 1358-1366
        • Wade D.
        Measurement in neurological rehabilitation.
        Oxford Univ Pr, Oxford1992
        • McDowell B.
        • Humphreys L.
        • Kerr C.
        • Stevenson M.
        Test-retest reliability of a 1-min walk test in children with bilateral spastic cerebral palsy.
        Gait Posture. 2009; 29: 267-269
        • Thompson P.
        • Beath T.
        • Bell J.
        • et al.
        Test-retest reliability of the 10-metre fast walk test and 6-minute walk test in ambulatory school-aged children with cerebral palsy.
        Dev Med Child Neurol. 2008; 50: 370-376
        • Maher C.A.
        • Williams M.T.
        • Olds T.S.
        The six-minute walk test for children with cerebral palsy.
        Int J Rehabil Res. 2008; 31: 185-188
        • Morton J.
        • Brownlee M.
        • McFadyen A.
        The effects of progressive resistance training for children with cerebral palsy.
        Clin Rehabil. 2005; 19: 283-289
        • Cohen J.
        Statistical power analysis for the behavioral sciences.
        2nd ed. Erlbaum, Hillsdale1988
        • Pedhazur E.
        • Pedhazur-Schmelkin L.
        Measurement, design, and analysis: an integrated approach.
        Lawrence Erlbaum, Hillsdale1991
        • Hair J.
        • Anderson R.
        • Tatham R.
        • Black W.
        Multivariate data analysis.
        5th ed. Prentice-Hall, Upper Saddle River1998
        • Grimm L.
        Statistical applications for the behavioral sciences.
        John Wiley & Sons, New York1993
        • Damiano A.
        • Abel M.
        Relation of gait analysis to gross motor function in cerebral palsy.
        Dev Med Child Neurol. 1996; 38: 389-396