The evaluation of the use in children with cerebral palsy of a method developed to quantify normal movement

Theofani Mpania, Iris Musa

Quality of movement is an important dimension of motor development in children with cerebral palsy (CP) since it indicates what movement patterns children use during activities. A literature review, however, revealed a lack of tests measuring the quality of movement with regard to movement patterns, especially the sit-to-stand pattern that is a fundamental activity for children?s independence. In 1999 Sarin developed a measure for quality of sit-to-stand in adults and the purpose of this study was to evaluate the use of this measure in children with CP in order to establish its reliability, face, content and construct validity, as well as sensitivity. Methods: Measurements taken by three paediatric therapists from videos of 10 CP children carrying out the activity were used to test inter-rater and intra-rater reliability. Construct validity was tested by comparing the CP children?s measurements with measurements from videos of 10 normal children. For testing sensitivity, measurements were taken from videos of the CP children before and after a 9-week period and comparisons were made. Results: Inter-rater reliability was found to be moderate to high between measurer A and B (r=+0.65, p=0.02 and r=+0.822, p=0.002), but low between measurer B and C (r=+0.253, p=0.24 and r=+0.311, p=0.191) and between measurer A and C (r=+0.372, p=0.145 and r=+0.234, p=0.258). Intra-rater reliability was found to be high for measurer A (r=+0.947, p<0.001), moderate for measurer B (r=+0.782, p=0.004), and low for measurer C (r=+0.312, p=0.19). A focus group judged the face and content validity as good. Construct validity was found to be high at a 0.001 level of significance. Sensitivity was low for measurer A (t=8, p=0.08 and t=5.5, p=0.07) and measurer C (t=10, p=0.128 and t=13, p=0.129), but high for measurer B (t=0.001, p=0.004 and t=1, p=0.0045). Conclusions: In this study, the Sarin measure?s overall reliability and sensitivity was low and may be associated with the experience and expertise of the therapist. However, changes are suggested to the scoring scale in order to improve the measure?s reliability and sensitivity. It is suggested that a refined Sarin measure may be useful when used by therapists to quantify quality of sit-to-stand.



The Effectiveness of Physiotherapy in Glenohumeral Joint Instability

Ioannis Griparis, S. Mavromoustakos, S. Arampatzidou

Instability is defined as an abnormal symptomatic motion of the glenohumeral joint, and can be caused due to the occurrence of a disorder between the static and dynamic stabilizing mechanisms. The result of such a situation is the varying kinetic pattern and the insufficient neuromuscular coordination. To achieve a satisfying diagnosis of this instability a good history, the results of imaging tests and the findings from the physical examination must all be combined. These three factors are important for the determination the therapy by the team of specialists. In any case ,the non-operative treatment (immobilization, physiotherapy) should be drawn to the limits before any surgical intervention is decided. Despite the fact that physiotherapy, and mainly the part concerning therapeutic exercise, is usually the first step to deal with the functional rehabilitation of the joints, it has not yet proved to be the most effective solution. It is therefore necessary, using long term and well designed clinical trials, to define the elements of the therapeutic exercises that will prove its efficacy as a first choice. The aims of this review is to define the clinical aspect (pathophysiology, physical examination tests) of instability, and to record results of the effectiveness of the physiotherapy, as a solution as presented through the current bibliography.