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Biomedical subjects

C Gowland

Publications and source records attributed to C Gowland.

17 recordsLinked to original sources
PubMed1998

Evaluating motor function in children with Down syndrome: validity of the GMFM.

The Gross Motor Function Measure (GMFM) was developed and validated originally by Russell and colleagues as an evaluative assessment of gross motor function in children with cerebral palsy (CP). The present study reports the results of reliability and validity testing of the GMFM for use with children with Down syndrome (DS). One hundred and twenty-three children with DS were assessed twice over a 6-month period, using the GMFM and the motor scale of the Bayley Scales of Infant Development - second edition (BSID-II). In addition to the usual method of scoring the GMFM using only observed motor behaviours (standard score), parent reports of children's activities not seen by the assessor on the day of testing were also obtained and a second score (reported score) was calculated for each GMFM assessment. Test-retest and interrater reliabilities were excellent (all >0.90). Observed correlations between change on GMFM and judgements of change made independently by parents, intervenors, and masked video raters were lower than hypothesized. However, the pattern of change scores in predefined age and severity subgroups supported the contention that the GMFM was able to detect differential amounts of change as predicted. The GMFM was shown to be relatively more responsive to change in gross motor function than the motor scale of the BSID-II. The 'reported' scores on the GMFM demonstrated better evidence of reliability, validity, and responsiveness than the standard scoring method and this approach is recommended for use when assessing children with DS.

Child↗
PubMed1995

Reliability of the Gross Motor Performance Measure.

BACKGROUND AND PURPOSE: The reporting of reliability coefficients and the method of their determination is expected of test developers. The purpose of this study was to estimate the interrater, intrarater, and test-retest reliability of the Gross Motor Performance Measure, a measure of quality of movement designed to accompany the Gross Motor Function Measure. SUBJECTS: Subjects were 28 children (25 with cerebral palsy, 2 nondisabled, 1 with head injury) between the ages of 1 and 10 years. METHODS: Reliability data were obtained from assessments of 19 therapists. RESULTS: Intraclass correlation coefficients for reliability varied from .92 to .96 for the total scores and from .84 to .94 for the five attribute scores. CONCLUSION AND DISCUSSION: When the Gross Motor Performance Measure was administered by therapists who are familiar with the Gross Motor Function Measure and had a 1-day training workshop, reliability of the total scores was above recommended minimums. Scores of single attributes were less reproducible.

Cerebral Palsy↗
PubMed1995

The Gross Motor Performance Measure: validity and responsiveness of a measure of quality of movement.

BACKGROUND AND PURPOSE: This article presents the results of a study to validate a measure of gross motor performance for its capacity to detect changes in the quality of movement in children with cerebral palsy aged 0 to 12 years. SUBJECTS AND METHODS: On two occasions, 4 to 6 months apart, physical therapists from three children's treatment centers assessed 106 children with cerebral palsy, 18 children who had sustained an acute head injury, and 29 nondisabled children. Validity was demonstrated by comparing changes on the measure across diagnoses, severity, and age groups. RESULTS: Several a priori hypotheses were supported; however, relationships with parent and therapist ratings were not clearly demonstrated. CONCLUSION AND DISCUSSION: The measure was found to be differentially responsive to changes in "stable" and "responsive" groups.

Analysis of Variance↗
PubMed1994

Training users in the gross motor function measure: methodological and practical issues.

BACKGROUND AND PURPOSE: The Gross Motor Function Measure (GMFM) is a criterion-referenced observational measure for assessing change in gross motor function for children with cerebral palsy (CP). The purposes of this report are to present data on the effects of training pediatric developmental therapists to administer and score the GMFM and to discuss some practical and methodological issues associated with training. SUBJECTS AND METHODS: A weighted kappa estimate pretraining and posttraining workshop was used to determine participants' agreement of scoring a videotaped GMFM assessment against experts' scoring of the same videotaped assessment. Several children with CP, representing a spectrum of ages, severities, and levels of function, were shown on the videotape. RESULTS: There was a significant improvement in agreement from a mean kappa of .58 to .82 (t = 15.38, df = 75, P < .001) for the first group and from .81 to .92 (t = 10.91, df = 72, P < .001) for the second group following training. CONCLUSION AND DISCUSSION: Although there are a number of advantages to using videotapes to train test users and to assess scoring reliability, this method does not evaluate participants' ability to administer the measure. Further work is needed to determine whether reliability is maintained in a clinical situation in which it is necessary to both administer and score the GMFM.

Adolescent↗
PubMed1993

Diagnostic classification of patients with low back pain: report on a survey of physical therapy experts.

BACKGROUND AND PURPOSE: A survey of expert orthopedic physical therapists was conducted to assist in the development of a classification system for patients with low back pain (LBP). The goal of the survey was to measure levels of agreement on labels and accompanying constellations of signs and symptoms for subgroups of patients with LBP. SUBJECTS: Twenty-four of the 30 expert orthopedic physical therapists who were originally contacted responded to the survey request. METHODS: A modified Delphi technique was used. The first stage involved a review of the literature and identification of 25 diagnostic classes of LBP. Experts were asked to rate the "appropriateness" of each diagnostic class for inclusion in a classification scheme. Clinical findings relevant to each diagnostic class were identified and rated on the degree of "essentialness" to that class. RESULTS: Three diagnostic classes--hypomobility dysfunction, nerve root adhesion, and sacroiliac hypermobility--were distinct in that the agreement criteria for the appropriateness of diagnostic classes as well as the surveyed essential signs and symptoms were met. Six of the 25 diagnostic classes did not meet the minimum levels required for agreement as appropriate diagnostic classes: facet syndrome, chronic pain behavior, muscle strain, iliolumbar ligament sprain, posterior ligament sprain, and myofascial dysfunction. CONCLUSION AND DISCUSSION: The importance of developing homogeneous subgroups of patients with LBP based on constellations of reliable clinical findings is emphasized.

Australia↗
PubMed1993

Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke.

BACKGROUND AND PURPOSE: The purpose of this study was to establish the interrater reliability of assessments made with the Fugl-Meyer evaluation of physical performance in a rehabilitation setting. SUBJECTS: Twelve patients (7 male, 5 female), aged 49 to 86 years (mean = 66), who had sustained a cerebrovascular accident participated in the study. All patients were admitted consecutively to a rehabilitation center and were between 6 days and 6 months poststroke. METHODS: Three physical therapists, each with more than 10 years of experience, assessed the patients in a randomized and balanced order using this assessment. The therapists standardized the assessment approach prior to the study but did not discuss the procedure once the study began. RESULTS: The overall reliability was high (overall intraclass correlation coefficient = .96), and the intraclass correlation coefficients for the subsections of the assessment varied from .61 for pain to .97 for the upper extremity. CONCLUSION AND DISCUSSION: The relative merits of using the Fugl-Meyer assessment as a research tool versus a clinical assessment for stroke are discussed.

Aged↗
PubMed1993

Measuring physical impairment and disability with the Chedoke-McMaster Stroke Assessment.

BACKGROUND AND PURPOSE: The Chedoke-McMaster Stroke Assessment measures the physical impairments and disabilities that impact on the lives of individuals with stroke. This measure has three overall purposes: 1) to stage motor recovery to classify individuals in terms of clinical characteristics, 2) to predict rehabilitation outcomes, and 3) to measure clinically important change in physical function. This study was carried out to evaluate the ability of this measure to yield reliable and valid results. METHODS: Thirty-two subjects from a stroke rehabilitation treatment unit were assessed by research and treating physical therapists using multiple measures on multiple occasions. The measure's three purposes dictated the study objectives and design. RESULTS: Intrarater, interrater, and test-retest reliabilities of the impairment and disability inventories were estimated. Reliability coefficients for the total scores ranged from 0.97 to 0.99. Construct and concurrent validities were studied by examining the correlations between this and other measures. A priori hypothetical constructs stated that these correlations should exceed 0.60. These constructs were confirmed; the impairment inventory total score was found to correlate with the Fugl-Meyer Test (r = 0.95, p < 0.001) and the disability inventory with the Functional Independence Measure (r = 0.79, p < 0.05). Additional study hypotheses were also substantiated. CONCLUSIONS: This study confirms that the Chedoke-McMaster Stroke Assessment yields both reliable and valid results. With the evaluation study now completed, the Chedoke-McMaster Stroke Assessment can be used with confidence as both a clinical and a research tool that can discriminate among subjects and evaluate patient outcomes.

Adolescent↗
PubMed1992

Agonist and antagonist activity during voluntary upper-limb movement in patients with stroke.

Forty-four patients with hemiplegia following stroke and 10 nondisabled subjects were studied to examine the contributions inadequate motor unit recruitment and co-contraction attributable to impaired antagonist inhibition play in the movement disorder of the hemiplegic arm. Electromyographic data were recorded from agonist and antagonist muscles while subjects attempted six specified tasks. Data from subjects who could complete the tasks were compared with those who could not complete the tasks. Differences between the two groups were found in the electromyographic data obtained from the agonist muscles. Electromyographic values were consistently and significantly lower in patients who were unable to complete the tasks than in patients who were able to complete the tasks. In the antagonist muscles, a significant difference was noted only once; in this case, the EMG values were again lower in the group of patients who were unable to complete the task. Inadequate recruitment of agonists, not increased activity in the antagonists, was a consistent finding in patients who were unable to carry out the movement tasks. This study theoretically supports aiming treatment efforts at improving motoneuron recruitment rather than reducing activity in antagonists while retraining arm function.

Adult↗
PubMed1991

Measuring quality of movement in cerebral palsy: a review of instruments.

There is a lack of appropriate evaluation instruments in the area of quality of movement in cerebral palsy. Ten measures of quality of movement, or gross motor performance, published between 1965 and 1990, were reviewed according to established criteria. These criteria include the purpose of the measure, validity, reliability, responsiveness, range of items, and description of qualitative components. These measures provide a foundation for further instrument development in the area of quality of movement. [Boyce WF, Gowland C, Rosenbaum PL, et al. Measuring quality of movement in cerebral palsy: a review of instruments.

Cerebral Palsy↗
PubMed1991

Development of a quality-of-movement measure for children with cerebral palsy.

Development of a suitable measure of quality of movement, or gross motor performance, for children with cerebral palsy is a complex undertaking. A variety of conceptual, methodological, and practical issues inherent in such a project are discussed in this article. We report on the methodology used in the planning and construction of the Gross Motor Performance Measure. The measure has been developed by a multicenter, interdisciplinary group of therapists, methodologists, research staff, and international experts. Five attributes of gross motor performance have been defined, scaled, and operationalized. Results of content validity studies demonstrate that the measure has adequate completeness, clarity, and potential for evaluating change in quality of movement in children who have cerebral palsy. The measure is currently undergoing extensive testing to determine the reliability, validity, and responsiveness of the obtained scores. [Boyce WF, Gowland C, Hardy S, et al. Development of a quality-of-movement measure for children with cerebral palsy.

Cerebral Palsy↗
PubMed1990

Issues in measuring change in motor function in children with cerebral palsy: a special communication.

Assessing clinical change in motor function in children with cerebral palsy is a complex measurement task. Whereas a variety of methods have been developed to quantify specific aspects of gross motor behavior (eg, gait analysis, electrophysiological tests, energy-consumption techniques), systematic measurement of overall gross motor function is a more difficult problem. This special communication reviews the structural and performance characteristics required of a well-developed, valid, and responsive clinically based evaluative measure. We discuss several recent approaches used to assess responsiveness and critically examine clinical measures used in randomized controlled trials of physical therapy for children with cerebral palsy. It is argued that the creation and validation of responsive evaluative measures is essential if we are to assess accurately whether our treatments do more good than harm.

Cerebral Palsy↗
PubMed1989

The gross motor function measure: a means to evaluate the effects of physical therapy.

This paper reports the results of a study to validate a measure of gross motor function in detecting change in the motor function of disabled children. Physiotherapists used this instrument to assess 111 patients with cerebral palsy, 25 with head injury and 34 non-disabled preschool children on two occasions, the second after an interval of four to six months. Parents and therapists independently rated the children's function within two weeks of each assessment, and a sample of paired assessments was videotaped for 'blind' evaluation by therapists. Correlations between scores for change on this measure and the judgments of change by parents, therapists and 'blind' evaluators supported the hypothesis that the instrument would be responsive to both negative and positive changes.

Adolescent↗
PubMed1986

The use of color in the environment of the elderly to enhance function.

Empirical evidence suggests that the functional level of the institutionalized elderly is favorably affected by enriching the environment with the specific use of color and light. Evidence of the validity of this supposition would form a worthwhile contribution to geriatric rehabilitation by promoting the independence of the elderly in the area of activities of daily living. The quality of literature on the appropriate use of environmental color for an institutionalized geriatric population is limited, being primarily descriptive in nature. In general, visual enhancement by the selective use of color is advocated to minimize the adverse effects of sensory deprivation and to enhance mood, whereas color coding and cueing are directed toward improving function. Faced with a variable literature base and a scarcity of studies that scientifically approach the question of what effect visual enhancement might have on function in the elderly, the authors of this paper are conducting a pilot study with the following objectives: To demonstrate that color cueing (in the form of color contrast applied to key objects in the environment) and increased lighting can enhance the performance of activities of daily living in an institutionalized elderly population. To study the concept that improvement in activities of daily living corresponds with improvement in the patient's mood and feelings of self-worth. To evaluate the effect of color and lighting changes in the environment on various aspects of behavior. It is hypothesized that improvement in behavior will accompany increased functional independence. Thus, we would expect to see a relationship between aspects of behavior and those aspects of mood and activities of daily living currently under investigation.

Aged↗
PubMed1983

Hemiplegic gait: analysis of temporal variables.

The objective of this study was to determine key quantitative variables in hemiplegic gait, and to correlate them with clinical abnormality, eg, degree of motor recovery. In 23 hemiplegic patients, clinical and locomotion laboratory assessments gave the following results. Two temporal gait variables, walking speed and symmetry of the swing/phase, showed a good correlation with the stage of motor recovery. Patients with greater degrees of motor recovery walked faster and more symmetrically than those with less motor recovery. None of the other temporal variables analyzed showed a significant relationship with the stage of motor recovery.

Adult↗
PubMed1982

EMG feedback treatment of upper limb in hemiplegic stroke patients: a pilot study.

Poor prognosis for upper limb recovery of stroke survivors has not changed in at least 28 years; only 4% to 5% of patients regain arm function during or after the active rehabilitation phase. This pilot study included 37 patients randomly assigned to either an integrated behavioral-physical therapy treatment program including electromyographic feedback (experimental group) or a standard exercise physical therapy program of like duration and intensity (control group). Both groups showed clinically significant improvements that exceeded previously reported experience. The experimental technique appears to be more effective when upper limb involvement is not severe in a late case, or when treatment is started early (within 3 months poststroke) in a severe case. The rehabilitation community should quickly investigate the improved prospects of restoring a greater number of useful upper limbs in this often neglected group of hemiplegic patients.

Biofeedback, Psychology↗
PubMedDate not supplied

Gross motor performance measure for children with cerebral palsy: study design and preliminary findings.

This project investigated the validity, reliability and responsiveness of the Gross Motor Performance Measure (GMPM). The GMPM was developed as an observational instrument to measure changes in quality of movement in children with cerebral palsy. Physical therapists from 3 children's treatment centres assessed 107 children with CP, 18 children with head injury and 33 non-disabled children. Assessments were conducted on 2 occasions, 4 to 6 months apart. The measurement protocol included assessment with the GMPM and the Gross Motor Function Measure (GMFM). Validity was tested by comparing changes in GMPM scores to parent and therapist independent ratings of the children's motor performance. Also, a sample (n = 30) of paired assessments was videotaped for 'masked' evaluation by therapists. Inter-rater, intra-rater and test-retest reliability studies (n = 30) were conducted. Responsiveness to change was determined through parent and therapist ratings of the importance of observed changes in quality of movement. Data collection for this study has just been completed. Validation hypotheses have been postulated regarding correlations between changes in GMPM scores; GMFM scores; age of children; diagnosis; severity of condition; parent, therapist and 'masked' evaluator judgement of change. Correlation analysis, t-test and analysis of variance results will be presented. Reliability data for the GMPM and parent/therapist rating scales will be presented using intra-class correlation coefficients. Data supporting responsiveness of the GMPM will be presented using an analysis of variance model for 'stable' and 'responsive' groups.

Adolescent↗