Biomedical subjects

Robert J Palisano

Publications and source records attributed to Robert J Palisano.

13 recordsLinked to original sources

PubMed2006

Performance of physical activities by adolescents with cerebral palsy.

BACKGROUND AND PURPOSE: Mobility and self-care are important considerations for successful transition of adolescents with cerebral palsy to adulthood. The purpose of this study was to characterize performance of physical activities from the perspective of adolescents themselves. SUBJECTS: The subjects were 156 adolescents with cerebral palsy, 11.6 to 17.7 years of age. METHODS: A therapist completed the Gross Motor Function Classification System (GMFCS). Adolescents completed the Activities Scale for Kids-Performance Version (ASKp) twice over a 1-year period. RESULTS: A repeated-measures analysis of variance indicated a main effect for GMFCS level. The main effect for time and the GMFCS level x time interaction were not significant. Post hoc comparisons indicated that ASKp scores differed among all GMFCS levels. DISCUSSION AND CONCLUSION: Performance of physical activities by adolescents with cerebral palsy differed based on GMFCS level and did not change over 1 year. The ASKp scores of adolescents in levels II through V suggest the need for physical assistance at times throughout the day. The results have implications for the role of the physical therapist in transition planning.

Activities of Daily Living↗

PubMed2006

Stability of the gross motor function classification system.

The aim of this study was to assess the stability of the Gross Motor Function Classification System (GMFCS) by examining whether children with cerebral palsy (CP) remain in the same level over time. Participants were 610 children with CP (342 males, 268 females; mean age 6y 9mo [SD 2y 10mo]), range 16mo-13y). Children were assessed 2 to 7 times (mean 4.3) at 6-month (children <6y old) or 12-month(children >or=6y old) intervals. Seventy-three per cent of children remained in the same level for all ratings. The weighted kappa coefficient between the first and last ratings was 0.84 for children less than 6 years old and 0.89 for children at least 6 years old, indicating excellent chance-corrected agreement. Children initially classified in Levels I and V were least likely to be reclassified. There was a tendency for children younger than 6 years who were reclassified to be done so to a lower level of ability. The results provide evidence of stability of the GMFCS.

Child↗

PubMed2006

A collaborative model of service delivery for children with movement disorders: a framework for evidence-based decision making.

Models of physical therapist service delivery provide a framework for integration of knowledge, research, and assumptions in a clinically relevant context that facilitates evidence-based decision making. In this perspective, a collaborative model of service delivery for children with movement disorders is presented. The focus is on services that address child and family priorities and preferences in settings where children live, learn, and play. The International Classification of Functioning, Disability and Health (ICF) is applied to identify relationships among the components of functioning, environmental, and personal factors that are important for the plan of care and achievement of outcomes. An assumption of the model is that physical therapists use multiple types of evidence to guide decision making. Application of the model and how child and family priorities change over time are illustrated through a longitudinal case report of a child with cerebral palsy.

Cerebral Palsy↗

PubMed2005

Assessment of motor development and function in preschool children.

The process of identification of children with delays or disorders in motor development includes developmental screening, examination, and reexamination. Throughout this process, various types of measures are used, including discriminative and evaluative measures. Discriminative and evaluative measures of motor development and function that are commonly used for preschool-aged children include the Bayley Scales of Infant Development II, Peabody Developmental Motor Scales, 2nd edition, Toddler and Infant Motor Evaluation, Pediatric Evaluation of Disability Inventory, and Gross Motor Function Measure. Selecting an appropriate measure is a crucial part of the examination process and should be geared toward the purpose of testing and characteristics of the child. Evidence of reliability and validity are important considerations for selection of a measure.

Child Development↗

PubMed2004

Recent advances in physical and occupational therapy for children with cerebral palsy.

Recent research and conceptual frameworks that emphasize family centered care and participation in family, school, and community life have contributed to advances in provision of health care by physical therapists and occupational therapists to children with cerebral palsy (CP) and their families. This article provides a contemporary perspective on physical and occupational therapy for children with CP. Topics include conceptual frameworks, early identification, prognosis for gross motor function, implications of impairment in motor control and muscle performance, and physical fitness and secondary prevention. Case scenarios and examples illustrate how current knowledge and research is applied to decision making within the context of the individual child and family.

Activities of Daily Living↗

PubMed2004

Limb distribution, motor impairment, and functional classification of cerebral palsy.

This study explored the relationships between the Gross Motor Function Classification System (GMFCS), limb distribution, and type of motor impairment. Data used were collected in the Ontario Motor Growth study, a longitudinal cohort study with a population-based sample of children with cerebral palsy (CP) in Canada (n=657; age 1 to 13 years at study onset). The majority (87.8%) of children with hemiplegia were classified as level I. Children with a bilateral syndrome were represented in all GMFCS levels, with most in levels III, IV, and V. Classifications by GMFCS and 'limb distribution' or by GMFCS and 'type of motor impairment' were statistically significantly associated (Pearson's chi2 p<0.001), though the correlation for limb distribution (two categories) by GMFCS was low (tau-b=0.43). An analysis of function (GMFCS) by impairment (limb distribution) indicates that the latter clinical characteristic does not add prognostic value over GMFCS. Although classification of CP by impairment level is useful for clinical and epidemiological purposes, the value of these subgroups as an indicator of mobility is limited in comparison with the classification of severity with the GMFCS.

Adolescent↗

PubMed2004

Muscle force and range of motion as predictors of standing balance in children with cerebral palsy.

Children with cerebral palsy frequently receive therapeutic intervention to remediate standing balance deficits. Evaluation of the impairments associated with poor balance could facilitate more effective treatment programs. This study evaluated the relationship between lower extremity force production, range of motion and standing balance in thirty-five children between the ages of 6 and 14 years of age with spastic cerebral palsy. Standing balance was evaluated using the Pediatric Clinical Test of Sensory Interaction (P-CTSIB). Hand-held dynamometry was used to assess force production and goniometry was used to assess range of motion. The results indicated that force production and range of motion are highly related to standing balance. Blocked, hierarchical multiple regression analysis revealed that force production explained 41% of the variance in P-CTSIB scores in this sample, while range of motion explained an additional 13%. Therefore, the total variance explained by these variables was 54%. Results of this study suggest that impairment level testing may allow the development of more effective individualized intervention programs to remediate balance deficits. Clinical suggestions are provided.

Adolescent↗

PubMed2004

Changes in mobility of children with cerebral palsy over time and across environmental settings.

This study examined changes in mobility methods of children with cerebral palsy (CP) over time and across environmental settings. Sixty-two children with CP, ages 6-14 years and classified as levels II-IV on the Gross Motor Function Classification System, were randomly selected from a larger data base and followed for three to four years. On each of several assessments, parents completed a questionnaire on their child's usual mobility methods in the home, school, and outdoors/community settings. During the first assessment interval, mobility methods increased to methods requiring more gross motor control. During the second assessment interval, mobility methods were unchanged or decreased to methods requiring less gross motor control. Changes within the child and within the environment are hypothesized to occur and to impact changes in mobility methods. Screening at regular intervals is recommended to monitor changes in mobility. Interventions to enhance mobility may be indicated during periods of change in the child or exposure to new environments.

Adolescent↗

PubMed2004

Reliability of a measure of muscle extensibility in fullterm and preterm newborns.

PURPOSE: The purpose of this study was to examine the test-retest and inter-rater reliability of a measure of muscle extensibility developed by Tardieu, de la Tour, Bret, and Tardieu (1982) in fullterm and preterm newborns. METHOD: Twenty-one fullterm infants and twenty preterm infants were examined by two physical therapists. Each physical therapist measured AO (shortened position of the muscle belly and lengthened tendon) and AMax (maximum muscle belly and tendon length) of the gastrocnemius/ soleus muscle twice in succession. Reliability was assessed using intraclass correlation coefficients (2,2) and (3,2). RESULTS: Inter-rater reliability between the two examiners ranged from .86 to .97 and test-retest reliability on the two measures ranged from .91 to .98. CONCLUSIONS: The results suggest that this measure of muscle extensibility is reliable in the gastrocnemius/soleus muscle with fullterm and preterm newborns. Further research is needed to investigate if differences in muscle extensibility are present between fullterm and preterm infants and the relationship between muscle extensibility and active movement.

Ankle↗

PubMed2004

Gross motor capability and performance of mobility in children with cerebral palsy: a comparison across home, school, and outdoors/community settings.

BACKGROUND AND PURPOSE: Mobility of children with cerebral palsy (CP) has generally been examined in terms of capability (what a child can do) in a controlled environment, rather than performance (what a child does do) in everyday settings. The purpose of this study was to compare gross motor capability and performance across environmental settings in children with CP. SUBJECTS: The subjects were 307 children with CP, aged 6 to 12 years, who were randomly selected across Ontario, Canada. METHODS: Children were grouped by capability (the highest of 3 items achieved on the Gross Motor Function Measure). Performance was measured via a parent-completed questionnaire on usual mobility methods in the home, at school, and in the outdoors or community. RESULTS: There were statistically significant differences in performance across settings for children in all capability groups. Children who were capable of crawling performed crawling more at home than at school or in the outdoors or community. Children who were capable of walking with support performed walking with support more at school than in the outdoors or community. Children who were capable of walking alone performed walking alone more at home than at school or in the outdoors or community, and more at school than in the outdoors or community. DISCUSSION AND CONCLUSION: The results provide evidence that children with CP with similar capability demonstrate differences in performance across settings. The results suggest that physical therapists should examine performance in the settings that are important to the child's daily life.

Cerebral Palsy↗

PubMed2003

Effect of environmental setting on mobility methods of children with cerebral palsy.

The aim of this study was to: (1) describe the usual mobility methods of children with cerebral palsy (CP) at home, school, and outdoors or in the community and (2) examine whether children with CP are more dependent on adult assistance for mobility in certain settings. The participants were a stratified random sample of 636 children with CP (355 males and 281 females; 2 to 12 years of age, mean 6.8 years SD 2.7), receiving rehabilitation services in Ontario, Canada. Children were grouped by age and Gross Motor Function Classification System (GMFCS) level. Among the five levels of the GMFCS, there were 185 children classified at level I, 81 children at level II, 113 children at level III, 132 children at level IV, and 125 children at level V. Information on children's usual mobility was obtained by parent report. The results of logistic regression indicated that compared with the school setting, children were more dependent on adult assistance for mobility when outdoors/in the community and less dependent at home. The majority of children aged from 4 to 12 years at levels III to V used wheelchair mobility at school and outdoors or in the community, however, only a small percentage self-propelled their wheelchair or used powered mobility. Of the children aged 4 to 12 years at level V, 39% were carried at home. The findings suggest that environmental setting is an important consideration for assessment and intervention to improve mobility of children with CP. For children who do not walk, attention should be given to the needs of caregivers and factors that are important for successful powered mobility.

Activities of Daily Living↗

PubMed2002

Prognosis for gross motor function in cerebral palsy: creation of motor development curves.

CONTEXT: Lack of a valid classification of severity of cerebral palsy and the absence of longitudinal data on which to base an opinion have made it difficult to consider prognostic issues accurately. OBJECTIVE: To describe patterns of gross motor development of children with cerebral palsy by severity, using longitudinal observations, as a basis for prognostic counseling with parents and for planning clinical management. DESIGN: Longitudinal cohort study of children with cerebral palsy, stratified by age and severity of motor function and observed serially for up to 4 years during the period from 1996 to 2001. SETTING: Nineteen publicly funded regional children's ambulatory rehabilitation programs in Ontario. PARTICIPANTS: A total of 657 children aged 1 to 13 years at study onset, representing the full spectrum of clinical severity of motor impairment in children with cerebral palsy. MAIN OUTCOME MEASURES: Severity of cerebral palsy, classified with the 5-level Gross Motor Function Classification System; function, formally assessed with the Gross Motor Function Measure (GMFM). RESULTS: Based on a total of 2632 GMFM assessments, 5 distinct motor development curves were created; these describe important and significant differences in the rates and limits of gross motor development among children with cerebral palsy by severity. There is substantial within-stratum variation in gross motor development. CONCLUSIONS: Evidence-based prognostication about gross motor progress in children with cerebral palsy is now possible, providing parents and clinicians with a means to plan interventions and to judge progress over time. Further work is needed to describe motor function of adolescents with cerebral palsy.

Adolescent↗

PubMed2002

Physical therapists' perceptions of factors influencing the acquisition of motor abilities of children with cerebral palsy: implications for clinical reasoning.

BACKGROUND AND PURPOSE: Evidence supporting factors predicting motor change for children with cerebral palsy is minimal. A consensus exercise using focus groups and survey methods was conducted to identify factors perceived to affect the acquisition of basic motor abilities among children with cerebral palsy from the time of diagnosis to 7 years of age. SUBJECTS: Fifty-seven physical therapists participated in one of 12 focus groups, and 60 physical therapists participated in a follow-up questionnaire survey via mail. METHODS: The nominal group technique was used to conduct the focus groups. RESULTS: Participants reached consensus about 12 factors in 4 constructs, which we called: (1) primary impairments (muscle tone/movement patterns, distribution of involvement, balance, and sensory impairment), (2) secondary impairments (range of motion/joint alignment, force production, health, and endurance), (3) personality characteristics (motivation), and (4) family factors (support to child, family expectations, and support to family). DISCUSSION AND CONCLUSION: The recognition of potential determinants of motor change could assist in the clinical reasoning that physical therapists use when planning interventions for children with cerebral palsy. Participants identified a set of variables, some of which are found in the literature, that can provide foundation knowledge for decision making and research on factors that bring about change in motor ability among children with cerebral palsy.

Attitude of Health Personnel↗