Biomedical subjects

S M Haley

Publications and source records attributed to S M Haley.

At least 19 recordsLinked to original sources

PubMed2005

Central auditory processing and social functioning following brain injury in children.

PRIMARY OBJECTIVE: To describe the percentage of children with central auditory processing disorders (CAPD) and examine the recovery patterns of social functional skills in children with and without CAPD admitted to inpatient rehabilitation following an acquired brain injury (ABI). RESEARCH DESIGN: Retrospective, descriptive. METHODS AND PROCEDURES: Repeated measures ANOVAs were used to examine overall differences in social functioning between groups, within groups and interaction effects for the Paediatric Evaluation of Disability Inventory (PEDI) Social Functional Skills and Caregiver Assistance scales for 31 children admitted to inpatient rehabilitation following ABI. MAIN OUTCOMES AND RESULTS: Significant overall effects were found in group differences and test occasions, but no significant interaction for either PEDI scale. Both groups showed significant intra-group changes between admission and discharge on both scales. CONCLUSIONS: Children with and without CAPD recovered social functional skills during inpatient rehabilitation. Children with CAPD were admitted and discharged with lower Social Function scores but demonstrated greater changes. The identification of CAPD during inpatient rehabilitation allows for appropriate discharge recommendations and realistic recovery expectations.

Adolescent↗

PubMed2001

Espionage scandal leads science news.

Two Japanese molecular biologists are charged with espionage in a case that could strain scientific relations between the U.S. and Japan, report both Nature and Science in their top stories this week.

Cell Line↗

PubMed2001

Short-term durability and improvement of function in traumatic brain injury: a pilot study using the Paediatric Evaluation of Disability Inventory (PEDI) classification levels.

PRIMARY OBJECTIVE: To describe the short-term durability and improvement of functional outcomes for children and adolescents with traumatic brain injury (TBI) up to 6 months after discharge from inpatient rehabilitation. RESEARCH DESIGN: Retrospective, descriptive. METHODS AND PROCEDURES: Twenty-five (28.1%) of 89 children discharged from inpatient rehabilitation were available for outpatient follow-up within 6 months. The Paediatric Evaluation of Disability Inventory (PEDI) functional skill classification levels in the domains of self-care, mobility, and social function, recorded at discharge and follow-up, were examined using the Wilcoxon matched pairs signed rank test (two-tailed). MAIN OUTCOMES AND RESULTS: Most (64-80%) of the children sustained the outcome level achieved at hospital discharge in one or more of the three domains. Significant differences (p < 0.05) from discharge to follow-up were detected in mobility and social function levels. Differences between children with and without follow-up were non-significant in all but one variable (social function level at hospital discharge). CONCLUSIONS: The results of this study suggest that children after TBI sustain outcomes achieved during inpatient rehabilitation and make significant gains in mobility and social function skills within 6 months of returning home. More research is needed to predict those children who will continue to recover and to identify factors that facilitate recovery in the community setting.

Activities of Daily Living↗

PubMed2001

Variation by diagnostic and practice pattern groups in the mobility outcomes of inpatient rehabilitation programs for children and youth.

BACKGROUND AND PURPOSE: The purpose of this study was to describe variation in functional mobility outcomes among children and youth with different diagnoses and belonging to groups with different practice patterns from an inpatient pediatric rehabilitation hospital setting. SUBJECTS: A sample of 138 individuals between the ages of 1 and 22 years (mean=9.4, SD=5.3) was enrolled. METHODS: Physical therapists administered the "Mobility" domain of the Pediatric Evaluation of Disability Inventory at the time of admission and at the time of discharge. Mobility level (combined admission and discharge scores) and amount of change between and within 4 diagnostic groups (traumatic brain injury, non-traumatic brain injury, orthopedic, and neurological) and 5 neuromuscular and musculoskeletal practice pattern groups were calculated, and post hoc analyses were done for specific contrast comparisons. RESULTS: Mobility scores between admission and discharge for all subgroups were different. Practice pattern groups were useful for identifying variations in level of motor performance. Diagnostic groups best described differences in mobility change during inpatient rehabilitation. DISCUSSION AND CONCLUSION: The use of practice patterns as grouping categories may enhance our understanding of variation in clinical outcomes of children during inpatient rehabilitation.

Activities of Daily Living↗

PubMed2001

Self-care recovery of children with brain injury: descriptive analysis using the Pediatric Evaluation of Disability Inventory (PEDI) functional classification levels.

The purpose of this study was to describe self-care recovery of children and adolescents with acquired brain injury using six newly derived self-care functional classification levels, to examine the responsiveness of the levels, and to compare level changes with scaled score changes. Upon admission and discharge to inpatient rehabilitation, the Pediatric Evaluation of Disability Inventory (PEDI) Functional Skills Self-Care domain was administered by occupational therapy staff to 152 children and adolescents with brain injury (mean age = 9.3 years; SD = +/- 5.2). Scaled scores were converted to self-care classification levels. Using the Wilcoxon matched pairs signed rank test, a difference between admission and discharge level was found for the entire group. Children with traumatic brain injury and stroke demonstrated the most change. When compared with scaled score changes, minimal sensitivity was lost when using classification levels. The PEDI self-care levels provide a responsive analysis of recovery and offer an alternative to the reporting of change scores.

Activities of Daily Living↗

PubMed2000

New directions in pediatric rehabilitation measurement: the growing challenge.

The Center on Rehabilitation Effectiveness (CRE) was created in 1998 at Boston University's Sargent College of Health and Rehabilitation Sciences. An important reason for the creation of the Center was demand by purchasers of health services and patients for high quality yet cost-effective rehabilitation programs, particularly with respect to pediatric services. This demand for accountability has created many pressures and challenges for the psychometric community. These challenges include: pediatric rehabilitation assessments that are conceptually grounded in rehabilitation theory; new instruments that are short yet sensitive enough to detect meaningful disability restrictions and that are sensitive enough to measure meaningful change; and new scales that offer real meaningful comparisons across patients. The purpose of this paper is to explain how the Center for Rehabilitation Effectiveness will meet these growing challenges.

Academies and Institutes↗

PubMed1998

Comparison of Rasch and summated rating scales constructed from SF-36 physical functioning items in seven countries: results from the IQOLA Project. International Quality of Life Assessment.

Rasch models for polytomous items were used to assess the scaling assumptions and compare item response patterns in the 10-item SF-36 physical functioning scale (PF-10) for general population respondents in Denmark, Germany, Italy, the Netherlands, Sweden, the United Kingdom, and the United States. The Rasch model of physical functioning developed in the United States was compared to models for other countries, and each country was compared to a multinational composite. Strong scale congruence across the seven countries was demonstrated; items that varied between countries and from the composite may reflect unique cultural response patterns or differences in translation. Scoring algorithms based on the Rasch model for each country were superior to the current Likert scoring in tests of relative validity (RV) in discriminating among age groups in all countries. In relation to the Likert PF-10 scoring (RV = 1.00), scores estimated using the Rasch rating scale model achieve a median RV of 1.31 (range: 1.01-1.59), while the Rasch partial credit model attained a median RV of 1.44 (range: 1.01-2.23). Rasch models hold good potential for improving health status measures, estimating individual scores when responses to scale items are missing, and equating scores across countries.

Aged↗

PubMed1997

Evaluation of the MOS SF-36 Physical Functioning Scale (PF-10): II. Comparison of relative precision using Likert and Rasch scoring methods.

This study examined the relative precision (RP) of two methods of scoring the 10-item Physical Functioning Scale (PF-10) from a large sample of patients (n = 3445) of the Medical Outcomes Study. Based on a Likert scaling model, the PF-10 summated scoring method was compared with a Rasch Item Response Theory (IRT) scaling model in which raw scores were transformed into a latent trait variable of physical functioning. Potential differences between scoring methods were hypothesized to be attributed to: (1) the logarithmic nature of the Rasch transformation; (2) the unevenness of the PF-10 item distributions; and (3) reduction of within-group variance. RP ratios favored the Rasch model in discriminating between patients who differed in disease severity. The Rasch and Likert scoring models performed similarly for tests involving sensitivity to change over a two-year follow-up period. In all comparisons, differences between methods were most apparent in clinical groups whose scores most approximated the extremes of the score distribution. Further research is necessary to test for differences between scoring models in discrimination and sensitivity to change among clinical groups whose scores are sufficiently spread across the continuum of physical functioning, in particular patients with either very high or low physical functioning. The Rasch model of scoring may have important implications for the clinical interpretation of individual scores at all ranges of the scale.

Data Interpretation, Statistical↗

PubMed1995

Validity of the Peabody Developmental Gross Motor Scale as an evaluative measure of infants receiving physical therapy.

BACKGROUND AND PURPOSE: The purpose of this study was to examine the validity of the Peabody Developmental Gross Motor Scale (PDMS-GM) as an evaluative measure of infants receiving physical therapy. SUBJECTS AND METHODS: Infants who attended an early intervention program (N = 124) were grouped by diagnosis: cerebral palsy, Down syndrome, hydrocephalus, preterm with developmental delay, full term with developmental delay, and other. The PDMS-GM was administered to each infant three times over a 6-month period by a therapist who did not provide treatment. RESULTS: Mean scaled scores and age-equivalent scores increased for each group. Individual change was examined using the reliable change index. The results indicated that the change in total raw score for 62% of the infants was greater than what could be attributed to measurement error. When minimal clinically important change was defined as 10 scaled score points, the index of responsiveness was equal to 0.5. This finding indicates that a sample size of 68 subjects per group would be needed when the PDMS-GM is used as an outcome measure in research. CONCLUSION AND DISCUSSION: The mean change scores for each group support the use of the PDMS-GM as an evaluative measure. For many infants, particularly infants with cerebral palsy, the PDMS-GM was not responsive to change over a 6-month period. The index of responsiveness suggests that the PDMS-GM should be used only as an outcome measure in large clinical trials. The PDMS-GM is not recommended for evaluating the direct effects of physical therapy but is recommended for providing a global measure of change in motor development as part of a multidimensional assessment.

Cerebral Palsy↗

PubMed1994

Evaluation of the MOS SF-36 physical functioning scale (PF-10): I. Unidimensionality and reproducibility of the Rasch item scale.

Indexes developed to measure physical functioning as an essential component of general health status are often based on sets of hierarchically-structured items intended to represent a broad underlying concept. Rasch Item Response Theory (IRT) provides a methodology to examine the hierarchical structure, unidimensionality, and reproducibility of item positions (calibrations) along a scale. Data gathered on the 10-item Physical Functioning Scale (PF-10) from a large sample of Medical Outcomes Study patients (N = 3445) were used to examine the hierarchical order, unidimensionality, and reproducibility of item calibrations. Rasch-IRT analyses generated an empirical item hierarchy, confirmed the unidimensionality of the PF-10 for most patients, and established the reproducibility of item calibrations across patient populations and repeated tests. These findings support the content validity of the PF-10 as a measure of physical functioning and suggest that valid Rasch-IRT summary scores could be generated as an alternative to the current Likert summative scores. Unidimensionality and reproducibility of the item scale are essential prerequisites for the development of Rasch-based person measures of physical functioning that can be used across populations and over repeated tests.

Activities of Daily Living↗

PubMed1994

Physical therapy episodes of care for patients with low back pain.

BACKGROUND AND PURPOSE: Although individuals with low back pain frequently receive treatment from a physical therapist, few published studies exist that describe who sees a physical therapist for their low back pain nor is much known about physical therapy episodes of care for this condition. Secondary analysis of data from the American Physical Therapy Association's Survey of Physical Therapy Outpatient Practice provides new descriptive data on services provided to a national, representative sample of patients discharged from hospital-based and private outpatient practices. In addition, specific hypotheses were tested on clinical and background factors believed to influence low back pain episodes of care. SUBJECTS: Patients with low back pain represented over 25% of all outpatient discharges from physical therapy practices. METHODS: A mail survey was conducted with representatives of a national probability sample of facilities that provided outpatient physical therapy services. Data were provided on each facility and on a discharge sample of patients treated at each facility. RESULTS: On average, episodes of care extended over 5 weeks and consisted of 11 therapy visits, for an average charge of $766.70. Duration and charge for low back episodes of care did not differ, on average, in private versus hospital-based practices. Certain aspects of care, however, did vary across regions of the country. Episodes of care charged to workers' compensation were costlier than those charged to other insurance carriers, and whites were charged less, on average, than nonwhites. Duration of back symptoms was related to intensity, duration, and charges incurred for the episode of care. CONCLUSION AND DISCUSSION: Further research is needed to understand the reasons for the relationships observed in this study, as well as studies that relate care provided by physical therapists to specific patient outcomes. Further research is also needed to compare outcomes achieved across different health professions.

Adult↗

PubMed1994

Measuring physical disablement: the contextual challenge.

Context is a fundamental consideration in physical therapy assessment and in the interpretation of physical disablement. Specification of context may include physical requirements of a task such as the demands for speed or a specific degree of accuracy, or the social context in which an activity is performed such as dressing for work versus dressing for leisure activities. Context also encompasses individual factors such as the importance of particular activities within the person's culture or value system, or the specific types of roles requiring physical functioning that a person resumes upon discharge from physical therapy. Data are presented to illustrate the differences in performance across related physical tasks and between self-care and mobility tasks in home and school settings in children with severe functional delays. These data highlight the potential impact of context on performance. Implications for future development of functional assessments are discussed, particularly in light of the importance of incorporating contextual information in the clinical interpretation of disablement outcomes for patient groups and individual patients.

Activities of Daily Living↗

PubMed1992

Measurement of isometric force in children with and without Duchenne's muscular dystrophy.

The purpose of this study was to examine the consistency of measurements of maximal isometric force production in children using an electronic strain gauge. A standardized protocol of force testing from the Tufts Quantitative Neuromuscular Examination was adapted to obtain isometric force measurements in seven muscle groups bilaterally. Ten children with Duchenne's muscular dystrophy (DMD) and 10 age-matched children without DMD were recruited for the study. A generalizability framework was used to examine variations in measurements attributable to group differences, test occasions within the same day, and extremity side. Intertester reliability estimates were also completed on a subsample of children with and without DMD. A three-way analysis of variance between groups, sides, and test occasions demonstrated a significant group main effect for all muscle groups. In general, significant main effects were not present for side or test occasion. Test-retest intraclass correlation coefficients (ICCs) for all muscle groups ranged from .88 to .99 for the children with DMD and from .85 to .98 for the children without DMD. Intertester ICCs were slightly lower, ranging from .74 to .97 for the children with DMD and from .71 to .98 for the children without DMD. The results indicate that the electronic strain-gauge protocol produces reproducible force measurements in seven selected muscle groups in children with and without DMD. Brussock CM, Haley SM, Munsat TL, Bernhardt DB. Measurement of isometric force in children with and without Duchenne's muscular dystrophy.

Adolescent↗

PubMed1992

Applicability of the hierarchical scales of the Tufts Assessment of Motor Performance for school-aged children and adults with disabilities.

The relative difficulty of motor performance tasks for school-aged children and adults with physical disabilities within a standardized motor performance test was examined. The Tufts Assessment of Motor Performance (TAMP) was administered to 69 children (ages 6-18 years, X = 12.1, SD = 3.9) and 137 adults (ages 19-83 years, X = 46.7, SD = 20.0) with neurological and musculoskeletal impairments. The purpose of the study was to determine whether the hierarchical scales of the motor performance tasks between the pediatric and adult disability samples were congruent. Correlations of task difficulty calibrations (r = .76; P less than .01) and task rank ordering (rho = .76; P less than .01) were moderately high and positive between pediatric and adult subjects. Significant age-group differences emerged in relation to a number of individual motor performance tasks. In general, mobility and ambulation tasks were relatively easier for children, whereas manipulation tasks were relatively easier for adults. The data suggest a strong similarity in the overall pattern of motor performance task difficulty for children and adults. The results support the use by physical therapists of two parallel versions of the TAMP to describe the motor performance of adults and school-aged children with physical disabilities.

Activities of Daily Living↗

PubMed1992

Goal attainment scaling as a measure of change in infants with motor delays.

Goal attainment scaling (GAS) is an individualized criterion-referenced measure of change that has several unique features, compared with the behavioral objective, and five possible levels of attainment for each goal. The validity of GAS as a measure of motor change was investigated in 65 infants, 3 to 30 months of age, with motor delays. For each infant, two goals to be attained within a 6-month period of intervention were established. After the 6-month period, the mean GAS T-score of 55.4 was significantly higher than the expected mean of 50. This finding indicated that the infants' motor change exceeded the therapists' expectations. Neither the type nor the category of goal influenced the therapists' ability to select outcomes that the infants were capable of achieving. Because moderate and low correlations were found between GAS T-scores and Peabody gross motor and fine motor change scores, the two assessments appear to measure different aspects of motor development. Selected child, family, and program variables were examined as sources of bias in GAS T-scores. Motor delay was the only variable that biased GAS T-scores; infants who were less delayed had higher GAS T-scores. The results indicate that GAS was responsive to change in individualized motor goals and support the model of GAS as an idiosyncratic measure. The unique features of GAS offer advantages for measurement of motor change compared with the behavioral objective and norm-referenced developmental scales.

Bias↗

PubMed1991

Tufts assessment of motor performance: an empirical approach to identifying motor performance categories.

The Tufts Assessment of Motor Performance (TAMP) is a criterion-referenced test that measures motor performance capabilities of basic self-care skills, mobility and physical aspects of communication. Discrete motor performance tasks were identified within each of the 32 items. The purpose of this paper is to report the results of an empirical method of determining the factor structure underlying the motor performance tasks of the TAMP. Initially, motor performance tasks were categorized into a priori groupings based on previous literature and clinical judgment. The TAMP was administered to 206 children and adults (age range 6 to 86 years) with physical disabilities. Diagnoses included a variety of musculoskeletal and neurologic disorders. A principal-factor analysis was used to organize and cluster the item tasks into appropriate common factors. Seven factors were identified that accounted for 70.6% of the total variance for the assistance dimension; similar results were obtained for other measurement dimensions of the TAMP. The defined factor structure has patterns of similarity to the motor performance variables as defined by clinical judgment; however, the tasks were organized into factors that were more functionally oriented than expected. The results provide a framework for which the motor performance tasks of the TAMP might be organized into scales that identify essential performance constructs for rehabilitation. The results permit examination of the nature and clinical importance of these common motor performance factors for clinical evaluation and the description of functional disability.

Adolescent↗

PubMed1990

Concurrent and construct validity of the Pediatric Evaluation of Disability Inventory.

The purpose of this study was to determine the validity of the Development Edition (pilot version) of the Pediatric Evaluation of Disability Inventory (PEDI) in groups of disabled and nondisabled children. The PEDI is a new functional assessment instrument for the evaluation of disabled children aged 6 months to 7 years. The PEDI has been developed to identify functional status and change along three dimensions: 1) functional skill level, 2) caregiver assistance, and 3) modifications or adaptive equipment used. The PEDIs were administered as a parental-report questionnaire, and the results were compared with data obtained by the Battelle Developmental Inventory Screening Test (BDIST). The BDIST is a standardized assessment with developmental and adaptive content. Subjects were 20 children between the ages of 2 and 8 years with arthritic conditions and spina bifida and 20 nondisabled children matched for age and sex. All subjects' scores on the BDIST cognitive domain were no greater than 1.50 standard deviations below the mean for their age group. Concurrent validity was supported by moderately high Pearson product-moment correlations between BDIST and PEDI summary scores (r = .70-.80). Construct validity was supported by significant differences between the disabled and nondisabled groups' PEDI scores and by discriminant analysis identifying the PEDI scores as better group discriminators than the BDIST scores. Results validate the Developmental Edition of the PEDI and support the further development and standardization of the final version. Use of the PEDI in clinical pediatric physical therapy practice is discussed.

Adolescent↗

PubMed1990

Characteristics of cost outliers who did not benefit from stroke rehabilitation.

The purpose of this paper is twofold: 1) to identify stroke patients who generated substantial charges during inpatient rehabilitation, but did not seem to benefit from that experience and 2) to identify factors that can predict which patients will fall into this group using only variables known at admission to rehabilitation. High cost stroke patients during inpatient medical rehabilitation are examined to determine how they differ from low cost patients and to identify a subset who did not appear to benefit from rehabilitation. This paper is based on longitudinal charge data involving 73 former stroke rehabilitation patients discharged from three Boston area rehabilitation facilities in 1984. Medical charges are presented on initial acute and rehabilitation inpatient stays and on care received in the 12 months after discharge. Among these 73 stroke patients, charges for inpatient medical rehabilitation amounted to nearly 1.8 million dollars, excluding physician fees and out-of-pocket expenses. Of this total, 57.6% was accured by only 33% of the patients. Fourteen patients, who were both rehabilitation cost outliers and apparent rehabilitation "failures," were identified. Rehabilitation charges for these 14 amounted to $673,232 or 37.5% of the total rehabilitation charges for all 73 patients.

Adult↗