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Hassani S.,Shriners Hospitals for Children Chicago | Krzak J.J.,Shriners Hospitals for Children Chicago | Johnson B.,Shriners Hospitals for Children Salt Lake City | Flanagan A.,Shriners Hospitals for Children Chicago | And 6 more authors.
Developmental Medicine and Child Neurology | Year: 2014

Aim: This prospective multicenter study assessed performance and changes over time, with and without surgical intervention, in the modified Timed Up and Go (mTUG) and One-Minute Walk tests (1MWT) in children with bilateral cerebral palsy (CP). Minimum clinically important differences (MCIDs) were established for these tools. Method: Two hundred and nineteen participants with bilateral spastic CP (Gross Motor Function Classification System [GMFCS] levels I-III) were evaluated at baseline and 12 months follow-up. The non-surgical group (n=168; 54 females, 114 males; mean age 12y 11mo, [SD 2y 7mo], range 8y 1mo-19y) had no surgical interventions during the study. The surgical group (n=51; 19 females, 32 males; mean age 12y 10mo [SD 2y 8mo] range 8y 2mo-17y 5mo) underwent soft-tissue and/or bony procedures within 12 months from baseline. The mTUG and 1MWT were collected and MCIDs were established from the change scores of the non-surgical group. Results: Dependent walkers (GMFCS level III) required more time to complete the mTUG (p≤0.01) than independent walkers (GMFCS levels I and II). For the 1MWT, distance walked decreased with increasing impairment (p≤0.01). 1MWT and mTUG change scores were not significantly different at any GMFCS level for either the surgical or non-surgical groups (p≤0.01). Interpretation: Children with varying levels of function (GMFCS level) perform differently on the 1MWT and mTUG. The data and MCID values can assist clinicians in interpreting changes over time and in assessing interventions. © 2013 Mac Keith Press. Source


Hassani S.,Director of Research Administration | Krzak J.,Director of Research Administration | Flanagan A.,Director of Research Administration | Bagley A.,Shriners Hospitals for Children Northern California | And 6 more authors.
Critical Reviews in Physical and Rehabilitation Medicine | Year: 2011

The purpose of this work is to provide comparison data for muscle strength and measures of activity and participation stratified by GMFCS level, age, and cerebral palsy (CP) type. Clinicians can use the data to determine treatment goals based on the patients' matched peer group. Methods used were data were collected on 377 individuals with hemiplegia and diplegia, GMFCS levels I-III, ages eight to18 years. Lower extremity muscle strength, Gillette gait index (GGI), one-minute walk test (1MWT), and timed up-and-go (TUG) were collected. Results showed that strength differed among GMFCS levels and age for both CP types. The GGI and 1 MWT discriminated among GMFCS levels within each CP type. The TUG discriminated between GMFCS levels I and III and levels II and III for the diplegic group. We conclude that differences in strength and measures of activity and participation were found across GMFCS levels and CP type. The reported stratified data can serve as an important clinical tool in determining realistic treatment goals and clinical outcomes. © 2011 by Begell House, Inc. Source


Flanagan A.,Shriners Hospitals for Children Chicago | Krzak J.,Shriners Hospitals for Children Chicago | Hassani S.,Shriners Hospitals for Children Chicago | Bagley A.,Shriners Hospitals for Children Northern California | And 6 more authors.
Critical Reviews in Physical and Rehabilitation Medicine | Year: 2011

The objective of this work was to quantitatively describe the relationships among overall lower extremity strength and body composition with measures of activity in ambulatory children with cerebral palsy (CP). The design was a prospective, multicenter cohort, cross-sectional study among seven pediatric orthopedic facilities. The participants included children ages eight to 18 years (n = 392; 249 male, 143 female), GMFCS levels I- III (I = 155; II = 160; III = 77) with diplegia (n = 280, mean age 12.9 ± 2.7 years) and hemiplegia (n = 112, mean age 12.6 ± 2.9 years). Main outcome measures include lower extremity strength, body composition, and activity. Quantitative relationships among variables were reported using Pearson correlation coefficients with p < 0.001. Results show strength had fair to moderate correlations with GMFM-66 and PODCI global function, sports and physical function, and transfer and basic mobility scores for children with diplegia. Children with hemiplegia demonstrated a fair correlation between strength and GMFM-66 score. For children with diplegia and hemiplegia, BMI was not correlated with measures of function or activity. Body fat percentage demonstrated a fair correlation with PODCI global function scores for children with hemiplegia. Body composition measures had a fair correlation to overall strength for both those with hemiplegia and diplegia. Stronger relationships among measures were observed in higher functioning children. It is concluded that a positive relationship exists between lower extremity strength and measures of activity in ambulatory children with CP. There are multiple factors influencing activity in children with CP, and strength and body composition should not be ignored. © 2011 by Begell House, Inc. Source


Johnson B.A.,Shriners Hospitals for Children Salt Lake City | MacWilliams B.A.,Shriners Hospitals for Children Salt Lake City | MacWilliams B.A.,University of Utah | Stevenson D.A.,Shriners Hospitals for Children Salt Lake City | Stevenson D.A.,University of Utah
Human Movement Science | Year: 2014

Previous research has evaluated the motor proficiency of children with neurofibromatosis type 1 (NF1) and found delays on the balance subtest. However the balance subtest was found to have low sensitivity for identifying balance impairments. This study examines the differences in postural control between children with NF1 and peers with typical development using a force plate. A single limb stance test on a force plate was completed for all participants. The force plate variables, center of pressure maximum distance in the anterior/posterior direction (COPmax A/P) and center of pressure velocity (COPvel A/P) were compared between groups. The NF1 group's performance was significantly poorer than the control group in both COPmax A/P (p=.01) and COPvel A/P (p=.01). When separated into specific age ranges, only the children in the NF1 group between 5 and 12. years of age demonstrated statistically significant differences in the COP variables. The COP variables for the 13- to 18-year-old group were not significantly different. These results indicate that young children with NF1 have poor postural control. However, postural control appears to improve with maturation. © 2014 Elsevier B.V. Source


Johnson B.A.,Shriners Hospitals for Children Salt Lake City | MacWilliams B.A.,Shriners Hospitals for Children Salt Lake City | MacWilliams B.A.,University of Utah | Carey J.C.,University of Utah | And 4 more authors.
Pediatric Physical Therapy | Year: 2010

PURPOSE: Neurofibromatosis type 1 (NF1) is a genetic disorder with associated musculoskeletal abnormalities, tumors, and developmental delays. The purpose of this study was to investigate and characterize the motor proficiency of children with NF1. METHODS: Children with NF1 were assessed using the Bruininks-Oseretsky Test (BOT 2) instrument. The NF1 group scores were compared with age and sex-matched test norms. RESULTS: Twenty-six children participated in the study. The NF1 group had statistically significant lower scores (P < .05) for the total motor composite (Z = -1.62) and 7 of the 8 subtests. Nineteen percent (n = 5) scored in the average category, 54% (n = 14) scored in the below-average category, and 27% (n = 7) scored in the well-below-average category. CONCLUSIONS: Children with NF1 have significantly lower motor proficiency than the BOT 2 normative scores. The results indicate the BOT 2 is useful in identifying and characterizing delays in motor proficiency for children with NF1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins and Section on Pediatrics of the American Physical Therapy Association. Source

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