assessment procedures control cerebral palsy
TRANSCRIPT
Assessment Procedures for Postural Control for Children with Cerebral
Palsy Sarah (Sally) Westco; McCoy, PT, PhD
Department of RehabilitaBon Medicine University of Washington, Sea;le, WA,
USA
University of Washington
Overview of PresentaBon
• Overall Measurement Model for Children with CP
• Postural Control System Model
• Postural Control Motor ExaminaBon – Movement strategies – Control of Dynamics
Measurement Model from Move & PLAY study
• Movement and ParBcipaBon in Life AcBviBes in Young Children with CP (Bartle; et al. 2010)
• Child (Body Structure/FuncBon Impairments) – Primary – Secondary – Associated Health CondiBons/Co-‐MorbidiBes – AdapBve behavior
• Family Ecology – Family environment – Family Support to Child – Family ExpectaBons of Child
• Outcomes (AcBvity & ParBcipaBon) – Motor, self-‐care, parBcipaBon in play & work
Postural Control Model (Westco; & Burtner, 2004)
Postural Control Model (Horak, 2006)
• Musculoskeletal!– Biomechanical
Constraints!
• Motor!– Movement
Strategies!
– Control of Dynamics!
• Cogni-ve – Cogni-ve Processing
• Memory
– Reten-on of Learning
• Perceptual – Orienta-on in Space
– Sensory Strategies
Movement Strategies
• Components of PC movement strategies – Postural PreparaBons – ReacBve Postural Adjustments – AnBcipatory Postural Adjustments
• Control of dynamics within all movements
Postural Movement Strategies (Liu, 2001)
ExaminaBon of Postural Control
• Purpose of tes-ng: • DiscriminaBon
– IdenBfy if a balance problem exists
• EBology – Determine underlying cause
• Quali-es of tests: • ReflecBve of funcBonal capabiliBes & quality of postural strategies
• SensiBve & selecBve for postural control problems
• Reliable & valid • PracBcal-‐easy to use & inexpensive.
• Mancini & Horak, 2010
Movement Strategies
• Motor RPA: – Ordinal schemes: Movement Assessment of Infants – AutomaBc
ReacBons SecBon (MAI-‐AR) (Chandler et al. 1980)
Movement Strategies
• Motor APA: – Interval schemes: Lab tests (COP; EMG); FuncBonal reach test (FRT); Pediatric
Reach Test (PRT) (Liu, Zaino & Westco; McCoy 2007; Zaino & Westco; McCoy 2008; Donahue et al. 1994; Volkman et al. 2007; Bartle; & Burmingham 2003)
Movement Strategies
• Sifng reach tests • FuncBonal reach • Reach area • Bilateral reach
– (Sprigle et al. 2007)
• Standing Push-‐pull tests – In-‐place response – Compensatory stepping – Needs to be developed
Movement Strategies
• CombinaBon of Postural PreparaBon, RPA, APA • Pediatric Balance Scale (PBS)
– (Franjoine, Gunther, & Taylor, 1999, 2003; Ko; & Held, 2002; Gan et al. 2008) • Rated on ordinal scale as to Bme & quality
– 14 funcBonal movement items • StaBc & dynamic tasks • Sifng, standing, transfers • Reaching & turning
– Reliability: Inter-‐rater & test-‐retest high – Concurrent validity: high with funcBonal mobility tasks
Movement Strategies
• Pediatric Balance Scale – 14 funcBonal movement items:
• Sit to stand & Stand to sit (combine with TUG) • Sit unsupported • Transfers • Stand unsupported, with eyes closed, with feet together, heel-‐to-‐toe • Stand on one foot (TOLS) • Turn 360 degrees • Turn to look behind • Retrieve object from floor • Place alternate feet on stool • Reach forward with outstretched arm (FRT)
Movement Strategies
• Early Clinical Assessment of Balance – 430 Children with CP: Move & PLAY study
• Gross Motor FuncBon ClassificaBon System Levels I-‐V • Age 1.5 to 5 years • Children at GMFCS I-‐III tested on the Pediatric Balance Scale (PBS) (Franjoine, Gunther, & Taylor, 1999)
• Children at GMFCS IV-‐V tested on the Movement Assessment of Infants – AutomaBc ReacBons secBon (MAI-‐AR) (Chandler et al. 1980)
– Head control RPA to Standing APA and Control of dynamics
Movement Strategies
• Early Clinical Assessment of Balance – DeterminaBon of selecBon and combinaBon of items from full MAI AutomaBc ReacBons SecBon and full PBS
• MAI – all items except forward protecBon as difficult to test • PBS – Reduced number of items from 14 to 6
– Started with ‘Sit on Bench’ as next higher item from sit on floor within MAI
– Eliminated items that were difficult to test in 1.5-‐5 year-‐olds
– Chose 2 items for each of relaBvely easy, moderate, and difficult skills across the construct of postural control
• Total ECAB items 13 • Adjusted scoring so scores from 0-‐100
Movement Strategies
• Early Clinical Assessment of Balance – Construct Validity
Movement Strategies
• Early Clinical Assessment of Balance – MAI 7 Items – AutomaBc ReacBons SecBon
• Lateral head righ-ng (len & right) – Tested in supported sifng
• Head righ-ng in extension – Tested prone
• Head righ-ng in flexion – Tested in pull to sit
• Rota-on in the trunk (len & right) – Tested in rolling
• Equilibrium reac-ons in siMng (len & right) • Protec-ve extension to the side & backwards (len & right)
– Tested in sit
Movement Strategies
• Early Clinical Assessment of Balance – MAI Items re-‐scaled form original MAI
• Rated as: • 0 (no response) • 1 (slight response) • 2 (moderate response)
• 3 (complete & consistent response)
– Specific criteria for each item on score sheet
Movement Strategies
• Early Clinical Assessment of Balance – PBS Items
• SiMng with back unsupported but feet supported • Moving from siMng to standing
• Standing unsupported with eyes closed • Standing unsupported with feet together • Turning 360 degrees in standing unsupported • Placing alternate foot on the step while standing unsupported
Movement Strategies
• Early Clinical Assessment of Balance – PBS Items rated as:
• 0 (cannot do) • 1 (slight ability to complete)
• 2 (some ability to complete) • 3 (almost completes)
• 4 (fully completes)
Movement Strategies
• Early Clinical Assessment of Balance • Administer and score items on the scales • Total score calculated as follows:
– 7 items from MAI are summed • If child’s postural control is beyond an item you do not have to test and credit them for the item
– 6 items scores from PBS are reweighted to account for increased difficulty of execuBon and summed
• items 8 and 9 mulBplied by 1.5 • Items 10 and 11 mulBplied by 2.5 • Items 12 and 13 mulBplied by 4
– MAI and PBS item scores are then summed for total score between 0 and 100.
Movement Strategies
• Early Clinical Assessment of Balance – Video Prac-ce
Control of Dynamics
• Timed Up and Go (TUG) – (Williams et al. 2005)
• Timed Up and Down Stairs (TUDS) – (Zaino et al 2004)
• Standardized Walking Obstacle Course (SWOC) – (Held & Ko;, 2006)
• Timed Obstacle AmbulaBon Test (TOAT) – (Torseth et al. 2007; Barnes et al. 2009)
• Dynamic Gait Index (DGI) – (Jonsdofr & Ca;aneo, 2007; Hall & Herdman, 2006)
Control of Dynamics
• Standardized Walking Obstacle Course (SWOC) – 12.2 m X 0.9m path – Tested with:
• arms at side; • age-‐appropriate carrying task; • dimly lit environment
– Time, steps, stumbles, step-‐offs recorded
– High intra-‐ & inter-‐rater reliability
Control of Dynamics
• Timed Obstacle Ambula-on Test (TOAT) – Community obstacles – Time & balance – Reliability
• Time score high • Balance score moderate
Control of Dynamics
• Dynamic Gait Index – Quality of gait rated on 4-‐point scale
• Gait Level Surface • Change in gait speed • Gait with horizontal head turns • Gait with verBcal head turns • Gait and pivot turn • Step over obstacle • Step around obstacles • Stairs
– Reliability and validity high in adults; needs tesBng in children
ExaminaBon Summary
• Consider Postural control a complex movement
• Examine the components with appropriate tests
• Try to maintain standardized procedures
• Let you examinaBon results guide your intervenBon and measurement of outcomes
Thank-‐You and QuesBons?