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Purpose: The purpose of this study was to create a clear, standardized test description to rate spasticity severity into four categories according to the definition given by Lance [1], referred to as the Velocity Dependent Measure of Spasticity (VDMS)., Method: Muscle groups of the upper and lower limbs of children with neuromotor disorders were evaluated on their response to passive movement in a fast-versus slow-velocity test condition. The interrater and test-retest reliability were assessed using Gwet's alpha one (95%-CI) and the percentage agreement., Results: Two physiotherapists independently assessed 45 children and youths (age 4-19 years). The interrater reliability of the VDMS was substantial to almost perfect (Gwet's alpha one: 0.66-0.99, n= 45) while the test-retest reliability was almost perfect as well (Gwet's alpha one: 0.83-1.00, n= 42)., Conclusion: The VDMS can be recommended as a reliable assessment with a standardized procedure to assess spasticity of the extremities in children with neuromotor disorders.

Purpose: We investigated the combined impact of trunk control and lower extremities impairments on predicting gait capacity in children with cerebral palsy (CP) and evaluated relationships between trunk control and lower extremities impairments., Methods: Data of 52 children with CP [29 boys, mean age 11 years 9 months (±4 years 6 months)] were included in this observational study. Gait capacity was measured by the "modified Time Up and Go test". Experienced therapists performed the "Modified Ashworth Scale", "Manual Muscle Test", the "Selective Control Assessment of the Lower Extremity", and the "Trunk Control Measurement Scale". We calculated Spearman correlations coefficients (ρ) and performed regression analyses., Results: Trunk control was the strongest predictor (β = -0.624, p < 0.001) when explaining the variance of gait capacity and remained in the model together with spasticity (R 2  = 0.67). Muscle strength and selectivity correlated moderately to strongly with the trunk control and gait capacity (-0.68 ≤ ρ ≤ -0.78), but correlations for the spasticity were low (ρ<-0.3)., Conclusions: The interconnection between trunk control, leg muscle strength and selectivity for gait capacity in children with CP was shown. It indicates the significance of these impairments in gait assessment and, potentially, rehabilitation. Implications for Rehabilitation Trunk control was the strongest predictor for gait capacity in a regression model with lower extremity spasticity, muscle strength and selectivity and age as independent variables. Lower extremity muscle strength, selectivity, and trunk control explained a similar amount of gait capacity variance which is higher than that explained by lower extremity spasticity. Lower extremity muscle strength and selectivity correlated strongly with trunk control. Therefore, we cautiously suggest that a combined trunk control and lower extremity training might be promising for improving gait capacity in children with CP (Gross Motor Function Classification System level I-III), which needed to be tested in future intervention-studies.

Aim: As there is little evidence for concurrent validity of the Eating and Drinking Ability Classification System (EDACS), this study aimed to determine its concurrent validity and reliability in children and adolescents with cerebral palsy (CP)., Method: After an extensive translation procedure, we applied the German language version to 52 participants with CP (30 males, 22 females, mean age 9y 7mo [SD 4y 2mo]). We correlated (Kendall's tau or K τ ) the EDACS levels with the Bogenhausener Dysphagiescore (BODS), and the EDACS level of assistance with the Manual Ability Classification System (MACS) and the item 'eating' of the Functional Independence Measure for Children (WeeFIM). We further quantified the interrater reliability between speech and language therapists (SaLTs) and between SaLTs and parents with Kappa (κ)., Results: The EDACS levels correlated highly with the BODS (K τ =0.79), and the EDACS level of assistance correlated highly with the MACS (K τ =0.73) and WeeFIM eating item (K τ =-0.80). Interrater reliability proved almost perfect between SaLTs (EDACS: κ=0.94; EDACS level of assistance: κ=0.89) and SaLTs and parents (EDACS: κ=0.82; EDACS level of assistance: κ=0.89)., Interpretation: The EDACS levels and level of assistance seem valid and showed almost perfect interrater reliability when classifying eating and drinking problems in children and adolescents with CP., What This Paper Adds: The Eating and Drinking Ability Classification System (EDACS) correlates well with a dysphagia score. The EDACS level of assistance proves valid. The German version of EDACS is highly reliable. EDACS correlates moderately to highly with other classification systems., (© 2018 Mac Keith Press.)

Background: In children with cerebral palsy (CP), stiffness, caused by contractile and non-contractile structures, can influence motor performance. This study sought to determine whether the nerve mobility had a relevant impact on motor performance in children with CP. We hypothesized that a positive Straight Leg Raise (SLR) test, as well as smaller SLR hip angle, would relate to lower leg muscle strength, reduced motor capacity and less motor performance in children with CP., Methods: We applied a cross-sectional analysis on data including SLR, leg muscle strength, Gross Motor Function Measure (GMFM-66) and number of activity counts during daily life from thirty children with CP (6-18 years). We performed receiver operating characteristics and correlation analyses., Results: Positive SLR test could distinguish well between children with low versus high muscle strength and GMFM-66 scores. The SLR hip angle correlated significant with the level of disability and with muscle strength. The correlation with the GMFM-66 and the activity counts was fair., Conclusion: This study suggests that neural restriction of SLR is higher on functional and activity outcome than the measured SLR hip range of motion. Further studies should investigate weather improving nerve mobility can lead to an amelioration of function in children with CP.

Aim: Preventing restrictions to lower limb movement is part of the treatment given to children with cerebral palsy (CP). Such restrictions can be assessed using the 'straight leg raise' (SLR) test. This study investigated the interrater reliability and practicability of the SLR test in children with CP., Method: Experienced physiotherapists examined 23 children with CP (6-18y; eight females, 15 males) twice. The SLR hip range of motion (ROM) was measured using an electrogoniometer, and the test was rated based on sensitizing manoeuvres and biceps femoris muscle activity. Practicability was investigated by evaluating children's subjective feedback on the tolerable ROM., Results: Intraclass correlation coefficients for the SLR hip ROM varied, ranging from 0.84 (95% CI 0.61-0.93) to 0.93 (95% CI 0.87-0.96). Physiotherapists substantially agreed on SLR ratings (Cohen's kappa=0.73). Biceps femoris muscle activity decreased significantly with the release of tension on the sciatic nerve. All children were able to communicate the location and sensation of the maximally tolerated position., Interpretation: The SLR test proved to be reliable and practicable in children with CP and might improve clinical reasoning processes. Lower limb movement restrictions in these children may partly be related to limitations in sciatic nerve mobility. Further studies should investigate if the SLR test could estimate activities in children with CP., (© 2015 Mac Keith Press.)

Aim: Assessing impaired selective voluntary movement control in children with cerebral palsy (CP) has gained increasing interest. We investigated construct validity and intra- and interrater reliability of the Selective Control Assessment of the Lower Extremity (SCALE)., Method: Thirty-nine children (21 males, 18 females) with spastic CP, mean age 12 years 6 months [range 6y 11mo-19y 9mo], Gross Motor Function Classification System (GMFCS) levels I to IV, participated. Differences in SCALE scores were determined on joint levels and between patients categorized according to their limb distribution and GMFCS levels. SCALE scores were correlated with the Fugl-Meyer Assessment, Manual Muscle Test, and Modified Ashworth Scale. To determine reliability, the SCALE was applied once and recorded on video., Results: SCALE scores differed significantly between the less and more affected leg (p<0.001) and between most leg joints. Total SCALE scores differed significantly between GMFCS levels I and II. Correlations with Fugl-Meyer Assessment, Manual Muscle Test, and Modified Ashworth Scale were 0.88, 0.88, and -0.55 respectively. Intraclass correlation coefficients were all above 0.9, with the minimal detectable change below 2 points., Interpretation: The SCALE appears to be a valid and reliable tool to assess selective voluntary movement control of the legs in children with spastic CP., (© 2015 Mac Keith Press.)

Trunk control is essential for the performance of everyday tasks. Children with neurological impairments such as cerebral palsy (CP) or acquired brain injury (ABI) commonly show impaired trunk control, which leads to restriction in functional activities. The aim of this study was to provide construct validity of the German version of the Trunk Control Measurement Scale (TCMS). We investigated convergent and discriminant construct validity by comparing the TCMS with the Gross Motor Function Classification System (GMFCS) and the modified Timed up and Go (mTUG). Several TCMS items were validated with force plate measurements. The centre of pressure (COP) parameters included the standard deviation of amplitude, the COP displacement and the area. Fifty-two children with CP and ten children with ABI (mean age 10.9 years 4.9 months, range 5-18 years, GMFCS levels I-IV) participated. Spearman rank correlation coefficients calculated between the TCMS and the GMFCS and mTUG amounted to -0.75 and -0.42, respectively. Validating TCMS items with COP parameters was difficult. Nevertheless, the results support the validity of the TCMS in children with brain lesions. This study provides paediatric therapists working in German speaking countries with a valid tool to assess impaired trunk control in these children. Although originally designed for children with CP, our results show that the TCMS may also be applicable to children with ABI, but more research is needed on a larger population., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

• The tactile threshold test is feasible and valid in children with UMN lesions. • The tactile localization tasks are feasible and valid in children with UMN lesions. • The scores differed significantly between children with and without UMN lesions. • The inter-rater reliability was high for all 3 outcome measures. To investigate the feasibility, discriminative and convergent validity, and inter-rater reliability of a lower limb tactile function and 2 body awareness assessments in children with upper motor neuron (UMN) lesions. Cross-sectional psychometric study. Pediatric rehabilitation center. Forty individuals with UMN lesions (mean age 11.7 years, SD 3.4 years; 27 girls) and 40 neurotypically developing children of the same age participated (N=80). Not applicable. We assessed the tactile threshold (TT) with monofilaments and body awareness with tactile localization tasks (TLTs) for structural (TLT action) and spatial (TLT perception) body representation at the foot sole. We compared the test outcomes between children with UMN lesions and neurotypically developing children with the Wilcoxon signed-rank test. Furthermore, we quantified the relations between the 3 tests with Spearman correlations (r s) and the interrater reliability with quadratic weighted kappa (κ QW). About 80% of the children with UMN lesions perceived the tests easy to perform. The children with UMN lesions had significantly reduced somatosensory function compared with the neurotypically developing children. For the more affected leg, we found good relations between the TT and the TLT action (r s =0.71; P <.001) and between the 2 TLTs (r s =0.66; P <.001), and a fair relation between the TT and the TLT perception (r s =0.31; P =.06). The inter-rater reliability analyses for the sum scores showed almost perfect agreement for the TT (κ QW more affected leg 0.86; less affected leg 0.81), substantial agreement for TLT action (κ QW more affected leg 0.76; less affected leg 0.63), and almost perfect agreement for TLT perception (κ QW more affected leg 0.88; less affected leg 0.74). The 3 tests are feasible to assess lower limb somatosensory function in children with UMN lesions. Discriminative and convergent validity and reliability of the 3 tests were confirmed. Further studies should investigate responsiveness and association with motor function of these outcome measures. [ABSTRACT FROM AUTHOR]