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Objective. Positional plagiocephaly/brachycephaly (PPB) is associated with lower cognitive scores in school-aged children. This study tested the hypothesis that infant motor skills mediate this association. Methods. Children with a history of PPB (cases, n = 187) and without PPB (controls, n = 149) were followed from infancy through approximately 9 years of age. Infant motor skills were assessed using the Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-3), and cognition was assessed using the Differential Ability Scales, 2nd edition (DAS-2). The Bayley-3 motor composite was examined as a mediator of the association between PPB and DAS-2 general cognitive ability (GCA) scores. In secondary analyses, mediation models were examined for the DAS-2 verbal ability, nonverbal ability, and working memory scores; models using the Bayley-3 fine versus gross motor scores also were examined. Results. Cases scored lower than controls on the DAS-GCA ([beta] = -4.6; 95% CI = -7 . 2 t o -2.0), with an indirect (mediated) effect of [beta] = -1.5 (95% CI = -2.6 to -0.4) and direct effect of [beta] = -3.1 (95% CI = -5.7 to -0.5). Infant motor skills accounted for approximately 33% of the case-control difference in DAS-2 GCA scores. Results were similar for other DAS-2 outcomes. Evidence of mediation was greater for Bayley-3 gross motor versus fine motor scores. Conclusion. Infant motor skills partially mediate the association between PPB and cognition in school-aged children. Monitoring motor development and providing intervention as needed may help offset associated developmental concerns for children with PPB. Impact. To our knowledge, this study is the first longitudinal investigation of the development of children with and without PPB from infancy through the early school years and the first to examine motor skills as a mediator of cognitive outcomes in this population. The findings highlight the importance of early motor skills for other developmental outcomes. Lay Summary. Infants' motor skills are related to the development of PPB and its association with later cognition. If your child has PPB, physical therapists may have an important role in assessing and providing treatment to promote motor development. Keywords: Infant, Motor Development, Plagiocephaly, Cognitive Function, Introduction Positional plagiocephaly/brachycephaly (PPB) became prevalent after the Back to Sleep campaign to prevent sudden infant death syndrome. (1,2) Assessments and treatments for PPB have focused on the cosmetic effects [...]

Background. Diminished sensory adaptation has been associated with poor balance control for children with fetal alcohol spectrum disorders (FASD). A virtual reality system, Sensorimotor Training to Affect Balance, Engagement and Learning (STABEL), was developed to train sensory control for balance. Objectives. The purpose of this study was to examine the STABEL system in children with FASD and children with typical development (TD) to (1) determine the feasibility of the STABEL system and (2) explore the immediate effects of the STABEL system on sensory attention and postural control. Design. This is a technical report with observational study data. Methods. Eleven children with FASD and 11 children with TD, aged 8 to 16 years, completed 30 minutes of STABEL training. The children answered questions about their experience using STABEL. Sensory attention and postural control were measured pre- and post-STABEL training with the Multimodal Balance Entrainment Response system and compared using repeated-measures analysis of variance. Results. All children engaged in game play and tolerated controlled sensory input during the STABEL protocol. Immediate effects post-STABEL training in both groups were increased postural sway velocity and some changes in entrainment gain. Children with FASD showed higher entrainment gain to vestibular stimuli. There were no significant changes in sensory attention fractions. Limitations. The small sample size, dose of STABEL training, and exploratory statistical analyses are study limitations, but findings warrant larger systematic study to examine therapeutic effects. Conclusions. Children completed the training protocol, demonstrating the feasibility of the STABEL system. Differences in postural sway velocity post-STABEL training may have been affected by fatigue, warranting further investigation. Limited immediate effects suggest more practice is needed to affect sensory attention; however, entrainment gain changes suggest the STABEL system provoked vestibular responses during balance practice., Balance is achieved by the cooperative interaction of motor and musculoskeletal systems and 3 sensory subsystems: visual, vestibular, and somatosensory (proprioceptive and cutaneous information). (1,2) These sensory subsystems interact to [...]

Background. Falls in people with multiple sclerosis (MS) are a serious health concern, and the percentage of people who restrict their activity because of concerns about falling (CAF) is not known. Mobility function and accumulated impairments are associated with fall risk in older adults but not in people with stroke and have not been studied in people with MS. Objective. The purposes of this study were: (1) to estimate the percentage of people who have MS and report falling, CAF, and activity restrictions related to CAF; (2) to examine associations of these factors with fall status; and (3) to explore associations of fall status with mobility function and number of accumulated impairments. Design. A cross-sectional survey was conducted. Methods. A total of 575 community-dwelling people with MS provided information about sociodemographics, falls, CAF, activity restrictions related to CAF, mobility function, and accumulated impairments. Chi-square statistics were used to explore associations among these factors. Results. In all participants, about 62% reported CAF and about 67% reported activity restrictions related to CAF. In participants who did not experience falls, 25.9% reported CAF and 27.7% reported activity restrictions related to CAF. Mobility function was associated with fall status; participants reporting moderate mobility restrictions reported the highest percentage of falls, and participants who were nonwalkers (ie, had severely limited self-mobility) reported the lowest percentage. Falls were associated with accumulated impairments; the participants who reported the highest percentage of 2 or more falls were those with 10 impairments. Limitations. This cross-sectional study relied on self-reported falls, mobility, and impairment status, which were not objectively verified. Conclusions. Both CAF and activity restrictions related to CAF were common in people with MS and were reported by people who experienced falls and those who did not. The association of fall status with mobility function did not appear to be linear. Fall risk increased with declining mobility function; however, at a certain threshold, further declines in mobility function were associated with fewer falls, possibly because of reduced fall risk exposure., Multiple sclerosis (MS) is a demyelinating inflammatory disease of the central nervous system. It is the most common disabling neurological disease in young adults, (1,2) is commonly diagnosed between the [...]

Background. Mobility, specifically community walking, is important, but often limited among survivors of stroke. The factors that influence the recovery of community walking are not clearly understood. Objective. The purpose of this research was to examine mobility disability following stroke, specifically: (1) the association between subjective and objective measures of participation in community walking and (2) the association between personal factors and participation in community walking. Design. A cross-sectional study design was used. Methods. Fifty community-dwelling survivors of stroke, aged 50 to 79 years, were enrolled in the study. Participation in community walking was measured subjectively (perceived difficulty and satisfaction) and objectively using self-report data (number of trips and walking-related activities) and step data (pedometer). The association between subjective and objective measures of participation was analyzed using Pearson correlation. The association of personal factors (age, sex, number of comorbidities, fatigue, depression, balance and fall self-efficacy, and importance of walking) with measures of participation was analyzed using multiple linear regression. Results. Subjective and objective measures of participation were weakly associated. Self-efficacy was the only personal factor that was strongly associated with both subjective and objective measures of participation. Personal factors explained 27% to 55% of the variability in participation in community walking. Limitations. Limitations included a small sample size and limited diversity among participants. Reliability of the pedometer used in this study has not been established in the stroke population. Conclusions. Subjective and objective measures of participation in community walking were only weakly correlated, suggesting that they measure different aspects of mobility; thus, to fully capture participation, it is critical to measure both. Personal factors were associated with subjective and objective measures of participation and are important in explaining variability in community walking following stroke., The leading cause of disability in American adults is stroke, affecting approximately 795,000 people each year. (1) Limitation in community walking has been identified as one of the most debilitating [...]

Background and Purpose Assessment of walking activity in youth with cerebral palsy (CP) has traditionally been 'capacity-based.' The purpose of this study was to describe the day-to-day ambulatory activity 'performance' of youth with CP compared with youth who were developing typically. Subjects Eighty-one youth with CP, aged 10 to 13 years, who were categorized as being in Gross Motor Function Classification System (GMFCS) levels I to III and 30 age-matched youth who were developing typically were recruited. Methods Using a cross-sectional design, participants wore the StepWatch monitor for 7 days while documenting average daily total step counts, percentage of time they were active, ratio of medium to low activity levels, and percentage of time at high activity levels. Results The youth with CP demonstrated significantly lower levels of all outcomes than the comparison group. Discussion and Conclusion Daily walking activity and variability decreased as functional walking level (GMFCS level) decreased. Ambulatory activity performance within the context of the daily life for youth with CP appears valid and feasible as an outcome for mobility interventions in CP., The ambulatory types of cerebral palsy (CP), hemiplegia and diplegia, comprise 48% to 79% of all cases. (1) Most people with CP who are ambulatory experience limitations in their walking [...]

Background: Reliable information on both global need for prosthetic services and the current prosthetist workforce is limited. Global burden of disease estimates can provide valuable insight into amputation prevalence due to traumatic causes and global prosthetists needed to treat traumatic amputations.Objectives: This study was conducted to quantify and interpret patterns in global distribution and prevalence of traumatic limb amputation by cause, region, and age within the context of prosthetic rehabilitation, prosthetist need, and prosthetist education.Study design: A secondary database descriptive study.Methods: Amputation prevalence and prevalence rate per 100,000 due to trauma were estimated using the 2017 global burden of disease results. Global burden of disease estimation utilizes a Bayesian metaregression and best available data to estimate the prevalence of diseases and injuries, such as amputation.Results: In 2017, 57.7 million people were living with limb amputation due to traumatic causes worldwide. Leading traumatic causes of limb amputation were falls (36.2%), road injuries (15.7%), other transportation injuries (11.2%), and mechanical forces (10.4%). The highest number of prevalent traumatic amputations was in East Asia and South Asia followed by Western Europe, North Africa, and the Middle East, high-income North America and Eastern Europe. Based on these prevalence estimates, approximately 75,850 prosthetists are needed globally to treat people with traumatic amputations.Conclusion: Amputation prevalence estimates and patterns can inform prosthetic service provision, education and planning.

Background: Information access is essential for quality healthcare provision and education. Despite technological advances, access to prosthetics and orthotics information in low- and middle-income countries is not ubiquitous. The current state of information access, availability, and exchange among prosthetics and orthotics faculty is unknown.Objectives: Describe information exchange networks and access at two prosthetics and orthotics programs in Ghana and the United States.Study design: Cross-sectional survey, social network analysis.Methods: An online survey of faculty at two prosthetics and orthotics programs using REDCap. The survey included a social network analysis, demographics, and prosthetics and orthotics information resources and frequency of use. Descriptive statistics were calculated.Results: Twenty-one faculty members completed the survey (84% response). Ghanaian faculty were on average younger (median Ghana: 27 years, United States: 43 years), had less teaching experience, and had less education than US faculty. Textbooks were the most commonly used resource at both programs. The Ghanaian network had more internal connections with few outside sources. The US network had fewer internal connections, relied heavily upon four key players, and had numerous outside contacts.Conclusion: Ghana and US faculty have two distinct information exchange networks. These networks identify key players and barriers to dissemination among faculty to promote successful knowledge translation of current scientific literature and technology development. Social network analysis may be a useful method to explore information sharing among prosthetics and orthotics faculty, and identify areas for further study.

We want to thank Goodgold for her thoughtful and clinically relevant comments about our study. Our research team appreciates her acknowledgment of the ecological validity of monitoring ambulatory activity with [...]