Another advantage of the SCALE in comparison to the other 24 assessment tools SMC, m-Trost, lies in its evaluation of five lower extremity joints 25 rather than one or three joints. Furthermore, as its ordinal scoring system relies on the impression of 29 the rater i.
These limitations spastic CP, ordinal 32 scoring system also apply for the other three clinical tools. In terms of psychometric quality as well 39 as clinical utility see Table I , none of the identified laboratory based measures seem to 40 offer great advantage over the other.
The equipment required to record the outcome 41 measures was often customized, making it difficult for other groups researchers or 42 clinicians to apply and confirm or extend findings of studies exploring the laboratory 43 based measures using EMG, kinematics, or torque measurements. Furthermore, the 44 measurement procedures appear time consuming and complex in comparison to more 45 routinely applied clinical assessments. Personnel also required extensive training in the 46 application and analysis of these measures see Table I.
Only five out of 5 items needed further discussion, and none required the rating of a third reviewer. This 6 high agreement was likely the result of the specific rating rules which we established as 7 recommended by the COSMIN group.
For example, when scoring the reliability items 4- 8 7 for the SCALE, we decided in advance to score the use of video for the evaluating of 9 the inter- and intra-rater reliability as appropriate, as this allows a discrete evaluation of 10 the scoring system by maintaining the stability of test conditions and patient status as 11 well as saving on time and resources.
In contrast, a video approach was not considered 12 to be appropriate for determining test-retest reliability when the stability of the patient is 13 evaluated. This modified scoring improved the overall rating of all studies 19 with the exception of the construct and content validity score of the studies from Fowler 20 et al.
While we consider it important that each single 25 question should be evaluated separately for its content validity in a Health Care 26 Questionnaire where the COSMIN was originally developed for , it could be questioned 27 whether the same rating rules are needed for an assessment tool like the SCALE that 28 consists of a similar procedure repeated for different joints.
Its responsiveness to change has not been assessed, but it may be expected 33 that due to its ordinal scoring system its sensitivity to measure changes of SVMC is 34 limited. To improve its sensitivity and simultaneously to benefit from its child-friendly 35 procedure, combining the SCALE with another more sensitive measure appears to be 36 promising. This idea has also been proposed in previous studies.
Currently, the SCALE appeared to have the highest 4 level of evidence regarding its reliability and construct validity compared to other clinical 5 and laboratory-based measures of SVMC. However, only by means of reliable, 6 validated, and responsive SVMC tools used in carefully designed intervention studies, it 7 will be possible to provide a scientifically rigorous contribution to the ongoing debate 8 with regard to the possibility to improve SVMC of the lower extremity in children with 9 UMN lesions.
None of the funders were involved in the study design, data 16 collection, analysis, and manuscript preparation and publication decisions. All ideas and decisions in 20 relation to this study were made independently by the authors. Development of a quality-of-movement measure for children with 24 cerebral palsy.
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Joint moment contributions to swing knee 5 extension acceleration during gait in individuals with spastic diplegic cerebral 6 palsy. The effect of lower extremity selective voluntary motor 8 control on interjoint coordination during gait in children with spastic diplegic 9 cerebral palsy. In hemiparesis there are some muscles which are always involved and which finally give rise to a peculiar abnormal mass movement pattern and attitude that is characteristic of many hemiparesis patient.
The spasticity invariably affects the anti-gravity muscle for reasons not clearly understood. It is however presumed that this anti-gravity muscles are relatively more stretched than pro-gravity muscles in neutral position hence stimulating the stretch reflex giving rise to spasticity. Thus is can observed that the following muscles does not take part in either of the synergies :.
Read more about Motor Cortex Function on Wikipedia. It is highly essential to understand that synergies are different from the abnormal attitude seen in a hemiparesis patient. The abnormal hemiplegic attitude is due to the combination of strongest component of the flexor and extensor synergy in both upper and lower limbs.
Return from voluntary motor control to home page. Return from voluntary motor control to neuro rehab. Pes anserine bursitis tendinitis involves inflammation of the bursa at the insertion of the pes anserine tendons on the medial proximal tibia. Williams flexion exercises focus on placing the lumbar spine in a flexed position to reduce excessive lumbar lordotic stresses. Follow dasphysio on Twitter. Follow prodyut.
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