Activities Scale for Kids: Performance Version
The previous information has been reviewed. There are no further updates to the ASKp at this time.
Article Summary:
Bellows D, Bucevska M, Verchere C: Coordination and Balance in Children with Birth-Related Brachial Plexus Injury: A Preliminary Study Physiother Can. 2015 Spring; 67(2): 105-112. Available from: https://www.ncbi.nlm.nih.gov.ezproxy.elon.edu/pmc/articles/PMC4407124/
The purpose of this study was to determine whether children with birth-related brachial plexus injury (BRBPI) have deficits in coordination and balance. This injury is associated with excessive traction to the infant’s head or arm causing damage to the brachial plexus during a difficult childbirth. The population of the study consisted of 39 children with BRBPI that aged from 5-15 years old with a mean age of 9. The study excluded children with neuromuscular disorders or cognitive delay that could prevent the participant from performing the functional assessment. Diagnosis of BRBPI is mainly based on physical characteristics. The methods used were a prospective cohort study. Range of motion, strength, active movement, balance and coordination motor skills, and self-reported functional outcomes were assessed. Numerous outcome measures were used for this study and they included: the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) to measure coordination and balance during motor skills; the Movement Assessment Battery for Children—Second Edition (MABC-2) to measure balance in children with motor difficulties; the Toronto Active Movement Scale (AMS)—to look at the AROM of both the affected and non-affected upper extremities; and the Activities Scale for Kids—Performance Version (ASKp) which is a self-reported functional outcome that measures physical disability in children experiencing activity limitations. It assesses personal care, dressing, eating/drinking, locomotion, stairs, play, transfers, standing skills, and miscellaneous. The ASKp has not been validated for children with BRBPI but matches the age cohort of the study as well as the desired assessment of children with limitations in activity. In this study, there was no true intervention, rather assessment and measurement of PROM, AROM, strength, and body coordination and balance based on appropriate measures from specific scales listed in the outcome measures.
The results of this study presented that 25 of the 38 participants (65.8% because 1 participant did not complete the ASKp) had an ASKp score indicating some level of disability. The study found a statistically significant difference in balance between the 25 participants and those that did not have disabilities. Also, 26 of 39 participants scored below average on the MABC-2 Balance test, while 11 scored below average on the BOT-2 Balance subset test. Participants that indicated some level of disability on the ASKp had significantly lower balance scores on the MABC-2 and BOT-2 compared to those with no indications of disability on the ASKp. The majority of the population studied was found to be at risk or had significant difficulty with balance.
The major strengths of this study included a well-distributed age range of participants between ages 5-15 which is the appropriate age range for the ASKp. It also included a balanced gender population, and a balanced impairment group in regard to left upper extremity vs right upper extremity impairment due to BRBPI. The study demonstrated a positive correlation of age and ASKp scores that may indicate increased independence with ADLs as children get older. Limitations of the study included a small sample size that limited variability in patient presentation. The assessor of the study was not blind which could have limited the study. Also, one participant did not complete the ASKp due to a language barrier. Since this study looked at balance concerns, it is possible that families with children that have balance issues were more likely to volunteer for this study.
In conclusion, 66% of the participants scored below average on balance tests while 25 of the 38 participants had functional outcomes indicative of disability on the ASKp. Children with ASKp scores indicating disability may have balance issues. Based on the scores of the outcome measures demonstrating deficits with balance, body coordination, and some levels of disability, interventions that include components of balance would be a valuable treatment tool for children with birth-related brachial plexus injuries.
3 responses to “Activities Scale for Kids: Performance Version”
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Well written summary Chris! I would be really curious to know more about the mechanism of injury. For instance are balance and coordination issues caused by damaged sensory and motor innervation at the peripheral level, is there disruption in the CNS or is it a combination of both? I also wondered how frequently this occurs with delivery and found several articles with different statistics. One article reported an incidence between 0.15-3 per 1000 births and another ranged from 0.42-5.1 per 1000 births. These ranges seem low (thankfully). I appreciate you sharing this information, and I’m glad we have yet another tool in our kits for screening sub-adults.
Very well organized and informative summary. I believe that self-report outcome measures such as the ASKp are very valuable with this patient population. It is important to examine life in the clinic and at home through the lens of the pediatric patient and family. Balance and coordination are not the immediate functional concerns associated with brachial plexus injuries. The content of this article highlights the importance of evaluating the entire patient before us to truly identify all functional impairments. Thank you for sharing!
Great summary and comments! thank you for your contributions!!