Pediatric Evaluation of Disability Inventory Article Summary

Posted on: February 25, 2021 | By: hclay | Filed under: Pediatric Evaluation of Disability Inventory (PEDI)

Kusumoto Y, Tsuchiya J, Watanabe Y, et al. Characteristics of dynamic standing balance with and without an insole in patients with spastic diplegia cerebral palsy. J Phys Ther Sci. 2020;32(1):23-26. doi:10.1589/jpts.32.23

 

Purpose: The purpose of this study was to inspect the quality of dynamic balance in individuals with spastic diplegia cerebral palsy both with and without the use of an insole in their shoes.

Population: Individuals included within this study had to have a diagnosis of spastic diplegia CP, a non-reducible ankle deformity and the ability to comprehend and follow instructions given to them. 11 participants were included.

Methods: There were two groups within this study: one group that would perform the dynamic balance assessment barefoot and one group that would be given custom insoles to perform the testing in. Testing included examining area of postural sway, center of movement distance between both anterior/posterior and left/right foot positions and the index of postural stability (IPS). For this specific study the following equation was used in order to calculate IPS “log[(area of stability limit + area of postural sway)/area of postural sway].” The authors of the study then had trained physical therapists execute the Pediatric Evaluation of Disability Inventory (both the functional and caregiver editions) via interview of the participants legal guardians.

Outcome Measures: Index of Postural Stability (IPS),  Pediatric Evaluation of Disability Inventory – Functional Skills Scales (PEDI-FSS), Pediatric Evaluation of Disability Inventory – Caregiver Assistance Scale (PEDI-CAS)

Intervention: The intervention for this study was a custom-fit insole designed specifically for the participants. Each insole had some commonalities in design to include: heel height of 0-5 mm and the inclusion of both a medial longitudinal arch pad as well as metatarsal pad.

Results: Significant correlation between the IPS and area of postural sway with the PEDI-FSS and PEDI-CAS appeared only from date collected while patients were barefoot. Insoles were proved to be beneficial in improving both static and dynamic balance amongst participants.

Strengths: One of the major strengths of this study was choosing to use an outcome measure with proven reliability, validity and responsiveness.

Limitations: The large age range utilized in this study, I believe it one of the major limitations. Of the eleven participants, ages ranged from 6-55. Although cerebral palsy is not progressive, patients will still experience increasing challenges as they age such as: increased difficulty walking, increased stiffness, etc. Because of this, it is likely hard to compare the effect of insoles on dynamic postural stability when looking at a 6 y.o. vs. a 55 y.o.

Conclusion: In conclusion, this study show that individuals with spastic diplegia CP do indeed demonstrate an improvement in both static and dynamic balance when wearing insoles. Participants were better able to balance while manipulating the center of pressure within the base of support when insoles were inserted in the shoe. Correlations between the IPS and PEDI-CAS/PEDI-FSS varied depending on whether or not participants were barefoot or wearing shoes with custom insoles. This proving to be the case, assessing dynamic balance while barefoot may be indicated in future studies regarding balance assessments in individuals with spastic diplegia CP to get a better understanding of a patient’s functional skills as well as the amount of caregiver assistance they may need.

 

 

2 responses to “Pediatric Evaluation of Disability Inventory Article Summary”

  1. mfairly says:

    Interesting article! My question is did they discuss why they had such a large age range for this study? Did they have a hard time finding enough participants in the same age range? I could imagine it is hard to gather a large study of persons diagnosed with Spastic Diplegia of similar ages especially if performing a study in one particular area.

  2. hclay says:

    They did not discuss why their age range was so large, but I do agree with you that it is likely very challenging to find a large group with the same diagnosis AND same relative age. I do think that this played a big role in their study though and contributed to the lack of generalizability.

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