Relevant factors of self-care in children and adolescents with spastic cerebral palsy – Article Summary
PEDI Article: Relevant factors of self-care in children and adolescents with spastic cerebral palsy:
Kusumoto Y, Takaki K, Matsuda T, Nitta O. Relevant factors of self-care in children and adolescents with spastic cerebral palsy. PLoS One. 2021;16(7):e0254899. doi:10.1371/journal.pone.0254899
Purpose: The purpose of this study was look at factors of self-care and manual ability in children with spastic CP and prediction of functional independence.
Population: Participants in the study included children and adolescents with cerebral palsy from Japanese hospitals and medical centers whom met the inclusion criteria: 1) Spastic CP diagnosis; 2) 5-18 years old; 3) Ability to follow directions and communicate. There were 76 participants (40 males & 36 females) which all provided consent to participate. Participants represented different types of CP including spastic hemiplegia (11), spastic diplegia (45), and spastic quadriplegia (20).
Methods & Measures: The design of this study was a cross-sectional study. Levels on the Japanese GMFCS (gross motor skills) and MACS (manual ability) were determined by therapist observation and used to indicate the severity of disability. The Pediatric Evaluation of Disability Inventory (PEDI), was used to assess children’s ability with self-care, mobility, and social functioning. The Japanese verson of the PEDI was used and only looked at self-care scores from the PEDI Functional Skills Scale (PEDI-FSS) and PEDI Caregiver Assistance Scale (PEDI-CAS). The Box and Blocks test (BBT) and Japanese hand dynamometry (TOEI LIGHT, Grip D, Japan) were used to assess gross manual dexterity and grip strength. No interventions were given in this study.
Results: The Shapiro-Wilk test was used to assess the normality of the data. Multiple linear regression analysis was used to examine which factors were related to self-care capability and performance. According to the study, the scores from the PEDI-FSS were correlated with the Box and Blocks (BBT) scores and GMFCS, and the scores from the PEDI-FSS scores were correlated with the Box and Blocks (BBT) , GMFCS, and age.
Strengths & Limitations: Some strengths of this study include the observation of different types of CP and the capability for self-care with each. Another strength of the study was the inclusion of clinical tools with great reliability, validity, and responsiveness. In this study, they looked at PEDI self-care domains; however, they did not provide a detailed examination of each component and the relationships among them. GMFCS level V was excluded from participation, so not all levels were evaluated. Another limitation of this study, was the inability to separate spasticity and voluntary muscle use when using hand dynamometry.
Conclusion: Overall, this study supports the use of different assessments and classification systems to assess self-care capability and performance in those with spastic CP. Tests and measures showed that gross manual dexterity and gross motor ability are important predictors for functional independence.
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This seems like an interesting study. As a cross sectional study, we are getting just a snapshot of the population of interest at a given point in time. It would be interesting to conduct a prospective longitudinal cohort study to watch this population over time, and monitor the results of the outcome measures and functional independence.