The family needs of parents of preschool children with cerebral palsy: the impact of child's gross motor and communications functions.

PubMed

Bertule, Dace; Vetra, Anita

2014-01-01

An understanding of the needs of families of preschool children with cerebral palsy (CP) is of essential importance if efficient and cost-effective services are to be provided to them. The aims of this study were to identify the most frequently expressed needs of families with preschool children with CP; differences in the amount and types of family needs based on the child's gross motor function and communication function level; and the impact of the child's gross motor function and communication function level on the type and amount of family needs. A total of 227 parents of preschool children with CP completed a modified version of the Family Needs Survey and a demographic questionnaire. Children's gross motor function level and communication function level was classified using the Gross Motor Function Classification System (GMFCS) and the Communication Function Classification System (CFCS), respectively. The total number of family needs differed based on GMFCS and CFCS levels. Children's GMFCS and CFCS level were not significant predictors of overall family needs (adjusted R(2)=0.163). In this model the GMFCS level of children did not account for the total number of family needs, while the CFCS level did. Child's limitations in terms of communication and gross motor functions must be taken into consideration when planning services for families with preschool children with CP. Copyright © 2014 Lithuanian University of Health Sciences. Production and hosting by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

Body composition, diet, and physical activity: a longitudinal cohort study in preschoolers with cerebral palsy.

PubMed

Oftedal, Stina; Davies, Peter Sw; Boyd, Roslyn N; Stevenson, Richard D; Ware, Robert S; Keawutan, Piyapa; Benfer, Katherine A; Bell, Kristie L

2017-02-01

Altered body composition in children with cerebral palsy (CP) could be due to differences in energy intake, habitual physical activity (HPA), and sedentary time. We investigated the longitudinal relation between the weight-for-age z score (WZ), fat-free mass (FFM), percentage of body fat (%BF), and modifiable lifestyle factors for all Gross Motor Function Classification System (GMFCS) levels (I-V). The study was a longitudinal population-based cohort study of children with CP who were aged 18-60 mo (364 assessments in 161 children; boys: 61%; mean ± SD recruitment age: 2.8 ± 0.9 y; GMFCS: I, 48%; II, 11%; III, 15%; IV, 11%; and V, 15%). A deuterium dilution technique or bioelectrical impedance analysis was used to estimate FFM, and the %BF was calculated. Energy intake, HPA, and sedentary time were measured with the use of a 3-d weighed food diary and accelerometer wear. Data were analyzed with the use of a mixed-model analysis. Children in GMFCS group I did not differ from age- and sex-specific reference children with typical development for weight. Children in GMFCS group IV were lighter-for-age, and children in GMFCS group V had a lower FFM-for-height than those in GMFCS group I. Children in GMFCS groups II-V had a higher %BF than that of children in GMFCS group I, with the exception of orally fed children in GMFCS group V. The mean %BF of children with CP classified them as overfat or obese. There was a positive association between energy intake and FFM and also between HPA level and FFM for children in GMFCS group I. Altered body composition was evident in preschool-age children with CP across functional capacities. Gross motor function, feeding method, energy intake, and HPA level in GMFCS I individuals are the strongest predictors of body composition in children with CP between the ages of 18 and 60 mo. © 2017 American Society for Nutrition.

Improvement of ambulatory function with multilevel soft tissue surgery in children with spastic diplegic cerebral palsy.

PubMed

Thamkunanon, Verasak

2011-08-01

Single Event Multilevel soft tissue surgery in spastic diplegic children also was effective for improving ambulatory function obviously as multilevel bone and soft tissue surgery. Just muscle and tendon surgery seem to be enough for better lever arm dysfunction of the lower extremity. It has safe, simple and rapid recovery. Gross Motor Functional Classification System (GMFCS) improvement after single event multilevel soft tissue surgery had been observed in these study groups of patients. Retrospective review in 93 spastic diplegic children who were more than 3 years old, had ability to understand communication, at least leaned sitting and one-hand gross function ability had been operated on by single event multilevel soft tissue surgery. GMFCS was assessed at the time of pre-operation and 6-12 months after operation. Analyzing GMFCS change was performed by statistics. Average 7 site surgery per one patient, 84% GMFCS level improvement and 16% GMFCS level non-improvement were reported. Nine cases (9.7%) were improved 2 level of GMFCS and 74% improved 1 level. GMFCS level compared between pre- and post surgery had changed by the significant statistic (p < 0.001). The average GMFCS level improvement for all groups was 0.93 level. The average age in the improved group (75 months old) was less than the non-improved group (92 month old), was a trend difference in statistic (p = 0.032). Single Event Multilevel Soft tissue surgery was effective in improving the GMFCS level average 1 level. It changed ambulatory function of spastic diplegic CP children obviously, immediately and safely. Younger age might get more benefit than older children.

Functional outcomes in children and young people with dyskinetic cerebral palsy.

PubMed

Monbaliu, Elegast; De La Peña, Mary-Grace; Ortibus, Els; Molenaers, Guy; Deklerck, Jan; Feys, Hilde

2017-06-01

This cross-sectional study aimed to map the functional profile of individuals with dyskinetic cerebral palsy (CP), to determine interrelationships between the functional classification systems, and to investigate the relationship of functional abilities with dystonia and choreoathetosis severity. Fifty-five children (<15y) and young people (15-22y) (30 males, 25 females; mean age 14y 6mo, standard deviation 4y 1mo) with dyskinetic CP were assessed using the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Communication Function Classification System (CFCS), Eating and Drinking Ability Classification System (EDACS), and Viking Speech Scale (VSS), as well as the Dyskinesia Impairment Scale. Over 50 per cent of the participants exhibited the highest limitation levels in GMFCS, MACS, and VSS. Better functional abilities were seen in EDACS and CFCS. Moderate to excellent interrelationship was found among the classification scales. All scales had significant correlation (r s =0.65 - 0.81) with dystonia severity except for CFCS in the young people group. Finally, only MACS (r s =0.40) and EDACS (r s =0.55) in the young people group demonstrated significant correlation with choreoathetosis severity. The need for inclusion of speech, eating, and drinking in the functional assessment of dyskinetic CP is highlighted. The study further supports the strategy of managing dystonia in particular at a younger age followed by choreoathetosis in a later stage. © 2017 Mac Keith Press.

Proximal Femoral Varus Derotation Osteotomy in Children with Cerebral Palsy: The Effect of Age, Gross Motor Function Classification System Level, and Surgeon Volume on Surgical Success.

PubMed

Shore, Benjamin J; Zurakowski, David; Dufreny, Chantal; Powell, Dustin; Matheney, Travis H; Snyder, Brian D

2015-12-16

The purpose of this study was to evaluate mid-term results of proximal femoral varus derotation osteotomy (VDRO) in children with cerebral palsy and determine what effect age, Gross Motor Function Classification System (GMFCS) level, and surgeon volume had on surgical success. We analyzed a cohort of children with cerebral palsy who underwent VDRO for hip displacement at a tertiary-level pediatric hospital between 1994 and 2007. Age, sex, GMFCS level, preoperative radiographic parameters, previous botulinum toxin administration or soft-tissue release, adjunctive pelvic osteotomy, the performance of bilateral surgery at the index VDRO, and surgeon volume (the number of procedures performed) were recorded. Results were analyzed via univariate and multivariate analyses for association with the need for revision hip surgery. Kaplan-Meier survivorship curves were generated, determining the time from index surgery to failure (defined as the need for subsequent surgical procedures on the hip and/or pelvis, or a hip migration percentage of >50% at the time of final follow-up), and were further stratified according to osseous versus soft-tissue revision. A total of 567 VDROs were performed in 320 children (mean age [and standard deviation], 8.2 ± 3.8 years). The mean follow-up was 8.3 years (range, three to eighteen years). Of the initial 320 patients, 117 (37%) were considered to have had failure. Multivariate Cox regression analysis confirmed that younger age at surgery (p < 0.001), increased GMFCS level (p = 0.01), and lower annual surgical hip volume (p = 0.02) were significant independent predictors of any type of surgical revision. Furthermore, soft-tissue release at VDRO was protective against revision (p = 0.02). Five-year survivorship analysis revealed a 92% success rate for children classified as GMFCS levels I and II compared with a 76% success rate for those of GMFCS level V (p < 0.01). This study demonstrated a 37% failure rate after VDRO in children with cerebral palsy. Older age, lower GMFCS level, and increased surgeon volume were strong predictors of surgical success. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

A Cross-sectional Survey of Growth and Nutritional Status in Children With Cerebral Palsy in West China.

PubMed

Wang, Fangfang; Cai, Qianyun; Shi, Wei; Jiang, Huayin; Li, Na; Ma, Dan; Wang, Qiu; Luo, Rong; Mu, Dezhi

2016-05-01

We describe the growth and nutritional status of children with cerebral palsy (2 to 18 years old) in West China and to explore the correlation between the nutritional status and age, gender, and gross and fine motor function. We performed a cross-sectional survey of children registered as having cerebral palsy in the China Disabled Persons' Federation branch in Chengdu. Growth (height and weight) and nutritional (body mass index) status were recorded. Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) were used to determine gross and fine motor function, respectively. The association between nutritional status and age, GMFCS and MACS levels was evaluated. We enrolled 377 children (53.6% male), among whom 160 (42.4%) were stunting, 48 (12.7%) underweight, 81 (21.5%) thin, and 70 (18.5%) overweight and obese. Thinness was the main nutritional problem in older patients (12 to 18 years), whereas overweight and obesity were the major issues in younger patients (2 to 12 years). Growth deviation and malnutrition were significantly more prevalent in patients with severe motor impairments. A significant negative correlation was found between nutritional status and age, GMFCS and MACS levels, and between growth and GMFCS and MACS levels. Growth abnormality is common in children with cerebral palsy. Malnutrition and overnutrition both exist in children with cerebral palsy. Characteristics at different age stages and motor functional levels should be taken into consideration in the management of growth and nutrition in this population. Copyright © 2016 Elsevier Inc. All rights reserved.

Functional Communication Profiles in Children with Cerebral Palsy in Relation to Gross Motor Function and Manual and Intellectual Ability.

PubMed

Choi, Ja Young; Park, Jieun; Choi, Yoon Seong; Goh, Yu Ra; Park, Eun Sook

2018-07-01

The aim of the present study was to investigate communication function using classification systems and its association with other functional profiles, including gross motor function, manual ability, intellectual functioning, and brain magnetic resonance imaging (MRI) characteristics in children with cerebral palsy (CP). This study recruited 117 individuals with CP aged from 4 to 16 years. The Communication Function Classification System (CFCS), Viking Speech Scale (VSS), Speech Language Profile Groups (SLPG), Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and intellectual functioning were assessed in the children along with brain MRI categorization. Very strong relationships were noted among the VSS, CFCS, and SLPG, although these three communication systems provide complementary information, especially for children with mid-range communication impairment. These three communication classification systems were strongly related with the MACS, but moderately related with the GMFCS. Multiple logistic regression analysis indicated that manual ability and intellectual functioning were significantly related with VSS and CFCS function, whereas only intellectual functioning was significantly related with SLPG functioning in children with CP. Communication function in children with a periventricular white matter lesion (PVWL) varied widely. In the cases with a PVWL, poor functioning was more common on the SLPG, compared to the VSS and CFCS. Very strong relationships were noted among three communication classification systems that are closely related with intellectual ability. Compared to gross motor function, manual ability seemed more closely related with communication function in these children. © Copyright: Yonsei University College of Medicine 2018.

Validation of Accelerometer Cut-Points in Children With Cerebral Palsy Aged 4 to 5 Years.

PubMed

Keawutan, Piyapa; Bell, Kristie L; Oftedal, Stina; Davies, Peter S W; Boyd, Roslyn N

2016-01-01

To derive and validate triaxial accelerometer cut-points in children with cerebral palsy (CP) and compare these with previously established cut-points in children with typical development. Eighty-four children with CP aged 4 to 5 years wore the ActiGraph during a play-based gross motor function measure assessment that was video-taped for direct observation. Receiver operating characteristic and Bland-Altman plots were used for analyses. The ActiGraph had good classification accuracy in Gross Motor Function Classification System (GMFCS) levels III and V and fair classification accuracy in GMFCS levels I, II, and IV. These results support the use of the previously established cut-points for sedentary time of 820 counts per minute in children with CP aged 4 to 5 years across all functional abilities. The cut-point provides an objective measure of sedentary and active time in children with CP. The cut-point is applicable to group data but not for individual children.

Pediatric outcomes data collection instrument scores in ambulatory children with cerebral palsy: an analysis by age groups and severity level.

PubMed

Barnes, Douglas; Linton, Judith L; Sullivan, Elroy; Bagley, Anita; Oeffinger, Donna; Abel, Mark; Damiano, Diane; Gorton, George; Nicholson, Diane; Romness, Mark; Rogers, Sarah; Tylkowski, Chester

2008-01-01

The Pediatric Outcomes Data Collection Instrument (PODCI) was developed in 1994 as a patient-based tool for use across a broad age range and wide array of musculoskeletal disorders, including children with cerebral palsy (CP). The purpose of this study was to establish means and SDs of the Parent PODCI measures by age groups and Gross Motor Function Classification System (GMFCS) levels for ambulatory children with CP. This instrument was one of several studied in a prospective, multicenter project of ambulatory patients with CP between the aged 4 and 18 years and GMFCS levels I through III. Participants included 338 boys and 221 girls at a mean age of 11.1 years, with 370 diplegic, 162 hemiplegic, and 27 quadriplegic. Both baseline and follow-up data sets of the completed Parent PODCI responses were statistically analyzed. Age was identified as a significant predictor of the PODCI measures of Upper Extremity Function, Transfers and Basic Mobility, Global Function, and Happiness With Physical Condition. Gross Motor Function Classification System levels was a significant predictor of Transfers and Basic Mobility, Sports and Physical Function, and Global Function. Pattern of involvement, sex, and prior orthopaedic surgery were not statistically significant predictors for any of the Parent PODCI measures. Mean and SD scores were calculated for age groups stratified by GMFCS levels. Analysis of the follow-up data set validated the findings derived from the baseline data. Linear regression equations were derived, with age as a continuous variable and GMFCS levels as a categorical variable, to be used for Parent PODCI predicted scores. The results of this study provide clinicians and researchers with a set of Parent PODCI values for comparison to age- and severity-matched populations of ambulatory patients with CP.

Comparisons of severity classification systems for oropharyngeal dysfunction in children with cerebral palsy: Relations with other functional profiles.

PubMed

Goh, Yu-Ra; Choi, Ja Young; Kim, Seon Ah; Park, Jieun; Park, Eun Sook

2018-01-01

This study aimed to investigate the relationships between various classification systems assessing the severity of oropharyngeal dysphagia and communication function and other functional profiles in children with cerebral palsy (CP). This is a prospective, cross-sectional, study in a university-affiliated, tertiary-care hospital. We recruited 151 children with CP (mean age 6.11 years, SD 3.42, range 3-18yr). The Eating and Drinking Ability Classification System (EDACS) and the dysphagia scales of Functional Oral Intake Scale (FOIS), Swallow Function Scales (SFS), and Food Intake Level Scale (FILS) were used. The Communication Function Classification System (CFCS) and Viking Speech Scale (VSS) were employed to classify communication function and speech intelligibility, respectively. The Pediatric Evaluation of Disability Inventory (PEDI) with the Gross Motor Function Classification System (GFMCS) and the Manual Ability Classification System (MACS) level were also assessed. Spearman correlation analysis to investigate the associations between measures and univariate and multivariate logistic regression models to identify significant factors were used. Median GMFCS level of participants was III (interquartile range II-IV). Significant dysphagia based on EDACS level III-V was noted in 23 children (15.2%). There were strong to very strong relationships between the EDACS level with the dysphagia scales. The EDACS presented strong associations with MACS, CFCS, and VSS, a moderate association with GMFCS level, and a moderate to strong association with each domain of the PEDI. In multivariate analysis, poor functioning in EDACS were associated with poor functioning in gross motor and communication functions. Copyright © 2017. Published by Elsevier Ltd.

Parents' Experiences and Perceptions when Classifying their Children with Cerebral Palsy: Recommendations for Service Providers.

PubMed

Scime, Natalie V; Bartlett, Doreen J; Brunton, Laura K; Palisano, Robert J

2017-08-01

This study investigated the experiences and perceptions of parents of children with cerebral palsy (CP) when classifying their children using the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), and the Communication Function Classification System (CFCS). The second aim was to collate parents' recommendations for service providers on how to interact and communicate with families. A purposive sample of seven parents participating in the On Track study was recruited. Semi-structured interviews were conducted orally and were audiotaped, transcribed, and coded openly. A descriptive interpretive approach within a pragmatic perspective was used during analysis. Seven themes encompassing parents' experiences and perspectives reflect a process of increased understanding when classifying their children, with perceptions of utility evident throughout this process. Six recommendations for service providers emerged, including making the child a priority and being a dependable resource. Knowledge of parents' experiences when using the GMFCS, MACS, and CFCS can provide useful insight for service providers collaborating with parents to classify function in children with CP. Using the recommendations from these parents can facilitate family-provider collaboration for goal setting and intervention planning.

Multimorbidity in Middle-Aged Adults with Cerebral Palsy

PubMed Central

Cremer, Nicole; Hurvitz, Edward A.; Peterson, Mark D.

2017-01-01

Background Individuals with cerebral palsy have less lean body mass, greater relative adiposity, and lower fitness and physical activity participation; and yet, the prevalence of age-related multimorbidity in this population has yet to be established. Purpose To examine the prevalence of lifestyle-related chronic conditions and multimorbidity in a sample of middle-aged adults with cerebral palsy. Methods A clinic-based sample of middle-aged adults with cerebral palsy was examined using Electronic Medical Records Search Engine (EMERSE) software. Our cohort included n= 435 individuals aged 40–60 years old, with an ICD-9/10-CM Diagnosis Code for cerebral palsy. Prevalence of 12 chronic conditions were evaluated, including existing diagnoses or historical record of: osteopenia/osteoporosis, myocardial infarction, stroke, coronary artery disease, impaired glucose tolerance/type 2 diabetes, other cardiovascular conditions, rheumatoid arthritis, osteoarthritis, asthma, emphysema, pre-hypertension/hypertension, and hyperlipidemia. Multivariate logistic models were used to estimate adjusted mulitmorbidity (i.e., ≥2 chronic conditions), adjusting for age, sex, smoking status, obesity, and Gross Motor Function Classification System (GMFCS). Results There were 137 unique multimorbidity combinations. Multimorbidity was significantly more prevalent among obese versus non-obese individuals for both GMFCS I–III (75.8% vs. 53.6%) and GMFCS IV–V (79.0% vs 64.2%), but was also significantly higher in non-obese individuals with GMFCS IV–V (64.2%) compared to individuals with non-obese individuals with GMFCS I–III (53.6%). Both obesity status (OR: 2.20; 95% CI 1.32–2.79) and the GMFCS IV–V category (OR: 1.81; 95% CI 1.32–3.68) were independently associated with multimorbidity. Conclusion Middle-aged adults with cerebral palsy have high estimates of multimorbidity, and both obesity and higher GMFCS levels are independently associated with greater risk. PMID:28065772

Investigating the impact of pain, age, Gross Motor Function Classification System, and sex on health-related quality of life in children with cerebral palsy.

PubMed

Findlay, Briar; Switzer, Lauren; Narayanan, Unni; Chen, Shiyi; Fehlings, Darcy

2016-03-01

To explore whether health-related quality of life (HRQOL) can be predicted by pain, age, Gross Motor Function Classification System (GMFCS) level, and sex in children with cerebral palsy (CP) and whether different pain etiologies have varying effects on HRQOL. Children with CP aged 3 to 19 years and their caregivers were consecutively recruited. Caregivers reported their child's pain (Health Utilities Index 3 [HUI3] pain subset) and HRQOL (DISABKIDS questionnaires). Physicians identified pain etiologies. A multiple linear regression model determined whether pain, GMFCS level, sex, and age predicted HRQOL. An ANOVA evaluated the effects of pain etiologies on HRQOL. Three hundred and forty-four participants were approached and 87% (n=300) participated. Sufficient data were available on 248 (72% of total sample). Sixty-six participants (27%) formed the pain group with HUI3 pain scores of at least 3. The presence of pain and increasing age significantly negatively predicted HRQOL (p<0.001, R(2) =0.141), while GMFCS and sex did not. Musculoskeletal deformity (24%) and hypertonia (18%) were the most frequent pain causes. HRQOL statistically differed depending on the pain etiology (p=0.028) with musculoskeletal deformity showing the lowest mean HRQOL. The presence of pain and increasing age negatively predict HRQOL in CP. musculoskeletal deformity has the greatest negative impact on HRQOL. © 2015 Mac Keith Press.

The effect of long-term conventional physical therapy and independent predictive factors analysis in children with cerebral palsy.

PubMed

Chen, Yi-Nien; Liao, Su-Fen; Su, Li-Fei; Huang, Hsin-Ya; Lin, Chung-Che; Wei, Ta-Sen

2013-10-01

This study evaluated the effect of long-term conventional physical therapy (PT) on cerebral palsy (CP) children and to identify the predictors of therapy's response. We performed a retrospective review of CP children treated with PT, and their motor function was assessed every 3 months between 2008 and 2011. Fifty-six children with a mean age of 4.2 ± 2.8 years, gross motor function classification system (GMFCS) levels were level I (n = 14), level II (n = 20), level III (n = 5), level IV (n = 8), and level V (n = 9). In the generalized estimating equations model, there was a significant improvement in the Gross Motor Function Measure (GMFM-66) score (p < 0.001); the improvement was different in five GMFCS levels (p < 0.001) and GMFCS level II had faster progression. The younger CP children had better PT efficacy, and the GMFM-66 score continued improving until 8.4 years old in the older group. The long-term conventional PT is effective even in older CP children, and PT was most efficient in younger children and GMFCS level II.

Comprehension of spoken language in non-speaking children with severe cerebral palsy: an explorative study on associations with motor type and disabilities.

PubMed

Geytenbeek, Joke J M; Vermeulen, R Jeroen; Becher, Jules G; Oostrom, Kim J

2015-03-01

To assess spoken language comprehension in non-speaking children with severe cerebral palsy (CP) and to explore possible associations with motor type and disability. Eighty-seven non-speaking children (44 males, 43 females, mean age 6y 8mo, SD 2y 1mo) with spastic (54%) or dyskinetic (46%) CP (Gross Motor Function Classification System [GMFCS] levels IV [39%] and V [61%]) underwent spoken language comprehension assessment with the computer-based instrument for low motor language testing (C-BiLLT), a new and validated diagnostic instrument. A multiple linear regression model was used to investigate which variables explained the variation in C-BiLLT scores. Associations between spoken language comprehension abilities (expressed in z-score or age-equivalent score) and motor type of CP, GMFCS and Manual Ability Classification System (MACS) levels, gestational age, and epilepsy were analysed with Fisher's exact test. A p-value <0.05 was considered statistically significant. Chronological age, motor type, and GMFCS classification explained 33% (R=0.577, R(2) =0.33) of the variance in spoken language comprehension. Of the children aged younger than 6 years 6 months, 52.4% of the children with dyskinetic CP attained comprehension scores within the average range (z-score ≥-1.6) as opposed to none of the children with spastic CP. Of the children aged older than 6 years 6 months, 32% of the children with dyskinetic CP reached the highest achievable age-equivalent score compared to 4% of the children with spastic CP. No significant difference in disability was found between CP-related variables (MACS levels, gestational age, epilepsy), with the exception of GMFCS which showed a significant difference in children aged younger than 6 years 6 months (p=0.043). Despite communication disabilities in children with severe CP, particularly in dyskinetic CP, spoken language comprehension may show no or only moderate delay. These findings emphasize the importance of introducing alternative and/or augmentative communication devices from early childhood. © 2014 Mac Keith Press.

Annual changes in radiographic indices of the spine in cerebral palsy patients.

PubMed

Lee, Seung Yeol; Chung, Chin Youb; Lee, Kyoung Min; Kwon, Soon-Sun; Cho, Kyu-Jung; Park, Moon Seok

2016-03-01

We estimated the annual changes in radiographic indices of the spine in cerebral palsy (CP) patients and analyzed the factors that influence its progression rate. We included CP patients who had undergone whole-spine radiography more than twice and were followed for at least 1 year. The scoliosis Cobb angle, coronal balance, apical vertebral translation, apical rotation, and pelvic obliquity were measured on anteroposterior (AP) radiographs; thoracic kyphosis and lumbar lordosis angles, and sagittal balance was measured on lateral radiographs; and migration percentage was measured on AP hip radiographs to determine hip instability. For each gross motor function classification system (GMFCS) level, the Cobb angles, apical vertebral translation, coronal and sagittal balance, and pelvic obliquity were adjusted by multiple factors with a linear mixed model. A total of 184 patients (774 radiographs) were included in this study. There was no significant annual change in scoliosis Cobb, thoracic kyphosis, and lumbar lordosis angles in the GMFCS level I-II and III groups. In the GMFCS level IV-V group, there was an annual increase of 3.4° in the scoliosis Cobb angle (p = 0.020). The thoracic kyphosis angle increased by 2.2° (p = 0.018) annually in the GMFCS level IV-V group. Apical vertebral translation increased by 5.4 mm (p = 0.029) annually in the GMFCS level IV-V group. Progression of coronal and sagittal balance and pelvic obliquity with aging were not statistically significant. Sex, hip instability, hip surgery, and triradiate cartilage did not affect the progression of scoliosis and the balance of the spine and pelvis. The scoliosis Cobb angle, thoracic kyphosis angle, and apical vertebral translation in the GMFCS level IV-V CP patients progressed with age. These findings can predict radiographic progression of scoliosis in CP patients.

Management of cerebral palsy varies by healthcare region.

PubMed

Rackauskaite, Gija; Uldall, Peter W; Bech, Bodil H; Østergaard, John R

2015-11-01

Cerebral palsy (CP) is the most common type of motor disability in childhood. The aim of the present paper was to describe regional differences in the management of CP in school-aged children in Denmark. This was a cross-sectional study based on the Danish Cerebral Palsy Registry. The parents of 462 children answered a questionnaire about their child's treatment and the family's characteristics. Descriptive and logistic regression analyses were performed for every treatment modality, stratified by the Gross Motor Function Classification System (GMFCS) level and adjusted for family and child characteristics. Significant regional differences were found regarding the provision of occupational therapy at all GMFCS levels, speech therapy at GMFCS levels II-V and orthopaedic surgery at GMFCS levels I and III-V. No regional differences were observed in the frequency of physiotherapy. We found no regional differences in the severity of disability. Regional differences in the management of CP cannot be explained by social differences or differences in the severity of the disability. This study was funded by the Research Foundation from the Central Denmark Region and the Department of Clinical Medicine at Aarhus University Hospital, the Augustinus Foundation, the Bevica Foundation, the Dagmar Marshalls Foundation, the Ludvig and Sara Elsass Foundation, and the Civil Engineer Frode V. Nyegaard's and his Wife's Foundation. not relevant.

Clinical characteristics and functional status of children with different subtypes of dyskinetic cerebral palsy.

PubMed

Sun, Dianrong; Wang, Qiang; Hou, Mei; Li, Yutang; Yu, Rong; Zhao, Jianhui; Wang, Ke

2018-05-01

Dyskinetic cerebral palsy (CP) is the second major subtype of CP. Dyskinetic CP can be classified into different subtypes, but the exact clinical characteristics of these subtypes have been poorly studied. To investigate the clinical characteristics and functional classification of dyskinetic CP from the perspective of neurologic subtypes in a hospital-based follow-up study.This was an observational study of consecutive children with dyskinetic CP treated at The Affiliated Women & Children Hospital of Qingdao University (China) from October 2005 to February 2015. The children were stratified according to their neurologic subtype and assessed with the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS). MRI scanning was conducted at 1 year of age for most children.Twenty-six participants (28.0%) had dystonic CP, 26 (28.0%) had choreoathetotic CP, and 41 (44.1%) had mixed CP. Auditory impairment and basal ganglion lesions occurred more frequently in the dystonia group (n = 8, 31%; and n = 16, 67%), while seizures, microcephaly, white matter lesions, and mixed lesions were more frequent in the mixed type (n = 14, 34%; n = 10, 24%; n = 15, 41%; n = 12, 32%). Functional classification levels were distributed unequally among the 3 subgroups (P < .01). No significant difference between GMFCS and MACS was found among the 3 subgroups (P > .05).Different subtypes of dyskinetic CP have specific comorbidities, radiological characteristics, and functional attributes according to their etiological factors and brain lesions. Children with dystonic CP have more limited functional status than children with choreoathetotic CP.

Focal treatment of spasticity using botulinum toxin A in cerebral palsy cases of GMFCS level V: evaluation of adverse effects☆☆☆

PubMed Central

Tedesco, Ana Paula; Martins, Juliana Saccol; Nicolini-Panisson, Renata D’Agostini

2014-01-01

Objective To report on the experience of injections of botulinum toxin A (BTA) in a series of patients with cerebral palsy of Gross Motor Function Classification System (GMFCS) level V. Methods This was a retrospective case series study on 33 patients with cerebral palsy of GMFCS level V who received 89 sessions of BTA application (of which 84 were Botox® and five were other presentations), in which the basic aim was to look for adverse effects. Results The mean number of application sessions per patient was three, and the mean age at the time of each injection was 4 + 6 years (range: 1.6–13 years). The muscles that most frequently received injections were the gastrocnemius, hamstrings, hip adductors, biceps brachii and finger flexors. The mean total dose was 193 U and the mean dose per weight was 12.5 U/kg. Only one patient received anesthesia for the injections and no sedation was used in any case. No local or systemic adverse effects were observed within the minimum follow-up of one month. Conclusion The absence of adverse effects in our series was probably related to the use of low doses and absence of sedation or anesthesia. According to our data, BTA can be safely used for patients with cerebral palsy of GMFCS level V, using low doses and preferably without sedation or anesthesia. PMID:26229827

Reliability and cross-cultural validation of the Turkish version of Manual Ability Classification System (MACS) for children with cerebral palsy.

PubMed

Akpinar, Pinar; Tezel, Canan G; Eliasson, Ann-Christin; Icagasioglu, Afitap

2010-01-01

To determine the reliability and cross-cultural validation of the Turkish translation of the Manual Ability Classification System (MACS) for children with cerebral palsy (CP) and to investigate the relation to gross motor function and other comorbidities. After the forward and backward translation procedures, inter-rater and test-retest reliability was assessed between parents, physiotherapists and physicians using the intra-class correlation coefficient (ICC). Children (N = 118, 4 to 18 years, mean age 9 years 4 months; 68 boys, 50 girls) with various types of CP were classified. Additional data on the Gross Motor Function Classification System (GMFCS), intellectual delay, visual acuity, and epilepsy were collected. The inter-rater reliability was high; the ICC ranged from 0.89 to 0.96 among different professionals and parents. Between two persons of the same profession it ranged from 0.97 to 0.98. For the test-retest reliability it ranged from 0.91 to 0.98. Total agreement between the GMFCS and the MACS occurred in only 45% of the children. The level of the MACS was found to correlate with the accompanying comorbidities, namely intellectual delay and epilepsy. The Turkish version of the MACS is found to be valid and reliable, and is suggested to be appropriate for the assessment of manual ability within the Turkish population.

Measurement of Habitual Physical Activity Performance in Adolescents with Cerebral Palsy: A Systematic Review

ERIC Educational Resources Information Center

Clanchy, Kelly M.; Tweedy, Sean M.; Boyd, Roslyn

2011-01-01

Aim: This systematic review compares the validity, reliability, and clinical use of habitual physical activity (HPA) performance measures in adolescents with cerebral palsy (CP). Method: Measures of HPA across Gross Motor Function Classification System (GMFCS) levels I-V for adolescents (10-18y) with CP were included if at least 60% of items…

The benefits of a comprehensive rehabilitation program in patients diagnosed with spastic quadriplegia

PubMed Central

Rogoveanu, OC; Tuțescu, NC; Kamal, D; Alexandru, DO; Kamal, C; Streba, CT; Trăistaru, MR

2016-01-01

Spastic quadriplegia has as an etiopathogenic substrate, a non-progressive brain lesion; however, the clinical manifestations of the disease evolve over time. Children diagnosed with spastic quadriplegia show a variety of symptoms in different areas: sensorimotor, emotional, cognitive, and social. The purpose of this study was to assess the functional status in patients diagnosed with spastic quadriplegia, who followed a complex medical rehabilitation program, during a year, and highlight the importance of using physical and kinetic techniques in improving their status. A total of 10 children diagnosed with spastic quadriplegia were included in the study and the Gross Motor Function Classification System (GMFCS) and manual ability classification system (MACS) were used to evaluate the functionality status of each patient. Every patient was evaluated initially (T1), after six months of program (T2), and after they completed the study. All the children were originally monitored daily, for 5 days per week for a period of one month, then two times a week for a year. A statistically significant difference regarding the modification of the GMFCS and MACS stage was found, which occurred between the first and the third evaluation. The inverse correlation of the statistical significance between the ages of patients and the decrease in GMFCS or MACS stage was highlighted; the younger the patient, the more the scale decreased. A direct link between the gross motor function and the manual ability was noticed. Applying a complex rehabilitation program has proven efficient by improving both the gross motor functionality and the manual ability. PMID:27974931

The benefits of a comprehensive rehabilitation program in patients diagnosed with spastic quadriplegia.

PubMed

Rogoveanu, O C; Tuțescu, N C; Kamal, D; Alexandru, D O; Kamal, C; Streba, C T; Trăistaru, M R

2016-01-01

Spastic quadriplegia has as an etiopathogenic substrate, a non-progressive brain lesion; however, the clinical manifestations of the disease evolve over time. Children diagnosed with spastic quadriplegia show a variety of symptoms in different areas: sensorimotor, emotional, cognitive, and social. The purpose of this study was to assess the functional status in patients diagnosed with spastic quadriplegia, who followed a complex medical rehabilitation program, during a year, and highlight the importance of using physical and kinetic techniques in improving their status. A total of 10 children diagnosed with spastic quadriplegia were included in the study and the Gross Motor Function Classification System (GMFCS) and manual ability classification system (MACS) were used to evaluate the functionality status of each patient. Every patient was evaluated initially (T1), after six months of program (T2), and after they completed the study. All the children were originally monitored daily, for 5 days per week for a period of one month, then two times a week for a year. A statistically significant difference regarding the modification of the GMFCS and MACS stage was found, which occurred between the first and the third evaluation. The inverse correlation of the statistical significance between the ages of patients and the decrease in GMFCS or MACS stage was highlighted; the younger the patient, the more the scale decreased. A direct link between the gross motor function and the manual ability was noticed. Applying a complex rehabilitation program has proven efficient by improving both the gross motor functionality and the manual ability.

Bone density and size in ambulatory children with cerebral palsy.

PubMed

Al Wren, Tishya; Lee, David C; Kay, Robert M; Dorey, Frederick J; Gilsanz, Vicente

2011-02-01

To examine the relation of axial and appendicular bone properties in ambulatory children with cerebral palsy (CP) to functional (Gross Motor Function Classification System [GMFCS]) level. Quantitative computed tomography measurements were compared among 37 children with CP (12 children in GMFCS level I, five in level II, 18 in level III, two in level IV; five with hemiplegia, 23 with diplegia, two with triplegia, seven with quadriplegia; mean age 9y 4mo, SD 1y 6mo; 18 males, 19 females) and 37 children in a comparison group (same age and sex distributions). Linear regression was used to evaluate differences in volumetric cancellous bone density (vBMD) and geometric properties of the L3 vertebra and tibia, adjusting for height, weight, and sex as covariates. The comparison group had larger vertebrae than the children with CP (p = 0.02) owing to smaller vertebral size in GMFCS levels III and IV, but there was no difference in vertebral vBMD (p = 0.49). In the tibia, bone volumetric density (p = 0.09) and size (p = 0.02) decreased with increasing GMFCS level. GMFCS level had a greater effect on bone size in females than in males (p<0.07). Children with CP of all levels may have less bone in their tibias, whereas spine deficits differentially affect more involved children. Because even small bone deficits may manifest as osteoporosis later in life, it is important to study bone acquisition in all children with CP. © The Authors. Journal compilation © Mac Keith Press 2010.

Sleep concerns in children and young people with cerebral palsy in their home setting.

PubMed

McCabe, Susan M; Blackmore, A Marie; Abbiss, Chris R; Langdon, Katherine; Elliott, Catherine

2015-12-01

The aims were to identify in-home concerns about sleep in children and young people with cerebral palsy (CP) across age and Gross Motor Function Classification Scale (GMFCS) levels. This was a retrospective review of clinical notes of 154 children and young people with CP, aged 1-18 years (M = 7.8; standard deviation = 5.4) who received a home-based sleep service. Reported concerns were synthesised, for analysis according to age groups (1-5, 6-13, 14-18) and GMFCS levels. Sixteen factors of concern were derived from the home-based assessment reports. Most children and young people had multiple factors of concern. These varied across age groups and GMFCS levels. Body position was of concern across all age groups, for over 90% at GMFCS levels IV and V, and for 10% at GMFCS level I. Settling routines were of concern for more than 90% at GMFCS levels I and II, but for less than 50% at GMFCS levels IV and V. Settling routines were of concern to over 65% of those under 6 years but less than 25% of those over 14 years. Conversely, pain and pressure care concerned less than 10% of children under 6, and more than 35% of those over 14 years. Concerns about sleep vary across ages and GMFCS levels of children and young people with CP. Concerns relate to impairment of body structure and function, activity, environment, and personal supports. Multi-disciplinary, home-based assessment and interventions are recommended to address these concerns. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Impact of child and family characteristics on cerebral palsy treatment.

PubMed

Rackauskaite, Gija; Uldall, Peter W; Bech, Bodil H; Østergaard, John R

2015-10-01

The aim of the study was to describe the relationship between the child's and family's characteristics and the most common treatment modalities in a national population-based sample of 8- to 15-year-old children with cerebral palsy. A cross-sectional study, based on the Danish Cerebral Palsy Registry. The parents of 462 children answered a questionnaire about their child's treatment and the family's characteristics (living with a single parent, having siblings, living in a city, parental education level). Descriptive and logistic regression analyses were performed for every treatment modality, stratified by Gross Motor Function Classification System (GMFCS) level. An IQ below 85 was associated with weekly therapy in GMFCS level I (adjusted odds ratio [ORadj ] 2.5 [CI 1.1-5.7]) and the use of oral spasmolytics in GMFCS levels III to V (ORadj 3.1 [CI 1.3-7.4]). Older children in GMFCS levels III to V used daily orthoses less frequently (ORadj 0.7 [CI 0.6-0.9] per year). Of all of the family characteristics studied, only the parents' education level had significant associations with more than one treatment modality. A child's cognitive function showed an impact on treatment of the motor impairment in children 8 to 15 years of age with cerebral palsy. Parental education level may influence the choice of treatment. © 2015 Mac Keith Press.

Outcome assessments in children with cerebral palsy, part II: discriminatory ability of outcome tools.

PubMed

Bagley, Anita M; Gorton, George; Oeffinger, Donna; Barnes, Douglas; Calmes, Janine; Nicholson, Diane; Damiano, Diane; Abel, Mark; Kryscio, Richard; Rogers, Sarah; Tylkowski, Chester

2007-03-01

Discriminatory ability of several pediatric outcome tools was assessed relative to Gross Motor Function Classification System (GMFCS) level in patients with cerebral palsy. Five hundred and sixty-two patients (400 with diplegia, 162 with hemiplegia; 339 males, 223 females; age range 4-18y, mean 11y 1mo [SD 3y 7mo]), classified as GMFCS Levels I to III, participated in this prospective multicenter, cross-sectional study. All tools were completed by parents and participants when appropriate. Effect size indices (ESIs) for parametric variables and odds ratios for non-parametric data quantified the magnitude of differences across GMFCS levels. Binary logistic regression models determined discrimination, and receiver operating characteristic curves addressed sensitivity and specificity. Between Levels I and II, the most discriminatory tools were Gross Motor Function Measure (GMFM-66), velocity, and WeeFIM Mobility. Between Levels II and III, the most discriminatory tools were GMFM Dimension E, Pediatric Functional Independence Measure (WeeFIM) Self-Care and Mobility, cadence, and Gillette Functional Assessment Questionnaire Question 1. Large ESIs were noted for Parent and Child reports of Pediatric Outcomes Data Collection Instrument (PODCI) Sports & Physical Function, Parent report of PODCI Global Function, GMFM Dimension E, and GMFM-66 across all GMFCS level comparisons. The least discriminatory tools were the Quality of Life and cognition measures; however, these are important in comprehensive assessments of treatment effects.

Hip health at skeletal maturity: a population-based study of young adults with cerebral palsy.

PubMed

Wawrzuta, Joanna; Willoughby, Kate L; Molesworth, Charlotte; Ang, Soon Ghee; Shore, Benjamin J; Thomason, Pam; Graham, H Kerr

2016-12-01

We studied 'hip health' in a population-based cohort of adolescents and young adults with cerebral palsy to investigate associations between hip morphology, pain, and gross motor function. Ninety-eight young adults (65 males, 33 females) from the birth cohort were identified as having developed hip displacement (migration percentage >30) and were reviewed at a mean age of 18 years 10 months (range 15-24y). Hip morphology was classified using the Melbourne Cerebral Palsy Hip Classification Scale (MCPHCS). Severity and frequency of pain were recorded using Likert scales. Gross motor function was classified by the Gross Motor Function Classification System (GMFCS). Hip pain was reported in 72% of participants. Associations were found between pain scores and both hip morphology and GMFCS. Median pain severity score for MCPHCS grades 1 to 4 was 2 (interquartile range [IQR] 1.0-3.0) compared to 7 (IQR 6.0-8.0) for grades 5 and 6 (severe subluxation or dislocation). Hip surveillance and access to surgery were associated with improved hip morphology and less pain. Poor hip morphology at skeletal maturity was associated with high levels of pain. Limited hip surveillance and access to surgery, rather than GMFCS, was associated with poor hip morphology. The majority of young adults who had access to hip surveillance, and preventive and reconstructive surgery, had satisfactory hip morphology at skeletal maturity and less pain. © 2016 Mac Keith Press.

Motor Control of the Lower Extremity Musculature in Children with Cerebral Palsy

ERIC Educational Resources Information Center

Arpin, David J.; Stuberg, Wayne; Stergiou, Nicholas; Kurz, Max J.

2013-01-01

The aim of this investigation was to quantify the differences in torque steadiness and variability of the muscular control in children with cerebral palsy (CP) and typically developing (TD) children. Fifteen children with CP (age = 14.2 [plus or minus] 0.7 years) that had a Gross Motor Function Classification System (GMFCS) score of I-III and 15…

Feasibility and Reliability of the Modified Berg Balance Scale in Persons with Severe Intellectual and Visual Disabilities

ERIC Educational Resources Information Center

Waninge, A.; van Wijck, R.; Steenbergen, B.; van der Schans, C. P.

2011-01-01

Background: The purpose of this study was to determine the feasibility and reliability of the modified Berg Balance Scale (mBBS) in persons with severe intellectual and visual disabilities (severe multiple disabilities, SMD) assigned Gross Motor Function Classification System (GMFCS) grades I and II. Method: Thirty-nine participants with SMD and…

Noncommunicable disease and multimorbidity in young adults with cerebral palsy.

PubMed

Whitney, Daniel G; Hurvitz, Edward A; Ryan, Jennifer M; Devlin, Maureen J; Caird, Michelle S; French, Zachary P; Ellenberg, Elie C; Peterson, Mark D

2018-01-01

Individuals with cerebral palsy (CP) are at increased risk for frailty and chronic disease due to factors experienced throughout the lifespan, such as excessive sedentary behaviors and malnutrition. However, little is known about noncommunicable diseases (NCDs) and multimorbidity profiles in young adults with CP. The study objective was to compare NCD and multimorbidity profiles between young adults with and without CP. A clinic-based sample of adults (18-30 years) with (n=452) and without (n=448) CP was examined at the University of Michigan Medical Center. The prevalence and predictors of 13 NCDs were evaluated, including existing diagnoses or historical record of musculoskeletal, cardiometabolic, and pulmonary morbidities. The level of motor impairment was determined by the Gross Motor Function Classification System (GMFCS) and stratified by less vs more severe motor impairment (GMFCS I-III vs IV-V). Logistic regression was used to determine the odds of NCD morbidity and multimorbidity in adults with CP compared to adults without CP, and for GMFCS IV-V compared to GMFCS I-III in those with CP, after adjusting for age, sex, body mass index, and smoking. Adults with CP had a higher prevalence of osteopenia, osteoporosis, hypertension, myocardial infarction, hyperlipidemia, asthma, and multimorbidity compared to adults without CP, and higher odds of musculoskeletal (odds ratio [OR]: 6.97) and cardiometabolic morbidity (OR: 1.98), and multimorbidity (OR: 2.67). Adults with CP with GMFCS levels IV-V had a higher prevalence of osteopenia/osteoporosis, osteoarthritis, hypertension, other cardiovascular conditions, pulmonary embolism, and multimorbidity, and higher odds of musculoskeletal (OR: 3.41), cardiometabolic (OR: 2.05), pulmonary morbidity (OR: 1.42), and multimorbidity (OR: 3.45) compared to GMFCS I-III. Young adults with CP have a higher prevalence of chronic NCDs and multimorbidity compared to young adults without CP, which is pronounced in those with more severe motor impairment. These findings reiterate the importance of early screening for prevention of NCDs in CP.

Noncommunicable disease and multimorbidity in young adults with cerebral palsy

PubMed Central

Whitney, Daniel G; Hurvitz, Edward A; Ryan, Jennifer M; Devlin, Maureen J; Caird, Michelle S; French, Zachary P; Ellenberg, Elie C; Peterson, Mark D

2018-01-01

Purpose Individuals with cerebral palsy (CP) are at increased risk for frailty and chronic disease due to factors experienced throughout the lifespan, such as excessive sedentary behaviors and malnutrition. However, little is known about noncommunicable diseases (NCDs) and multimorbidity profiles in young adults with CP. The study objective was to compare NCD and multimorbidity profiles between young adults with and without CP. Methods A clinic-based sample of adults (18–30 years) with (n=452) and without (n=448) CP was examined at the University of Michigan Medical Center. The prevalence and predictors of 13 NCDs were evaluated, including existing diagnoses or historical record of musculoskeletal, cardiometabolic, and pulmonary morbidities. The level of motor impairment was determined by the Gross Motor Function Classification System (GMFCS) and stratified by less vs more severe motor impairment (GMFCS I–III vs IV–V). Logistic regression was used to determine the odds of NCD morbidity and multimorbidity in adults with CP compared to adults without CP, and for GMFCS IV–V compared to GMFCS I–III in those with CP, after adjusting for age, sex, body mass index, and smoking. Results Adults with CP had a higher prevalence of osteopenia, osteoporosis, hypertension, myocardial infarction, hyperlipidemia, asthma, and multimorbidity compared to adults without CP, and higher odds of musculoskeletal (odds ratio [OR]: 6.97) and cardiometabolic morbidity (OR: 1.98), and multimorbidity (OR: 2.67). Adults with CP with GMFCS levels IV–V had a higher prevalence of osteopenia/osteoporosis, osteoarthritis, hypertension, other cardiovascular conditions, pulmonary embolism, and multimorbidity, and higher odds of musculoskeletal (OR: 3.41), cardiometabolic (OR: 2.05), pulmonary morbidity (OR: 1.42), and multimorbidity (OR: 3.45) compared to GMFCS I–III. Conclusion Young adults with CP have a higher prevalence of chronic NCDs and multimorbidity compared to young adults without CP, which is pronounced in those with more severe motor impairment. These findings reiterate the importance of early screening for prevention of NCDs in CP. PMID:29750055

Longitudinal Growth, Diet, and Physical Activity in Young Children With Cerebral Palsy.

PubMed

Oftedal, Stina; Davies, Peter S W; Boyd, Roslyn N; Stevenson, Richard D; Ware, Robert S; Keawutan, Piyapa; Benfer, Katherine A; Bell, Kristie L

2016-10-01

To describe the longitudinal relationship between height-for-age z score (HZ), growth velocity z score, energy intake, habitual physical activity (HPA), and sedentary time across Gross Motor Function Classification System (GMFCS) levels I to V in preschoolers with cerebral palsy (CP). Children with CP (n = 175 [109 (62.2%) boys]; mean recruitment age 2 years, 10 months [SD 11 months]; GMFCS I = 83 [47.2%], II = 21 [11.9%], III = 28 [15.9%], IV = 19 [10.8%], V = 25 [14.2%]) were assessed 440 times between the age of 18 months and 5 years. Height/length ratio was measured or estimated via knee height. Population-based standards were used to calculate HZ and growth velocity z-score by age and sex categories. Feeding method (oral or tube) and gestational age at birth (GA) were collected from parents. Three-day ActiGraph and food diary data were used to measure HPA/sedentary time ratio and energy intake, respectively. Oropharyngeal dysphagia was rated with the Dysphagia Disorder Survey (part 2, Pediatric). Analysis was undertaken with mixed-effects regression models. For GMFCS level I, height and growth velocity did not differ from population-level growth standards. Children in levels II to V were significantly shorter, and those in levels III to V grew significantly more slowly than those in level I. There was a significant positive association between HZ and GA at all GMFCS levels. Energy intake, HPA, sedentary time, Dysphagia Disorder Survey score, and feeding method were not significantly associated with either height or growth velocity once GMFCS level was accounted for. Functional status and GA should be considered when assessing the growth of a child with CP. Research into interventions aimed at increasing active movement in GMFCS levels III to V and their efficacy in improving growth and health outcomes is warranted. Copyright © 2016 by the American Academy of Pediatrics.

Caracterization of adults with cerebral palsy.

PubMed

Margre, Anna L M; Reis, Maria G L; Morais, Rosane L S

2010-01-01

cerebral Palsy (CP) is a group of permanent disorders of the development of movement and posture that cause functional limitation and are attributed to non-progressive disorders which occur in the fetal or infant brain. In recent years, with the increase in life expectancy of individuals with CP, several studies have described the impact of musculoskeletal disabilities and functional limitations over the life cycle. to characterize adults with CP through sociodemographic information, classifications, general health, associated conditions, physical complications and locomotion. twenty-two adults with CP recruited from local rehabilitation centers in an inner town of Brazil participated in this study. A questionnaire was used to collect data on sociodemographic characteristics, comorbities, and physical complications. A brief physical therapy evaluation was carried out, and the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS) were applied. Data were analyzed through descriptive statistics. the mean age was 28.7 (SD 10.6) years, 86.4% of participants lived with parents, and 4.5% were employed. Most of the sample consisted of spastic quadriplegic subjects, corresponding to levels IV and V of the GMFCS and MACS. Different comorbidities and important physical complications such as scoliosis and muscle contractures were present. More than half of the participants were unable to walk. Most participants demonstrated important restrictions in social participation and lower educational level. Adults with CP can be affected by several physical complications and progressive limitations in gait.

Clinical relevance of valgus deformity of proximal femur in cerebral palsy.

PubMed

Lee, Kyoung Min; Kang, Jong Yeol; Chung, Chin Youb; Kwon, Dae Gyu; Lee, Sang Hyeong; Choi, In Ho; Cho, Tae-Joon; Yoo, Won Joon; Park, Moon Seok

2010-01-01

Proximal femoral deformity related to physis has not been studied in patients with cerebral palsy (CP). This study was performed to investigate the clinical relevance of neck shaft angle (NSA), head shaft angle (HSA), and proximal femoral epiphyseal shape in patients with CP, which represent the deformities of metaphysis, physis, and epiphysis, respectively. Three hundred eighty-four patients with CP (mean age 9.1 y, 249 males and 135 females) were included. Extent of involvement and functional states [Gross Motor Function Classification System (GMFCS) level] were obtained. Radiographic measurements including NSA, HSA, and qualitative shape of the proximal femoral epiphysis were evaluated and analyzed according to extent of involvement and GMFCS level. Reliability and correlation with each measurement were assessed. Multiple regression test was performed to examine the significant contributing factors to migration percentage (MP) that represents hip instability. NSA showed excellent interobserver reliability with intraclass correlation coefficients of 0.976. Correlation with the MP was higher in the NSA (r=0.419, P<0.001) than in the HSA (r=0.256, P<0.001). NSA, HSA, and MP tended to increase with increasing GMFCS level, and proportion of valgus deformed proximal femoral epiphysis also increased with increasing GMFCS level, which means valgus deformity and unstable hips in the less favorable functional states. Multiple regression analysis revealed NSA, GMFCS level, and shape of the proximal femoral epiphysis to be significant factors affecting MP. NSA appeared to be more clinically relevant than HSA in evaluating proximal femoral deformity in patients with CP. Shape of proximal femoral epiphysis is believed to have clinical implications in terms of hip instability. Diagnostic level II.

Relationship between communication skills and gross motor function in preschool-aged children with cerebral palsy.

PubMed

Coleman, Andrea; Weir, Kelly A; Ware, Robert S; Boyd, Roslyn N

2013-11-01

To explore the communication skills of children with cerebral palsy (CP) at 24 months' corrected age with reference to typically developing children, and to determine the relationship between communication ability, gross motor function, and other comorbidities associated with CP. Prospective, cross-sectional, population-based cohort study. General community. Children with CP (N=124; mean age, 24mo; functional severity on Gross Motor Function Classification System [GMFCS]: I=47, II=14, III=22, IV=19, V=22). Not applicable. Parents reported communication skills on the Communication and Symbolic Behavior Scales Developmental Profile (CSBS-DP) Infant-Toddler Checklist. Two independent physiotherapists classified motor type, distribution, and GMFCS. Data on comorbidities were obtained from parent interviews and medical records. Children with mild CP (GMFCS I/II) had mean CSBS-DP scores that were 0.5 to 0.6 SD below the mean for typically developing peers, while those with moderate-severe impairment (GMFCS III-V) were 1.4 to 2.6 SD below the mean. GMFCS was significantly associated with performance on the CSBS-DP (F=18.55, P<.001), with gross motor ability accounting for 38% of the variation in communication. Poorer communication was strongly associated with gross motor function and full-term birth. Preschool-aged children with CP, with more severe gross motor impairment, showed delayed communication, while children with mild motor impairment were less vulnerable. Term-born children had significantly poorer communication than those born prematurely. Because a portion of each gross motor functional severity level is at risk, this study reinforces the need for early monitoring of communication development for all children with CP. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Ability of independently ambulant children with cerebral palsy to ride a two-wheel bicycle: a case-control study.

PubMed

Toovey, Rachel; Reid, Susan M; Rawicki, Barry; Harvey, Adrienne R; Watt, Kerrianne

2017-04-01

Limited information exists on the ability of children with cerebral palsy (CP) to ride a two-wheel bicycle, an activity that may improve health and participation. We aimed to describe bicycle-riding ability and variables associated with ability to ride in children with CP (Gross Motor Functional Classification System [GMFCS] levels I-II) compared with children with typical development. This case-control study surveyed parents of 114 children with CP and 87 children with typical development aged 6 to 15 years (115 males, mean age 9y 11mo, standard deviation [SD] 2y 10mo). Kaplan-Meier methods were used to compare proportions able to ride at any given age between the two groups. Logistic regression was used to assess variables associated with ability to ride for children with CP and typical development separately. The proportion of children with CP able to ride at each level of bicycle-riding ability was substantially lower at each age than peers with typical development (p<0.001). While most children with typical development were able to ride independently by 10 years of age, 51% of children with CP classified as GMFCS level I and 3% of those classified as GMFCS level II had obtained independent riding in the community by 15 years of age. Variables associated with ability to ride for children classified as GMFCS level I were age and parent-rated importance of their child being able to ride. Some independently ambulant children with CP can learn to ride a bicycle, in particular if they are classified as GMFCS level I. Variables associated with ability to ride deserve consideration in shaping future efforts for the majority of this population who are not yet able to ride. © 2016 Mac Keith Press.

Ambulatory Activity of Children with Cerebral Palsy: Which Characteristics Are Important?

ERIC Educational Resources Information Center

van Wely, Leontien; Becher, Jules G.; Balemans, Astrid C. J.; Dallmeijer, Annet J.

2012-01-01

Aim: To assess ambulatory activity of children with cerebral palsy (CP), aged 7 to 13 years, and identify associated characteristics. Method: Sixty-two children with spastic CP (39 males, 23 females; mean age 10y 1mo, SD 1y 8mo; age range 7-13y), classified as Gross Motor Function Classification System (GMFCS) levels I to III, participated.…

Measuring Mobility Limitations in Children with Cerebral Palsy: Content and Construct Validity of a Mobility Questionnaire (MobQues)

ERIC Educational Resources Information Center

Van Ravesteyn, Nicolien T.; Scholtes, Vanessa A.; Becher, Jules G.; Roorda, Leo D.; Verschuren, Olaf; Dallmeijer, Annet J.

2010-01-01

Aim: The objective of this study was to assess the validity of a mobility questionnaire (MobQues) that was developed to measure parent-reported mobility limitations in children with cerebral palsy (CP). Method: The parents of 439 children with CP (256 males and 183 females; age range 2-18y; Gross Motor Function Classification System [GMFCS] levels…

Leisure participation-preference congruence of children with cerebral palsy: a Children's Assessment of Participation and Enjoyment International Network descriptive study.

PubMed

Imms, Christine; King, Gillian; Majnemer, Annette; Avery, Lisa; Chiarello, Lisa; Palisano, Robert; Orlin, Margo; Law, Mary

2017-04-01

To examine participation-preference congruence, regional differences in participation-preference congruence, and predictors of whether children with cerebral palsy participate in preferred activities. The sample (n=236) included 148 males and 88 females aged 10 to 13 years, living in Victoria, Australia (n=110), Ontario (n=80), or Quebec (n=46), Canada. Ninety-nine (41.9%) were classed at Gross Motor Function Classification System (GMFCS) level I; 89 (37.7%) at GMFCS level II/III; and 48 (20.3%) at GMFCS level IV/V. Participants completed the Children's Assessment of Participation and Enjoyment and Preferences for Activity of Children questionnaires. Regional comparisons were performed using one-way analyses of variance and factors influencing participation-preference congruence were explored using multiple linear regression. The proportion of children doing non-preferred activities in each activity type was generally low (2-17%), with only one regional difference. Higher proportions were not doing preferred active physical (range 23.2-29.1% across regions), skill-based (range 21.7-27.9% across regions), and social activities (range 12.8-14.5% across regions). GMFCS level was the most important predictor associated with not doing preferred activities. Children with cerebral palsy did not always participate in preferred active physical and skill-based activities. Understanding discrepancies between preferences and actual involvement may allow families and rehabilitation professionals to address participation barriers. © 2016 Mac Keith Press.

Body mass index in ambulatory cerebral palsy patients.

PubMed

Feeley, Brian T; Gollapudi, Kiran; Otsuka, Norman Y

2007-05-01

Malnutrition is a common problem in children with cerebral palsy. Although malnutrition is often recognized in patients with severe cerebral palsy, it can be unrecognized in less severely affected patients. The consequences of malnutrition are serious, and include decreased muscle strength, poor immune status, and depressed cerebral functioning. Low body mass index has been used as a marker for malnutrition. The purpose of this study was to determine which patients in an ambulatory cerebral palsy patient population were at risk for low body mass index. A retrospective chart review was performed on 75 patients. Age, sex, height, weight, type of cerebral palsy, and functional status [gross motor functional classification system (GMFCS) level] was recorded from the chart. Descriptive statistics with bivariate and multivariate regression analyses were performed. Thirty-eight boys and 37 girls with an average age of 8.11 years were included in the study. Unique to our patient population, all cerebral palsy patients were independent ambulators. Patients with quadriplegic cerebral palsy had a significantly lower body mass index than those with diplegic and hemiplegic cerebral palsy. Patients with a GMFCS III had significantly lower body mass index than those with GMFCS I and II. When multivariate regression analysis to control for age and sex was performed, low body mass index remained associated with quadriplegic cerebral palsy and GMFCS III. Malnutrition is a common health problem in patients with cerebral palsy, leading to significant morbidity in multiple organ systems. We found that in an ambulatory cerebral palsy population, patients with lower functional status or quadriplegia had significantly lower body mass index, suggesting that even highly functioning ambulatory cerebral palsy patients are at risk for malnutrition.

Correlation of technical surgical goals to the GDI and investigation of post-operative GDI change in children with cerebral palsy.

PubMed

Bickley, Christina; Linton, Judi; Scarborough, Nancy; Sullivan, Elroy; Mitchell, Katy; Barnes, Douglas

2017-06-01

The purpose of this study was to introduce a standardized set of surgical technical achievement goals (TAGs) as part of a comprehensive outcome assessment model for children with spastic cerebral palsy (CP) undergoing orthopaedic surgical intervention to improve gait. Examination of relationships of these surgical goals to the Gait Deviation Index (GDI) and use of two assessments in tandem provided a thorough picture of technical surgical outcomes. This study also investigated changes in GDI in children with spastic CP after surgery. Data from 269 participants with spastic CP, aged 4 to 19 years with Gross Motor Function Classification System (GMFCS) levels I, II, and III who underwent lower extremity orthopaedic surgical intervention to improve gait were retrospectively analyzed. Data were examined as one heterogeneous group and sub-grouped based on pattern of involvement and GMFCS level to determine change in GDI and relationships between GDI and TAGs. Differences in TAG achievement and GDI change by GMFCS level suggest a pairing of GDI with another technical measure to be beneficial. Analysis of the outcome tools individually revealed a significant difference between the pre-operative GDI and post-operative GDI mean for the entire group, as well as each of the subgroups. A significant difference in TAG achievement by GMFCS level was also noted. This paper provides evidence that lower extremity orthopedic intervention for the ambulatory child with spastic diplegic or hemiplegic CP improves gait and that a pairing of the GDI and TAGs system is beneficial to capture an accurate technical outcome assessment in both higher and lower functioning patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Spectrum of gross motor function in extremely low birth weight children with cerebral palsy at 18 months of age.

PubMed

Vohr, Betty R; Msall, Michael E; Wilson, Dee; Wright, Linda L; McDonald, Scott; Poole, W Kenneth

2005-07-01

The purpose of this study was to evaluate the relationship between cerebral palsy (CP) diagnoses as measured by the topographic distribution of the tone abnormality with level of function on the Gross Motor Function Classification System (GMFCS) and developmental performance on the Bayley Scales of Infant Development II (BSID-II). It was hypothesized that (1) the greater the number of limbs involved, the higher the GMFCS and the lower the BSID-II Motor Scores and (2) there would be a spectrum of function and skill achievement on the GMFCS and BSID-II Motor Scores for children in each of the CP categories. A multicenter, longitudinal cohort study was conducted of 1860 extremely low birth weight (ELBW) infants who were born between August 1, 1995 and February 1, 1998, and evaluated at 18 to 22 months' corrected age. Children were categorized into impairment groups on the basis of the typography of neurologic findings: spastic quadriplegia, triplegia, diplegia, hemiplegia, monoplegia, hypotonic and/or athetotic CP, other abnormal neurologic findings, and normal. The neurologic category then was compared with GMFCS level and BSID-II Motor Scores. A total of 282 (15.2%) of the 1860 children evaluated had CP. Children with more limbs involved had more abnormal GMFCS levels and lower BSID-II scores, reflecting more severe functional limitations. However, for each CP diagnostic category, there was a spectrum of gross motor functional levels and BSID-II scores. Although more than 1 (26.6%) in 4 of the children with CP had moderate to severe gross motor functional impairment, 1 (27.6%) in 4 had motor functional skills that allowed for ambulation. Given the range of gross motor skill outcomes for specific types of CP, the GMFCS is a better indicator of gross motor functional impairment than the traditional categorization of CP that specifies the number of limbs with neurologic impairment. The neurodevelopmental assessment of young children is optimized by combining a standard neurologic examination with measures of gross and fine motor function (GMFCS and Bayley Psychomotor Developmental Index). Additional studies to examine longer term functional motor and adaptive-functional developmental skills are required to devise strategies that delineate therapies to optimize functional performance.

Quality of Life and Health-Related Quality of Life of Adolescents with Cerebral Palsy

ERIC Educational Resources Information Center

Rosenbaum, Peter L.; Livingston, Michael H.; Palisano, Robert J.; Galuppi, Barbara E.; Russell, Dianne J.

2007-01-01

This study assessed quality of life (QOL) and health-related quality of life (HRQOL) of 203 adolescents with cerebral palsy (111 males, 92 females; mean age 16y [SD 1y 9mo]). Participants were classified using the Gross Motor Function Classification System (GMFCS), as Level I (n=60), Level II (n=33), Level III (n=28), Level IV (n=50), or Level V…

Sex differences in cerebral palsy incidence and functional ability: a total population study.

PubMed

Chounti, A; Hägglund, G; Wagner, P; Westbom, L

2013-07-01

To describe gender difference in a total population of children with cerebral palsy (CP), related to subtype, gross and fine motor function, and to compare CP incidence trends in girls and boys. All 590 children with CP born in southern Sweden 1990-2005 were included. CP subtype was classified according to the Surveillance of Cerebral Palsy in Europe, gross motor function according to Gross Motor Function Classification System (GMFCS) and manual ability according to Manual Ability Classification System (MACS). Trends in CP incidence by birth year were analysed using Poisson regression modelling. There was a male predominance in all levels of GMFCS except level II, in all levels of MACS and in all CP subtypes except ataxic CP. There was no statistically significant difference between males and females regarding gross motor function or manual ability. The CP incidence trends in boys compared with girls did not change during the period 1990-2005. No equalization was detected in the incidence of CP between girls and boys during recent years in this total population. We could not confirm any consistent sex difference in motor function levels. Male sex is a risk factor for CP. ©2013 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Predicting functional communication ability in children with cerebral palsy at school entry.

PubMed

Coleman, Andrea; Weir, Kelly; Ware, Robert S; Boyd, Roslyn

2015-03-01

To explore the value of demographic, environmental, and early clinical characteristics in predicting functional communication in children with cerebral palsy (CP) at school entry. Data are from an Australian prospective longitudinal study of children with CP. Children assessed at 18 to 24 and 48 to 60 months corrected age were included in the study. Functional communication was classified at 48 to 60 months using the Communication Function Classification System (CFCS). Predictive variables included communication skills at 18 to 24 months, evaluated using the Communication and Symbolic Behavioural Scales Developmental Profile (CSBS-DP) Infant-Toddler Checklist. Early Gross Motor Function Classification System (GMFCS), Manual Ability Classification System, and motor type and distribution were evaluated by two physiotherapists. Demographic and comorbid variables were obtained through parent interview with a paediatrician or rehabilitation specialist. A total of 114 children (76 males, 38 females) were included in the study. At 18 to 24 months the mean CSBS-DP was 84.9 (SD 19.0). The CFCS distribution at 48 to 60 months was I=36(32%), II=25(22%), III=20(18%), IV=19(17%), and V=14(12%). In multivariable regression analysis, only CSBS-DP (p<0.01) and GMFCS (p<0.01) at 18 to 24 months were predictors of functional communication at school entry. Body structure and function and not environmental factors impact functional communication at school entry in children with CP. This provides valuable guidance for early screening, parent education, and future planning of intervention programs to improve functional communication. © 2014 Mac Keith Press.

Treatment of Cerebral Palsy with Stem Cells: A Report of 17 Cases.

PubMed

Abi Chahine, Nassim H; Wehbe, Tarek W; Hilal, Ramzi A; Zoghbi, Victoria V; Melki, Alia E; Habib, Emil B Bou

2016-05-30

Cerebral Palsy (CP) is a disabling condition that affects a child's life and his/her family irreversibly. It is usually a non-progressive condition but improvement over time is rarely seen. The condition can be due to prenatal hypoxia, metabolic, genetic, infectious, traumatic or other causes. It is therefore a heterogeneous group that results in functional motor disability associated with different degrees of cognitive abnormalities. There are no treatments that can cure or even improve CP and the best available approach aims at functional, social and nutritional supportive care and counseling. In this paper, we report 17 sequential patients with CP treated with intrathecal administration of Bone Marrow Mononuclear Cells (BMMC). All patients had an uneventful post-injection course with 73% of the evaluable patients treated having a good response using the Gross Motor Function Classification System (GMFCS). The average improvement was 1.3 levels on the GMFCS with cognitive improvements as well.

Development and face validity of a cerebral visual impairment motor questionnaire for children with cerebral palsy.

PubMed

Salavati, M; Waninge, A; Rameckers, E A A; van der Steen, J; Krijnen, W P; van der Schans, C P; Steenbergen, B

2017-01-01

The objectives of this study were (i) to develop two cerebral visual impairment motor questionnaires (CVI-MQ's) for children with cerebral palsy (CP): one for children with Gross Motor Function Classification System (GMFCS) levels I, II and III and one for children with GMFCS levels IV and V; (ii) to describe their face validity and usability; and (iii) to determine their sensitivity and specificity. The initial versions of the two CVI-MQ's were developed based on literature. Subsequently, the Delphi method was used in two groups of experts, one familiar with CVI and one not familiar with CVI, in order to gain consensus about face validity and usability. The sensitivity and specificity of the CVI-MQ's were subsequently assessed in 82 children with CP with (n = 39) and without CVI (n = 43). With the receiver operating curve the cut-off scores were determined to detect possible presence or absence of CVI in children with CP. Both questionnaires showed very good face validity (percentage agreement above 96%) and good usability (percentage agreement 95%) for practical use. The CVI-MQ version for GMFCS levels I, II and III had a sensitivity of 1.00 and specificity of 0.96, with a cut-off score of 12 points or higher, and the version for GMFCS levels IV and V had a sensitivity of 0.97 and a specificity of 0.98, with a cut-off score of eight points or higher. The CVI-MQ is able to identify at-risk children with CP for the probability of having CVI. © 2016 John Wiley & Sons Ltd.

Participation in home, extracurricular, and community activities among children and young people with cerebral palsy.

PubMed

Orlin, Margo N; Palisano, Robert J; Chiarello, Lisa A; Kang, Lin-Ju; Polansky, Marcia; Almasri, Nihad; Maggs, Jill

2010-02-01

Participation in home, extracurricular, and community activities is a desired outcome of rehabilitation services for children and young people with cerebral palsy (CP). The purpose of this study was to investigate the effect of age and gross motor function on participation among children and young people with CP. Five hundred participants (277 males, 223 females) were grouped by age and Gross Motor Function Classification System (GMFCS) level. There were 291 children aged 6 to 12 years and 209 young people aged 13 to 21 years. There were 128 participants in GMFCS level I, 220 in levels II/III, and 152 in levels IV/V. Participants completed the Children's Assessment of Participation and Enjoyment to measure number of activities (diversity) and how often they were performed (intensity) in the past 4 months. Children had higher overall participation diversity and intensity than young people (p<0.001). Children and young people in GMFCS level I had the highest overall participation, followed by children and young people in levels II/III and IV/V. Children had higher participation in recreational (p<0.001) but not formal (such as team sports or clubs) or physical activities. Children (p<0.01) and young people (p<0.001) in level I had the highest participation in physical activities; diversity and intensity were generally low. The findings provide evidence of the effect of age and gross motor function on participation of children and young people with CP. Low participation in physical activities may have implications for fitness and health, especially for children and young people in GMFCS levels IV and V.

Early results of one-stage correction for hip instability in cerebral palsy.

PubMed

Kim, Hui Taek; Jang, Jae Hoon; Ahn, Jae Min; Lee, Jong Seo; Kang, Dong Joon

2012-06-01

We evaluated the clinical and radiological results of one-stage correction for cerebral palsy patients. We reviewed clinical outcomes and radiologic indices of 32 dysplastic hips in 23 children with cerebral palsy (13 males, 10 females; mean age, 8.6 years). Ten hips had dislocation, while 22 had subluxation. Preoperative Gross Motor Function Classification System (GMFCS) scores of the patients were as follows; level V (13 patients), level IV (9), and level III (1). Acetabular deficiency was anterior in 5 hips, superolateral in 7, posterior in 11 and mixed in 9, according to 3 dimensional computed tomography. The combined surgery included open reduction of the femoral head, release of contracted muscles, femoral shortening varus derotation osteotomy and the modified Dega osteotomy. Hip range of motion, GMFCS level, acetabular index, center-edge angle and migration percentage were measured before and after surgery. The mean follow-up period was 28.1 months. Hip abduction (median, 40°), sitting comfort and GMFCS level were improved after surgery, and pain was decreased. There were two cases of femoral head avascular necrosis, but no infection, nonunion, resubluxation or redislocation. All radiologic indices showed improvement after surgery. A single event multilevel surgery including soft tissue, pelvic and femoral side correction is effective in treating spastic dislocation of the hip in cerebral palsy.

Fundamental movement skills testing in children with cerebral palsy.

PubMed

Capio, Catherine M; Sit, Cindy H P; Abernethy, Bruce

2011-01-01

To examine the inter-rater reliability and comparative validity of product-oriented and process-oriented measures of fundamental movement skills among children with cerebral palsy (CP). In total, 30 children with CP aged 6 to 14 years (Mean = 9.83, SD = 2.5) and classified in Gross Motor Function Classification System (GMFCS) levels I-III performed tasks of catching, throwing, kicking, horizontal jumping and running. Process-oriented assessment was undertaken using a number of components of the Test of Gross Motor Development (TGMD-2), while product-oriented assessment included measures of time taken, distance covered and number of successful task completions. Cohen's kappa, Spearman's rank correlation coefficient and tests to compare correlated correlation coefficients were performed. Very good inter-rater reliability was found. Process-oriented measures for running and jumping had significant associations with GMFCS, as did seven product-oriented measures for catching, throwing, kicking, running and jumping. Product-oriented measures of catching, kicking and running had stronger associations with GMFCS than the corresponding process-oriented measures. Findings support the validity of process-oriented measures for running and jumping and of product-oriented measures of catching, throwing, kicking, running and jumping. However, product-oriented measures for catching, kicking and running appear to have stronger associations with functional abilities of children with CP, and are thus recommended for use in rehabilitation processes.

Humeral external rotation handling by using the Bobath concept approach affects trunk extensor muscles electromyography in children with cerebral palsy.

PubMed

Grazziotin Dos Santos, C; Pagnussat, Aline S; Simon, A S; Py, Rodrigo; Pinho, Alexandre Severo do; Wagner, Mário B

2014-10-20

This study aimed to investigate the electromyographic activity of cervical and trunk extensors muscles in children with cerebral palsy during two handlings according to the Bobath concept. A crossover trial involving 40 spastic diplegic children was conducted. Electromyography (EMG) was used to measure muscular activity at sitting position (SP), during shoulder internal rotation (IR) and shoulder external rotation (ER) handlings, which were performed using the elbow joint as key point of control. Muscle recordings were performed at the fourth cervical (C4) and at the tenth thoracic (T10) vertebral levels. The Gross Motor Function Classification System (GMFCS) was used to assess whether muscle activity would vary according to different levels of severity. Humeral ER handling induced an increase on EMG signal of trunk extensor muscles at the C4 (P=0.007) and T10 (P<0.001) vertebral levels. No significant effects were observed between SP and humeral IR handling at C4 level; However at T10 region, humeral IR handling induced an increase of EMG signal (P=0.019). Humeral ER resulted in an increase of EMG signal at both levels, suggesting increase of extensor muscle activation. Furthermore, the humeral ER handling caused different responses on EMG signal at T10 vertebra level, according to the GMFCS classification (P=0.017). In summary, an increase of EMG signal was observed during ER handling in both evaluated levels, suggesting an increase of muscle activation. These results indicate that humeral ER handling can be used for diplegic CP children rehabilitation to facilitate cervical and trunk extensor muscles activity in a GMFCS level-dependent manner. Copyright © 2014 Elsevier Ltd. All rights reserved.

Test-Retest Reliability of the 10-Metre Fast Walk Test and 6-Minute Walk Test in Ambulatory School-Aged Children with Cerebral Palsy

ERIC Educational Resources Information Center

Thompson, Patricia; Beath, Tricia; Bell, Jacqueline; Jacobson, Gabrielle; Phair, Tegan; Salbach, Nancy M.; Wright, F. Virginia

2008-01-01

Short-term test-retest reliability of the 10-metre fast walk test (10mFWT) and 6-minute walk test (6MWT) was evaluated in 31 ambulatory children with cerebral palsy (CP), with subgroup analyses in Gross Motor Function Classification System (GMFCS) Levels I (n=9), II (n=8), and III (n=14). Sixteen females and 15 males participated, mean age 9 years…

Relationship between gross motor and intellectual function in children with cerebral palsy: a cross-sectional study.

PubMed

Dalvand, Hamid; Dehghan, Leila; Hadian, Mohammad Reza; Feizy, Awat; Hosseini, Seyed Ali

2012-03-01

To explore the relationship between gross motor and intellectual function in children with cerebral palsy (CP). A cross-sectional study. Occupational therapy clinic. Children with CP (N=662; 281 girls, 381 boys; age range, 3-14y). Not applicable. Intelligence testing was carried out by means of the Wechsler Preschool and Primary Scale of Intelligence and the Wechsler Intelligence Scale for Children-Revised. Gross motor function level was determined by the Gross Motor Function Classification System Expanded and Revised (GMFCS E&R). Of the children, 10.4% were at level I of the GMFCS E&R, 38% at levels II and III, and 51.5% at levels IV and V. The lowest level of intelligence or profound intellectual disability was found in children with spastic quadriplegia (n=28, 62.2%). Children at the lowest levels (I-IV, GMFCS E&R) obtained higher ratings in terms of intelligence in comparison with children at level V. Based on the present results, the diagnosis was statistically related to the intellectual level as dependent variable (P<.01); accordingly, hypotonic, quadriplegic, and hemiplegic patients had the highest odds to assign higher ratings in abnormal intelligence, respectively. Sex and age were not statistically related to the dependent variable. The study results demonstrated a significant association between GMFCS E&R and intellectual function. Therefore, we suggest that particular attention should be paid to the intellectual level in terms of evaluations of gross motor function. These results, in respect, might be interested for occupational and physical therapists who are involved in rehabilitation programs for these children. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Scoliosis in Patients with Severe Cerebral Palsy: Three Different Courses in Adolescents.

PubMed

Oda, Yoshiaki; Takigawa, Tomoyuki; Sugimoto, Yoshihisa; Tanaka, Masato; Akazawa, Hirofumi; Ozaki, Toshifumi

2017-04-01

Patients with cerebral palsy (CP) frequently present with scoliosis; however, the pattern of curve progression is difficult to predict. We aimed to clarify the natural course of the progression of scoliosis and to identify scoliosis predictors. This was a retrospective, single-center, observational study. Total of 92 CP patients from Asahikawasou Ryouiku Iryou Center in Okayama, Japan were retrospectively analyzed. Cobb angle, presence of hip dislocation and pelvic obliquity, and Gross Motor Function Classification System (GMFCS) were investigated. Severe CP was defined as GMFCS level IV or V. The mean observation period was 10.7 years. Thirtyfour severe CP patients presented with scoliosis and were divided into 3 groups based on their clinical courses: severe, moderate and mild. The mean Cobb angles at the final follow-up were 129°, 53°, and 13° in the severe, moderate, and mild groups, respectively. The average progressions from 18 to 25 years were 2.7°/year, 0.7°/year, and 0.1°/year in the severe, moderate, and mild curve groups, respectively. We observed the natural course of scoliosis and identified 3 courses based on the Cobb angle at 15 and 18 years of age. This method of classification may help clinicians predict the patients' disease progression.

Selective dorsal rhizotomy for the treatment of severe spastic cerebral palsy: efficacy and therapeutic durability in GMFCS grade IV and V children.

PubMed

D'Aquino, Daniel; Moussa, Ahmad A; Ammar, Amr; Ingale, Harshal; Vloeberghs, Michael

2018-04-01

Selective dorsal rhizotomy (SDR) has been established as an effective surgical treatment for spastic diplegia. The applicability of SDR to the full spectrum of spastic cerebral palsy and the durability of its therapeutic effects remain under investigation. There are currently limited data in the literature regarding efficacy and outcomes following SDR in Gross Motor Function Classification System (GMFCS) IV and V patients. Intrathecal baclofen has traditionally been the surgical treatment of choice for these patients. When utilised primarily as a treatment for the relief of spasticity, it is proposed that SDR represents a rational and effective treatment option for this patient group. We report our outcomes of SDR performed on children with severe cerebral palsy (GMFCS grade IV and V). The commensurate improvement in upper as well as lower limb spasticity is highlighted. Apparent benefit to urological function following SDR in this patient group is also discussed. A retrospective review of prospectively collected data for 54 paediatric patients with severe cerebral palsy (GMFCS IV-V) who received SDR plus specialised physiotherapy. Mean age was 10.2 years (range, 3.0-19.5). SDR guided by electrophysiological monitoring was performed by a single experienced neurosurgeon. All subjects received equivalent physiotherapy. The primary outcome measure was change to the degree of spasticity following SDR. Spasticity of upper and lower limb muscle groups were quantified and standardised using the Ashworth score. Measures were collected at baseline and at 2-, 8- and 14-month postoperative intervals. In addition, baseline and 6-month postoperative urological function was also evaluated as a secondary outcome measure. The mean lower limb Ashworth score at baseline was 3.2 (range, 0-4). Following SDR, significant reduction in lower limb spasticity scores was observed at 2 months and maintained at 8 and 14 months postoperatively (Wilcoxon rank, p < 0.001). The mean reduction at 2, 8 and 14 months was 3.0, 3.2 and 3.2 points respectively (range, 1-4), confirming a sustained improvement of spasticity over a 1-year period of follow-up. Significant reduction in upper limb spasticity scores following SDR was also observed (mean, 2.9; Wilcoxon rank, p < 0.001). Overall, the improvement to upper and lower limb tone following SDR-generally to post-treatment Ashworth scores of 0-was clinically and statistically significant in GMFCS IV and V patients. Urological assessment identified pre-existing bladder dysfunction in 70% and 90% of GMFCS IV and V patients respectively. Following SDR, improvement in urinary continence was observed in 71% of affected GMFCS IV and 42.8% of GMFCS V patients. No serious postoperative complications were identified. We conclude that SDR is safe and-in combination with physiotherapy-effectively reduces spasticity in GMFCS grade IV and V patients. Our series suggests that spastic quadriplegia is effectively managed with significant improvements in upper limb spasticity that are commensurate with those observed in lower limb muscle groups. These gains are furthermore sustained more than a year postoperatively. In light of these findings, we propose that SDR constitutes an effective treatment option for GMFCS IV and V patients and a rational alternative to intrathecal baclofen.

Treatment of Cerebral Palsy with Stem Cells: A Report of 17 Cases

PubMed Central

Abi Chahine, Nassim H.; Wehbe, Tarek W.; Hilal, Ramzi A.; Zoghbi, Victoria V.; Melki, Alia E.; Bou Habib, Emil B.

2016-01-01

Cerebral Palsy (CP) is a disabling condition that affects a child’s life and his/her family irreversibly. It is usually a non-progressive condition but improvement over time is rarely seen. The condition can be due to prenatal hypoxia, metabolic, genetic, infectious, traumatic or other causes. It is therefore a heterogeneous group that results in functional motor disability associated with different degrees of cognitive abnormalities. There are no treatments that can cure or even improve CP and the best available approach aims at functional, social and nutritional supportive care and counseling. In this paper, we report 17 sequential patients with CP treated with intrathecal administration of Bone Marrow Mononuclear Cells (BMMC). All patients had an uneventful post-injection course with 73% of the evaluable patients treated having a good response using the Gross Motor Function Classification System (GMFCS). The average improvement was 1.3 levels on the GMFCS with cognitive improvements as well. PMID:27426090

An innovative cycling exergame to promote cardiovascular fitness in youth with cerebral palsy.

PubMed

Knights, Shannon; Graham, Nicholas; Switzer, Lauren; Hernandez, Hamilton; Ye, Zi; Findlay, Briar; Xie, Wen Yan; Wright, Virginia; Fehlings, Darcy

2016-01-01

To evaluate the effects of an internet-platform exergame cycling programme on cardiovascular fitness of youth with cerebral palsy (CP). In this pilot prospective case series, eight youth with bilateral spastic CP, Gross Motor Functional Classification System (GMFCS) level III, completed a six-week exergame programme. Outcomes were obtained at baseline and post-intervention. The primary outcome measure was the GMFCS III-specific shuttle run test (SRT-III). Secondary outcomes included health-related quality of life (HQL) as measured by the KIDSCREEN-52 questionnaire, six-minute walk test, Wingate arm cranking test and anthropomorphic measurements. There were significant improvements in the SRT-III (t = -2.5, p = 0.04, d = 0.88) post-intervention. There were no significant changes in secondary outcomes. An exergame cycling programme may lead to improvement in cardiovascular fitness in youth with CP. This study was limited by small sample size and lack of a comparison group. Future research is warranted.

An intensive virtual reality program improves functional balance and mobility of adolescents with cerebral palsy.

PubMed

Brien, Marie; Sveistrup, Heidi

2011-01-01

To examine functional balance and mobility in adolescents with cerebral palsy classified at Gross Motor Function Classification System (GMFCS) level I following an intensive short-duration virtual reality (VR) intervention. Single-subject, multiple-baseline design with 4 adolescents. Outcomes included the Community Balance and Mobility Scale (CB&M), the 6-Minute Walk Test (6MWT), the Timed Up and Down Stairs, and the Gross Motor Function Measure Dimension E. Assessments were recorded 3 to 6 times at baseline, 5 times during intervention, and 4 times at follow-up. Daily 90-minute VR intervention was completed for 5 consecutive days. Visual, statistical, and clinical significance analyses were used. Statistically significant improvements were shown in all adolescents on CB&M and 6MWT. True change was recorded in all for the CB&M and in 3 for the 6MWT. Functional balance and mobility in adolescents with cerebral palsy classified at GMFCS level I improve with intense, short duration VR intervention, and changes are maintained at 1-month posttraining.

Oropharyngeal dysphagia in preschool children with cerebral palsy: oral phase impairments.

PubMed

Benfer, Katherine A; Weir, Kelly A; Bell, Kristie L; Ware, Robert S; Davies, Peter S W; Boyd, Roslyn N

2014-12-01

This study aimed to document the prevalence and patterns of oral phase oropharyngeal dysphagia (OPD) in preschool children with cerebral palsy (CP), and its association with mealtime duration, frequency and efficiency. Cross-sectional population-based cohort study of 130 children diagnosed with CP at 18-36 months ca (mean = 27.4 months, 81 males) and 40 children with typical development (mean = 26.2, 18 males). Functional abilities of children with CP were representative of a population sample (GMFCS I = 57, II = 15, III = 23, IV = 12, V = 23). Oral phase impairment was rated from video using the Dyspahgia Disorders Survey, Schedule for Oral Motor Impairment, and Pre-Speech Assessment Scale. Parent-report was collected on a feeding questionnaire. Mealtime frequency, duration and efficiency were calculated from a three day weighed food record completed by parents. Gross motor function was classified using the Gross Motor Function Classification System (GMFCS). Overall, 93.8% of children had directly assessed oral phase impairments during eating or drinking, or in controlling saliva (78.5% with modified cut-points). Directly assessed oral phase impairments were associated with declining gross motor function, with children from GMFCS I having a 2-fold increased likelihood of oral phase impairment compared to the children with TD (OR = 2.0, p = 0.18), and all children from GMFCS II-V having oral phase impairments. Difficulty biting (70%), cleaning behaviours (70%) and chewing (65%) were the most common impairments on solids, and difficulty sipping from a cup (60%) for fluids. OPD severity and GMFCS were not related to mealtime frequency, duration or efficiency, although children on partial tube feeds had significantly reduced mealtime efficiency. Oral phase impairments were common in preschool children with CP, with severity increasing stepwise with declining gross motor function. The prevalence and severity of oral phase impairments were significantly greater for most tasks when compared to children with typical development, even for those with mild CP. Children who were partially tube fed had significantly lower feeding efficiency, so this could be a useful early indicator of children needing supplementation to their nutrition (through increasing energy density of foods/fluids, or tube feeds). Copyright © 2014 Elsevier Ltd. All rights reserved.

Musculoskeletal system problems and quality of life of mothers of children with cerebral palsy with different levels of disability.

PubMed

Kavlak, Erdoğan; Altuğ, Filiz; Büker, Nihal; Şenol, Hande

2015-01-01

The objective of this study is to investigate musculoskeletal system problems and quality of life of mothers of children with cerebral palsy with different levels of disability. 100 children (37 girls and 63 boys) with cerebral palsy (CP) and their mothers were included in this study. Functional levels of children with CP were assessed by using the Gross Motor Function Classification System (GMFCS) and the Pediatric Functional Independence Measure (WeeFIM). Quality of life of mothers regarding health was assessed by using the Nottingham Health Profile (NHP). Musculoskeletal system problems of mothers were assessed by using the Neck Disability Index (NDI) and the Roland-Morris Disability Questionnaire (RMDQ). No statistical significance was found when GMFCS levels of children with CP and the NHP, DASH-T, RMDQ, NDI and the BAE values of mothers were compared in an inter-group way (p> 0.05). When the NHP parameters and the existence of lower and arm pains of mothers were compared with their BAI, NDI, RMDQ and DASH-T scores, a statistically significant relationship was found among them (p< 0.05). As functional levels of children with CP get worse, upper extremity, lower back and neck problems and anxiety levels of mothers increase and this situation negatively affects mothers' quality of life.

Effects of Aquatic Intervention on Gross Motor Skills in Children with Cerebral Palsy: A Systematic Review.

PubMed

Roostaei, Meysam; Baharlouei, Hamzeh; Azadi, Hamidreza; Fragala-Pinkham, Maria A

2017-10-20

To review the literature on the effects of aquatic intervention on gross motor skills for children with cerebral palsy (CP). Six databases were searched from inception to January 2016. Aquatic studies for children aged 1-21 years with any type or CP classification and at least one outcome measuring gross motor skills were included. Information was extracted on study design, outcomes, and aquatic program type, frequency, duration, and intensity. Quality was rated using the Centre of Evidence-Based Medicine: Levels of Evidence and the PEDro scale. Of the 11 studies which met inclusion criteria, only two used randomized control trial design, and the results were mixed. Quality of evidence was rated as moderate to high for only one study. Most studies used quasi-experimental designs and reported improvements in gross motor skills for within group analyses after aquatic programs were held for two to three times per week and lasting for 6-16 weeks. Participants were classified according to the Gross Motor Function Classification System (GMFCS) levels I-V, and were aged 3-21 years. Mild to no adverse reactions were reported. Evidence on aquatic interventions for ambulatory children with CP is limited. Aquatic exercise is feasible and adverse effects are minimal; however, dosing parameters are unclear. Further research is needed to determine aquatic intervention effectiveness and exercise dosing across age categories and GMFCS levels.

Validation of Gujarati Version of ABILOCO-Kids Questionnaire.

PubMed

Diwan, Shraddha; Diwan, Jasmin; Patel, Pankaj; Bansal, Ankita B

2015-10-01

ABILOCO-Kids is a measure of locomotion ability for children with cerebral palsy (CP) aged 6 to 15 years & is available in English & French. To validate the Gujarati version of ABILOCO-Kids questionnaire to be used in clinical research on Gujarati population. ABILOCO-Kids questionnaire was translated into Gujarati from English using forward-backward-forward method. To ensure face & content validity of Gujarati version using group consensus method, each item was examined by group of experts having mean experience of 24.62 years in field of paediatric and paediatric physiotherapy. Each item was analysed for content, meaning, wording, format, ease of administration & scoring. Each item was scored by expert group as either accepted, rejected or accepted with modification. Procedure was continued until 80% of consensus for all items. Concurrent validity was examined on 55 children with Cerebral Palsy (6-15 years) of all Gross Motor Functional Classification System (GMFCS) level & all clinical types by correlating score of ABILOCO-Kids with Gross Motor Functional Measure & GMFCS. In phase 1 of validation, 16 items were accepted as it is; 22 items accepted with modification & 3 items went for phase 2 validation. For concurrent validity, highly significant positive correlation was found between score of ABILOCO-Kids & total GMFM (r=0.713, p<0.005) & highly significant negative correlation with GMFCS (r= -0.778, p<0.005). Gujarati translated version of ABILOCO-Kids questionnaire has good face & content validity as well as concurrent validity which can be used to measure caregiver reported locomotion ability in children with CP.

Are sporadic fidgety movements as clinically relevant as is their absence?

PubMed

Einspieler, Christa; Yang, Hong; Bartl-Pokorny, Katrin D; Chi, Xia; Zang, Fei-Fei; Marschik, Peter B; Guzzetta, Andrea; Ferrari, Fabrizio; Bos, Arend F; Cioni, Giovanni

2015-04-01

Infants with normal fidgety movements at 3 to 5 months after term are very likely to show neurologically normal development, while the absence of fidgety movements is an early marker for an adverse neurological outcome, mainly cerebral palsy (CP). The clinical significance of so-called sporadic fidgety movements (i.e., fidgety movements occur isolated in a few body parts and are of 1- to 3-second-duration) is not yet known. Our objective was to determine whether infants who had developed CP and had sporadic fidgety movements have a better outcome than infants who did not have fidgety movements. Longitudinal study. Retrospective analysis of prospectively collected data. 61 infants who developed CP (46 male, 15 female; 29 infants born preterm; videoed for the assessment of movements and postures at 9 to 16 weeks post-term age). The Gross Motor Function Classification System (GMFCS) was applied at 3 to 5 years of age. There was no difference between children diagnosed with CP who had sporadic fidgety movements at 9 to 16 weeks post-term age (n = 9) and those who never developed fidgety movements (n = 50) with regard to their functional mobility and activity limitation at 3 to 5 years of age. One infant had normal FMs and developed unilateral CP, GMFCS Level I; the remaining infant had abnormal FMs and developed bilateral CP, GMFCS Level II. There is no evidence that the occurrence of occasional isolated fidgety bursts indicates a milder type of CP. Copyright © 2015. Published by Elsevier Ireland Ltd.

Congenital cytomegalovirus is associated with severe forms of cerebral palsy and female sex in a retrospective population-based study.

PubMed

Smithers-Sheedy, Hayley; Raynes-Greenow, Camille; Badawi, Nadia; McIntyre, Sarah; Jones, Cheryl A

2014-09-01

Congenital cytomegalovirus (cCMV) infection can result in poor outcomes including cerebral palsy (CP). The aim of this study was to describe the incidence and comorbidities of CP reported to the Australian Cerebral Palsy Register (ACPR) as attributed to cCMV infection. This was a retrospective population-based study. Cases were drawn from Australian state CP registers with population level ascertainment, 1993 to 2003 (n=2265; 56.4% males, Gross Motor Function Classification System [GMFCS] ratings available for Victorian cases only: 70% GMFCS levels I to III and 30% GMFCS levels IV to V). Clinical data were extracted and cases with cCMV reported as a known cause were compared with cases where cCMV was not reported. Children with cCMV (n=34; 12 males, 22 females; mean [SD] gestational age, 36.4 wk [4.4], range 24-41 wk) accounted for 1.5% of CP cases; 2.9 per 100,000 live births, (95% confidence intervals 1.9-3.9). When compared with CP cases where cCMV was not reported, proportionally, more CP cases with cCMV were born to younger mothers (p<0.001), were female (64% vs 43%, p=0.014), had spastic quadriplegia (73% vs 21%, p<0.001), required wheeled mobility i.e. GMFCS IV or V (78% vs 28%, p<0.001), had epilepsy (70% vs 30%, p<0.001), deafness (40% vs 2%, p<0.001), functional blindness (20% vs 5%, p<0.001), and severe communication impairment (71% vs 25%, p<0.001). cCMV is an important potentially preventable cause of CP and is associated with severe disability and female sex in cases reported to the ACPR. Future studies utilising prospective sample collection for cCMV testing are needed to confirm these findings. © 2014 Mac Keith Press.

The impact of visual impairment on the ability to perform activities of daily living for persons with severe/profound intellectual disability.

PubMed

Dijkhuizen, Annemarie; Hilgenkamp, Thessa I M; Krijnen, Wim P; van der Schans, Cees P; Waninge, Aly

2016-01-01

The ability to perform activities of daily living (ADL) as a component of participation is one of the factors that contribute to quality of life. The ability to perform ADL for persons experiencing severe/profound intellectual disability (ID) may be reduced due to their cognitive and physical capacities. However, until recently, the impact of the significantly prevalent visual impairments on the performance of activities of daily living has not yet been revealed within this group. The purpose of this prospective cross-sectional study was to investigate the impact of visual impairment on the performance of activities of daily living for persons with a severe/profound intellectual disability. The Barthel Index (BI) and Comfortable Walking Speed (CWS) were used to measure the ability of performing activities of daily living (ADL) in 240 persons with severe/profound ID and having Gross Motor Functioning Classification System (GMFCS) levels I, II or III; this included 120 persons with visual impairment. The impact of visual impairment on ADL was analyzed with linear regression. The results of the study demonstrated that visual impairment slightly affects the ability of performing activities of daily living (BI) for persons experiencing a severe/profound intellectual disability. GMFCS Levels II or III, profound ID level, and visual impairment each have the effect of lowering BI scores. GMFCS Levels II or III, and profound ID level each have the effect of increasing CWS scores, which indicates a lower walking speed. A main effect of visual impairment is present on CWS, but our results do show a substantive interaction effect between GMFCS level III and visual impairment on Comfortable Walking Speed in persons with a severe/profound intellectual disability. Visual impairment has a slight effect on ability to perform ADL in persons experiencing severe/profound ID. Copyright © 2015 Elsevier Ltd. All rights reserved.

Computerized Adaptive Tests Detect Change Following Orthopaedic Surgery in Youth with Cerebral Palsy.

PubMed

Mulcahey, M J; Slavin, Mary D; Ni, Pengsheng; Vogel, Lawrence C; Kozin, Scott H; Haley, Stephen M; Jette, Alan M

2015-09-16

The Cerebral Palsy Computerized Adaptive Test (CP-CAT) is a parent-reported outcomes instrument for measuring lower and upper-extremity function, activity, and global health across impairment levels and a broad age range of children with cerebral palsy (CP). This study was performed to examine whether the Lower Extremity/Mobility (LE) CP-CAT detects change in mobility following orthopaedic surgery in children with CP. This multicenter, longitudinal study involved administration of the LE CP-CAT, the Pediatric Outcomes Data Collection Instrument (PODCI) Transfer/Mobility and Sports/Physical Functioning domains, and the Timed "Up & Go" test (TUG) before and after elective orthopaedic surgery in a convenience sample of 255 children, four to twenty years of age, who had CP and a Gross Motor Function Classification System (GMFCS) level of I, II, or III. Standardized response means (SRMs) and 95% confidence intervals (CIs) were calculated for all measures at six, twelve, and twenty-four months following surgery. SRM estimates for the LE CP-CAT were significantly greater than the SRM estimates for the PODCI Transfer/Mobility domain at twelve months, the PODCI Sports/Physical Functioning domain at twelve months, and the TUG at twelve and twenty-four months. When the results for the children at GMFCS levels I, II, and III were grouped together, the improvements in function detected by the LE CP-CAT at twelve and twenty-four months were found to be greater than the changes detected by the PODCI Transfer/Mobility and Sports/Physical Functioning scales. The LE CP-CAT outperformed the PODCI scales for GMFCS levels I and III at both of these follow-up intervals; none of the scales performed well for patients with GMFCS level II. The results of this study showed that the LE CP-CAT displayed superior sensitivity to change than the PODCI and TUG scales after musculoskeletal surgery in children with CP. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Aerobic Capacity in Children and Adolescents with Cerebral Palsy

ERIC Educational Resources Information Center

Verschuren, Olaf; Takken, Tim

2010-01-01

This study described the aerobic capacity [VO[subscript 2peak] (ml/kg/min)] in contemporary children and adolescents with cerebral palsy (CP) using a maximal exercise test protocol. Twenty-four children and adolescents with CP classified at Gross Motor Functional Classification Scale (GMFCS) level I or level II and 336 typically developing…

Do the self-concept and quality of life decrease in CP patients? Focussing on the predictors of self-concept and quality of life.

PubMed

Soyupek, Feray; Aktepe, Evrim; Savas, Serpil; Askin, Ayhan

2010-01-01

To find out if the quality of life (QOL) and self-concept of the children with cerebral palsy (CP) was different from that of children without disability, to investigate predictive variables that could affect self-concept and QOL. A total of 40 children with CP and 46 age-matched peers were included. The baseline characteristics including sex, type of CP, the level of disability according to Gross Motor Function Classification System (GMFCS) were recorded. Education levels of both children and parents, demographic features of parents, features of living area, usage of devices and associated impairments were filled out. Self-concept was measured using Piers-Harris Self-concept (PH) Scale. Quality of life was measured by Pediatric Quality of Life Inventory 4.0 (PedsQL). The physical and psychosocial health subscale scores of PedsQL (P-PedsQL and PS-PedsQL) were recorded. Significant differences in mean scores favouring the control group were found for PH scale, PedsQL scale (p < 0.001). P-PedsQL and PS-PedsQL of the CP group were lower than the control group (p < 0.001). PS-PedsQL report was significant predictor of self-concept. The presence of incontinence and GMFCS level were significant predictors of PedsQL and PPedsQL, respectively. Self-concept and QOL of the CP children were lower than the children without CP. Presence of incontinence, self-concept rating and GMFCS level were important to predict domains of QOL.

Validation of Gujarati Version of ABILOCO-Kids Questionnaire

PubMed Central

Diwan, Jasmin; Patel, Pankaj; Bansal, Ankita B.

2015-01-01

Background ABILOCO-Kids is a measure of locomotion ability for children with cerebral palsy (CP) aged 6 to 15 years & is available in English & French. Aim To validate the Gujarati version of ABILOCO-Kids questionnaire to be used in clinical research on Gujarati population. Materials and Methods ABILOCO-Kids questionnaire was translated into Gujarati from English using forward-backward-forward method. To ensure face & content validity of Gujarati version using group consensus method, each item was examined by group of experts having mean experience of 24.62 years in field of paediatric and paediatric physiotherapy. Each item was analysed for content, meaning, wording, format, ease of administration & scoring. Each item was scored by expert group as either accepted, rejected or accepted with modification. Procedure was continued until 80% of consensus for all items. Concurrent validity was examined on 55 children with Cerebral Palsy (6-15 years) of all Gross Motor Functional Classification System (GMFCS) level & all clinical types by correlating score of ABILOCO-Kids with Gross Motor Functional Measure & GMFCS. Result In phase 1 of validation, 16 items were accepted as it is; 22 items accepted with modification & 3 items went for phase 2 validation. For concurrent validity, highly significant positive correlation was found between score of ABILOCO-Kids & total GMFM (r=0.713, p<0.005) & highly significant negative correlation with GMFCS (r= -0.778, p<0.005). Conclusion Gujarati translated version of ABILOCO-Kids questionnaire has good face & content validity as well as concurrent validity which can be used to measure caregiver reported locomotion ability in children with CP. PMID:26557603

Postural asymmetries in young adults with cerebral palsy.

PubMed

Rodby-Bousquet, Elisabet; Czuba, Tomasz; Hägglund, Gunnar; Westbom, Lena

2013-11-01

The purpose was to describe posture, ability to change position, and association between posture and contractures, hip dislocation, scoliosis, and pain in young adults with cerebral palsy (CP). Cross-sectional data of 102 people (63 males, 39 females; age range 19-23 y, median 21 y) out of a total population with CP was analysed in relation to Gross Motor Function Classification System (GMFCS) levels I (n=38), II (n=21), III (n=13), IV (n=10), and V (n=20). The CP subtypes were unilateral spastic (n=26), bilateral spastic (n=45), ataxic (n=12), and dyskinetic CP (n=19). The Postural Ability Scale was used to assess posture. The relationship between posture and joint range of motion, hip dislocation, scoliosis, and pain was analysed using logistic regression and Spearman's correlation. At GMFCS levels I to II, head and trunk asymmetries were most common; at GMFCS levels III to V postural asymmetries varied with position. The odds ratios (OR) for severe postural asymmetries were significantly higher for those with scoliosis (OR=33 sitting), limited hip extension (OR=39 supine), or limited knee extension (OR=37 standing). Postural asymmetries correlated to hip dislocations: supine (r(s) =0.48), sitting (r(s) =0.40), standing (r(s) =0.41), and inability to change position: supine (r(s) =0.60), sitting (r(s) =0.73), and standing (r(s) =0.64). Postural asymmetries were associated with scoliosis, hip dislocations, hip and knee contractures, and inability to change position. © 2013 The Authors. Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press.

Postural asymmetries in young adults with cerebral palsy

PubMed Central

Rodby-Bousquet, Elisabet; Czuba, Tomasz; Hägglund, Gunnar; Westbom, Lena

2013-01-01

Aim The purpose was to describe posture, ability to change position, and association between posture and contractures, hip dislocation, scoliosis, and pain in young adults with cerebral palsy (CP). Methods Cross-sectional data of 102 people (63 males, 39 females; age range 19–23y, median 21y) out of a total population with CP was analysed in relation to Gross Motor Function Classification System (GMFCS) levels I (n=38), II (n=21), III (n=13), IV (n=10), and V (n=20). The CP subtypes were unilateral spastic (n=26), bilateral spastic (n=45), ataxic (n=12), and dyskinetic CP (n=19). The Postural Ability Scale was used to assess posture. The relationship between posture and joint range of motion, hip dislocation, scoliosis, and pain was analysed using logistic regression and Spearman’s correlation. Results At GMFCS levels I to II, head and trunk asymmetries were most common; at GMFCS levels III to V postural asymmetries varied with position. The odds ratios (OR) for severe postural asymmetries were significantly higher for those with scoliosis (OR=33 sitting), limited hip extension (OR=39 supine), or limited knee extension (OR=37 standing). Postural asymmetries correlated to hip dislocations: supine (rs=0.48), sitting (rs=0.40), standing (rs=0.41), and inability to change position: supine (rs=0.60), sitting (rs=0.73), and standing (rs=0.64). Conclusions Postural asymmetries were associated with scoliosis, hip dislocations, hip and knee contractures, and inability to change position. This article is commented on by Novak on page 974 of this issue. PMID:23834239

Longitudinal Study of Oropharyngeal Dysphagia in Preschool Children With Cerebral Palsy.

PubMed

Benfer, Katherine A; Weir, Kelly A; Bell, Kristie L; Ware, Robert S; Davies, Peter S; Boyd, Roslyn N

2016-04-01

To determine changes in prevalence and severity of oropharyngeal dysphagia (OPD) in children with cerebral palsy (CP) and the relationship to health outcomes. Longitudinal cohort study. Community and tertiary institutions. Children (N=53, 33 boys) with a confirmed diagnosis of CP assessed first at 18 to 24 months (Assessment 1: mean age ± SD, 22.9±2.9 mo corrected age; Gross Motor Function Classification System [GMFCS]: I, n=22; II, n=7; III, n=11; IV, n=5; V, n=8) and at 36 months (Assessment 2). Not applicable. OPD was classified using the Dysphagia Disorders Survey (DDS) and signs suggestive of pharyngeal dysphagia. Nutritional status was measured using Z scores for weight, height, and body mass index (BMI). Gross motor skills were classified on GMFCS and motor type/distribution. Prevalence of OPD decreased from 62% to 59% between the ages of 18 to 24 months and 36 months. Thirty percent of children had an improvement in severity of OPD (greater than smallest detectable change), and 4% had worse OPD. Gross motor function was strongly associated with OPD at both assessments, on the DDS (Assessment 1: odds ratio [OR]=20.3, P=.011; Assessment 2: OR=28.9, P=.002), pharyngeal signs (Assessment 1: OR=10.6, P=.007; Assessment 2: OR=15.8, P=.003), and OPD severity (Assessment 1: β=6.1, P<.001; Assessment 2: β=5.5, P<.001). OPD at 18 to 24 months was related to health outcomes at 36 months: low Z scores for weight (adjusted β=1.2, P=.03) and BMI (adjusted β=1.1, P=.048), and increased parent stress (adjusted OR=1.1, P=.049). Classification and severity of OPD remained relatively stable between 18 to 24 months and 36 months. Gross motor function was the best predictor of OPD. These findings contribute to developing more effective screening processes that consider critical developmental transitions that are anticipated to present challenges for children from each of the GMFCS levels. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Change in basic motor abilities, quality of movement and everyday activities following intensive, goal-directed, activity-focused physiotherapy in a group setting for children with cerebral palsy.

PubMed

Sorsdahl, Anne Brit; Moe-Nilssen, Rolf; Kaale, Helga K; Rieber, Jannike; Strand, Liv Inger

2010-04-27

The effects of intensive training for children with cerebral palsy (CP) remain uncertain. The aim of the study was to investigate the impact on motor function, quality of movements and everyday activities of three hours of goal-directed activity-focused physiotherapy in a group setting, five days a week for a period of three weeks. A repeated measures design was applied with three baseline and two follow up assessments; immediately and three weeks after intervention. Twenty-two children with hemiplegia (n = 7), diplegia (n = 11), quadriplegia (n = 2) and ataxia (n = 2) participated, age ranging 3-9 y. All levels of Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) were represented. Parents and professionals participated in goal setting and training. ANOVA was used to analyse change over repeated measures. A main effect of time was shown in the primary outcome measure; Gross Motor Function Measure-66 (GMFM-66), mean change being 4.5 (p < 0.01) from last baseline to last follow up assessment. An interaction between time and GMFCS-levels was found, implying that children classified to GMFCS-levels I-II improved more than children classified to levels III-V. There were no main or interaction effects of age or anti-spastic medication. Change scores in the Pediatric Evaluation of Disability Inventory (PEDI) ranged 2.0-6.7, p < 0.01 in the Self-care domain of the Functional Skills dimension, and the Self-care and Mobility domains of the Caregiver Assistance dimension. The children's individual goals were on average attained, Mean Goal Attainment Scaling (GAS) T-score being 51.3. Non-significant improved scores on the Gross Motor Performance Measure (GMPM) and the Quality of Upper Extremities Skills Test (QUEST) were demonstrated. Significant improvement in GMPM scores were found in improved items of the GMFM, not in items that maintained the same score. Basic motor abilities and self-care improved in young children with CP after goal-directed activity-focused physiotherapy with involvement of their local environment, and their need for caregiver assistance in self-care and mobility decreased. The individualized training within a group context during a limited period of time was feasible and well-tolerated. The coherence between acquisition of basic motor abilities and quality of movement should be further examined.

Correlation Between Fractional Anisotropy and Motor Outcomes in One-Year-Old Infants with Periventricular Brain Injury

PubMed Central

Madhavan, Sangeetha; Campbell, Suzann K.; Campise-Luther, Rose; Gaebler-Spira, Deborah; Zawacki, Laura; Clark, April; Boynewicz, Kara; Kale, Dipti; Bulanda, Michelle; Yu, Jinsheng; Sui, Yi; Zhou, Xiaohong Joe

2014-01-01

Purpose To determine whether motor outcomes of an exercise intervention beginning at 2 months corrected age (CA) in children with periventricular brain injury (PBI) are correlated with fractional anisotropy (FA) measures derived from diffusion tensor imaging (DTI) at 12 months CA. Materials and Methods DTI was performed in eight infants with PBI who were randomly assigned to kicking and treadmill stepping exercise or a no-training condition. Development was assessed using the Alberta Infant Motor Scale (AIMS) and the Gross Motor Function Classification System (GMFCS). FA values were derived from regions of interest (ROI) in the middle third of the posterior limb of the internal capsule (PLIC) and the posterior thalamic radiation (PTR). Results Significant correlations were observed between motor development and FA measures. For PLIC, the correlation coefficients were 0.82 between FA and AIMS, and -0.92 between FA and GMFCS, while for PTR the corresponding correlation coefficients were 0.73 and -0.80, respectively. Conclusion Results of this study suggest that quantitative evaluation of white matter tracts using DTI at 12 months CA may be useful for assessment of brain plasticity in children. PMID:24136687

Correlation between fractional anisotropy and motor outcomes in one-year-old infants with periventricular brain injury.

PubMed

Madhavan, Sangeetha; Campbell, Suzann K; Campise-Luther, Rose; Gaebler-Spira, Deborah; Zawacki, Laura; Clark, April; Boynewicz, Kara; Kale, Dipti; Bulanda, Michelle; Yu, Jinsheng; Sui, Yi; Zhou, Xiaohong Joe

2014-04-01

To determine whether motor outcomes of an exercise intervention beginning at 2 months corrected age (CA) in children with periventricular brain injury (PBI) are correlated with fractional anisotropy (FA) measures derived from diffusion tensor imaging (DTI) at 12 months CA. DTI was performed in eight infants with PBI who were randomly assigned to kicking and treadmill stepping exercise or a no-training condition. Development was assessed using the Alberta Infant Motor Scale (AIMS) and the Gross Motor Function Classification System (GMFCS). FA values were derived from regions of interest (ROIs) in the middle third of the posterior limb of the internal capsule (PLIC) and the posterior thalamic radiation (PTR). Significant correlations were observed between motor development and FA measures. For PLIC, the correlation coefficients were 0.82 between FA and AIMS, and -0.92 between FA and GMFCS, while for PTR the corresponding correlation coefficients were 0.73 and -0.80, respectively. Results of this study suggest that quantitative evaluation of white matter tracts using DTI at 12 months CA may be useful for assessment of brain plasticity in children. Copyright © 2013 Wiley Periodicals, Inc.

Correlation of quantitative sensorimotor tractography with clinical grade of cerebral palsy.

PubMed

Trivedi, Richa; Agarwal, Shruti; Shah, Vipul; Goyel, Puneet; Paliwal, Vimal K; Rathore, Ram K S; Gupta, Rakesh K

2010-08-01

The purpose of this study was to determine whether tract-specific diffusion tensor imaging measures in somatosensory and motor pathways correlate with clinical grades as defined using the Gross Motor Function Classification System (GMFCS) in cerebral palsy (CP) children. Quantitative diffusion tensor tractography was performed on 39 patients with spastic quadriparesis (mean age = 8 years) and 14 age/sex-matched controls. All patients were graded on the basis of GMFCS scale into grade II (n = 12), grade IV (n = 22), and grade V (n = 5) CP and quantitative analysis reconstruction of somatosensory and motor tracts performed. Significant inverse correlation between clinical grade and fractional anisotropy (FA) was observed in both right and left motor and sensory tracts. A significant direct correlation of mean diffusivity values from both motor and sensory tracts was also observed with clinical grades. Successive decrease in FA values was observed in all tracts except for left motor tracts moving from age/sex-matched controls to grade V through grades II and IV. We conclude that white matter tracts from both the somatosensory and the motor cortex play an important role in the pathophysiology of motor disability in patients with CP.

Sleep disorders in children with cerebral palsy: neurodevelopmental and behavioral correlates.

PubMed

Romeo, Domenico M; Brogna, Claudia; Quintiliani, Michela; Baranello, Giovanni; Pagliano, Emanuela; Casalino, Tiziana; Sacco, Annalisa; Ricci, Daniela; Mallardi, Maria; Musto, Elisa; Sivo, Serena; Cota, Francesco; Battaglia, Domenica; Bruni, Oliviero; Mercuri, Eugenio

2014-02-01

We aimed to estimate the frequency of sleep disorders in children with cerebral palsy (CP) using the Sleep Disturbance Scale for Children (SDSC) and to evaluate the relations between sleep disorders and motor, cognitive, and behavioral problems. One hundred and sixty-five children with CP ages 6-16 years (mean age, 11years) were assessed using the SDSC, the Gross Motor Function Classification System (GMFCS), the Wechsler Intelligence Scale for Children and the Child Behavior Check List (CBCL) to assess sleep, motor, cognitive, and behavioral problems, respectively. An abnormal total sleep score was found in 19% of children with CP; more than 40% of children had an abnormal score on at least one SDSC factor. The SDSC total score was significantly associated (P<.01) with mental retardation, epilepsy, CBCL scores, and level 5 on the GMFCS. Our results confirm that sleep disorders are common in children with cerebral palsy. The relationship between motor and cognitive behavior and epilepsy should be further explored to better understand how these factors influence one another to identify effective treatments and to improve the well-being of the child. Copyright © 2014 Elsevier B.V. All rights reserved.

Ambulatory Physical Activity Performance in Youth With Cerebral Palsy and Youth Who Are Developing Typically

PubMed Central

Bjornson, Kristie F; Belza, Basia; Kartin, Deborah; Logsdon, Rebecca; McLaughlin, John F

2007-01-01

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 all time 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. PMID:17244693

Cerebral Palsy in Children as a Risk Factor for Malnutrition.

PubMed

Perenc, Lidia; Przysada, Grzegorz; Trzeciak, Jadwiga

2015-01-01

The main aim of this study was to determine some malnutrition risk factors among children with cerebral palsy (CP). Children with CP often require the assistance of physical therapy centers. Experience suggests that, apart from physical disabilities, this group often suffers from malnutrition. Data were gathered in the hospital among 128 children aged 3-18 years who were suffering from CP. The children were admitted from 2011 to 2013 to the Center for Neurological Physical Therapy for children in the Regional Hospital No. 2. St. Queen Jadwiga in Rzeszow (RORE). Statistical analyses were conducted for data on gender, age, type of CP, motor function level according to Gross Motor Function Classification Scale (GMFCS), body mass index (BMI) and hemoglobin levels in blood. The risk of anemia differs based on gender--the risk is 6 times greater among boys than among girls (p = 0.0398). Risk of malnutrition is 3.5 times higher in children with tetraplegia than in children with diplegia or hemiplegia (p = 0.0043). Higher GMFCS scores are connected to greater proportions of malnourished children (for BMI z-score <-1.64, p = 0.0010). Among children with CP, malnourishment risk factors are male gender for anemia and tetraplegia and high GMFCS values. 2015 S. Karger AG, Basel.

Training effects of wheelchair dance on aerobic fitness in bedridden individuals with severe athetospastic cerebral palsy rated to GMFCS level V.

PubMed

Terada, Kyoko; Satonaka, Ayako; Terada, Yasuto; Suzuki, Nobuharu

2017-10-01

There were few studies about training effects of wheelchair dance on aerobic fitness in the bedridden individuals with severe cerebral palsy for whom the traditional maximal or submaximal exercise tests were not applicable. As the oxygen pulse (O2P), the oxygen uptake divided by the heart rate, is regarded to be a relative measure of stroke volume and the O2P correlates to peak oxygen uptake, we would be able to assess the training effects of wheelchair dance on aerobic fitness in those individuals measuring O2P. To study training effects of wheelchair dance on aerobic fitness in bedridden individuals with severe athetospastic cerebral palsy. Pre-post study design. A laboratory and a community care center. Bedridden individuals with athetospastic cerebral palsy rated to Gross Motor Function Classification System (GMFCS) level V (N.=6). The O2P was compared between during the rest, the waltz, and the jive at the baseline, the 3rd, the 6th, and the 12th month of the intervention of wheelchair dance 6 to 15 minutes at a time, 2 days a week or more. Paired Student's t-test showed that O2P during the waltz and the jive was significantly increased compared with that during the rest at the 6th and the 12th month, and O2P during the jive was also significantly increased compared with that during the rest at the 3rd, the 6th, and the 12th month of the intervention period. This is the first study that shows wheelchair dance may possibly increase aerobic fitness in bedridden individuals with severe athetospastic cerebral palsy rated GMFCS level V. Future studies with a larger sample will be warranted to prove the claim.

The Quality Function Measure: reliability and discriminant validity of a new measure of quality of gross motor movement in ambulatory children with cerebral palsy.

PubMed

Wright, F Virginia; Rosenbaum, Peter; Fehlings, Darcy; Mesterman, Ronit; Breuer, Ute; Kim, Marie

2014-08-01

Optimizing movement quality is a common rehabilitation goal for children with cerebral palsy (CP). The new Quality Function Measure (QFM)--a revision of the Gross Motor Performance Measure (GMPM)--evaluates five attributes: Alignment, Co-ordination, Dissociated movement, Stability, and Weight-shift, for the Gross Motor Function Measure (GMFM) Stand and Walk/Run/Jump items. This study evaluated the reliability and discriminant validity of the QFM. Thirty-three children with CP (17 females, 16 males; mean age 8y 11mo, SD 3y 1mo; Gross Motor Function Classification System [GMFCS] levels I [n=17], II [n=7], III [n=9]) participated in reliability testing. Each did a GMFM Stand/Walk assessment, repeated 2 weeks later. Both GMFM assessments were videotaped. A physiotherapist assessor pair independently scored the QFM from an assigned child's GMFM video. GMFM data from 112 children. That is, (GMFCS I [n=38], II [n=27], III [n=47]) were used for discriminant validity evaluation. QFM mean scores varied from 45.0% (SD 27.2; Stability) to 56.2% (SD 27.5; Alignment). Reliability was excellent across all attributes: intraclass correlation coefficients (ICCs) ≥0.97 (95% confidence intervals [CI] 0.95-0.99), interrater ICCs ≥0.89 (95% CI 0.80-0.98), and test-retest ICCs ≥0.90 (95% CI 0.79-0.99). QFM discriminated qualitative attributes of motor function among GMFCS levels (maximum p<0.05). The QFM is reliable and valid, making it possible to assess how well young people with CP move and what areas of function to target to enhance quality of motor control. © 2014 Mac Keith Press.

Assessment of oral and dental health status in children with cerebral palsy: An exploratory study

PubMed Central

Sedky, Nabila A

2018-01-01

Objectives: Evaluating oral and dental health status in Egyptian children with cerebral palsy (CP) in relation to gross motor skills and types of CP. Methods: A Cross-sectional study was conducted at el-Shatby Hospital for Children, Alexandria-Egypt. Oral examination for 62 children with CP between the age ranges 3–12 years was performed and decay missing filling-tooth/decay filling-tooth (DMFT/dft), simplified oral hygiene index (OHI-S), and modified gingival index (MGI) indices were charted. Maxillofacial defects, dental problems and drooling of saliva were assessed. Children’s CP type, motor milestone, and gross motor skills were determined. All statistical analyses were performed at P < 0.05 and 0.01. Results: About 84.0% of children had spastic quadriplegia, 41.9% were sit supported, 32.3% had Level IV gross motor function classification system (GMFCS), and 29.0% had Level V. No maxillofacial defects, 14.5% had dentine exposure >1/3 of the surface, and 22.6% had frequent/severe drooling saliva. Caries prevalence comprised 54.8%, 53.2% had poor oral hygiene (OHI-S index), and 43.6% had severe gingival inflammation (MGI index). The first best predictor variable for dft was “Motor Milestone.” GMFCS (Level IV and V) was the first best predictor variable for DMFT, OHI-S, and MGI indices. Conclusion: The majority of children had dental caries, poor oral hygiene, and severe gingival inflammation. Children who were sit supported had no neck support and stand supported were suffering from dental caries (dft) more than children who were sitting and walking alone. Children with Levels IV/V GMFCS were prone to have dental caries (DMFT), susceptible to suffer from bad oral hygiene, and older children experiencing severe gingivitis more than younger ones. PMID:29623011

Reliability and Construct Validity of the 6-Minute Racerunner Test in Children and Youth with Cerebral Palsy, GMFCS Levels III and IV.

PubMed

Bolster, Eline A M; Dallmeijer, Annet J; de Wolf, G Sander; Versteegt, Marieke; Schie, Petra E M van

2017-05-01

To determine the test-retest reliability and construct validity of a novel 6-Minute Racerunner Test (6MRT) in children and youth with cerebral palsy (CP) classified as Gross Motor Function Classification System (GMFCS) levels III and IV. The racerunner is a step-propelled tricycle. The participants were 38 children and youth with CP (mean age 11 y 2 m, SD 3 y 7 m; GMFCS III, n = 19; IV, n = 19). Racerunner capability was determined as the distance covered during the 6MRT on three occasions. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), and smallest detectable differences (SDD) were calculated to assess test-retest reliability. The ICC for tests 2 and 3 were 0.89 (SDD 37%; 147 m) for children in level III and 0.91 for children in level IV (SDD 52%; 118 m). When the average of two separate test occasions was used, the SDDs were reduced to 26% (104 m; level III) and 37% (118 m; level IV). For tests 1 to 3, the mean distance covered increased from 345 m (SD 148 m) to 413 m (SD 137 m) for children in level III, and from 193 m (SD 100 m) to 239 m (SD 148 m) for children in level IV. Results suggest high test-retest reliability. However, large SDDs indicate that a single 6MRT measurement is only useful for individual evaluation when large improvements are expected, or when taking the average of two tests. The 6MRT discriminated the distance covered between children and youth in levels III and IV, supporting construct validity.

Morphometric analysis of acetabular dysplasia in cerebral palsy: three-dimensional CT study.

PubMed

Gose, Shinichi; Sakai, Takashi; Shibata, Toru; Murase, Tsuyoshi; Yoshikawa, Hideki; Sugamoto, Kazuomi

2009-12-01

Three-dimensional computed tomography (3D-CT) eliminates the positioning errors and allows the clinician to more accurately assess the radiographic parameters present. To elucidate the 3D geometry of the acetabulum and the extent of hip subluxation/dislocation in patients with cerebral palsy (CP), quantitative morphometric analysis was performed using 3D-CT data. We evaluated 150 hips in 75 patients with bilateral spastic CP. The mean age of the patients was 5.4 years (range: 2.7 to 6.9 y). The fitting plane of the ilium was projected onto the coronal plane and then onto the sagittal plane, and then the angle formed with a horizontal line was defined as CTalpha (the lateral opening angle) and CTbeta (the sagittal inclination angle), respectively. The center of the acetabulum and the femoral head were defined, and the distance between these centers was divided by the femoral head diameter, defined as CT migration percentage (CTMP, %). In 123 (82%) of the 150 hips, the femoral head center was located posteriorly, superiorly, and laterally relative to the acetabular center. Large CTalpha cases tended to show large CTMP. CTalpha and CTMP were significantly larger in the cases with Gross Motor Functional Classification System (GMFCS) level IV/V and spastic quadriplegia, than in the cases with GMFCS level II/III and spastic diplegia. CTbeta showed significant correlation with the acetabular defect on the lateral 3D reconstructed images. Three-dimensional acetabular geometry and migration percentage in CP patients can be analyzed quantitatively using 3D-CT regardless of the abnormal spastic posture. The extent of acetabular dysplasia and subluxation is more severe in patients with GMFCS level IV/V and spastic quadriplesia. Level 4.

Therapy service use in children and adolescents with cerebral palsy: An Australian perspective.

PubMed

Meehan, Elaine; Harvey, Adrienne; Reid, Susan M; Reddihough, Dinah S; Williams, Katrina; Crompton, Kylie E; Omar, Suhaila; Scheinberg, Adam

2016-03-01

The aim of this study was to describe the patterns of therapy service use for a sample of children and adolescents with cerebral palsy over a 1 year period and to identify factors associated with frequency of therapy and parental satisfaction with therapy frequency. Parents of 83 children completed a survey on their child's use of occupational therapy, physiotherapy and speech and language pathology services over the previous year. Participants were randomly selected from a sample stratified by age and Gross Motor Function Classification System (GMFCS) level. During the year prior to survey completion, 83% of children had received occupational therapy, 88% had received physiotherapy and 60% had received speech and language pathology services. Frequency of therapy was higher for younger children (P < 0.01), those classified at GMFCS levels IV-V (P < 0.05) and those attending schools specifically for children with disabilities. Current structures for therapy service delivery for children with cerebral palsy are systems-based, and age-based funding systems and the organisation of services around the education system are preventing the delivery of needs-based therapy. Paediatricians that care for children and young people with cerebral palsy need to pay particular attention to those that may miss out on therapy due to age or school type, and support these families in accessing appropriate therapy. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Gait phenotypes in paediatric hereditary spastic paraplegia revealed by dynamic time warping analysis and random forests

PubMed Central

Martín-Gonzalo, Juan Andrés; Rodríguez-Andonaegui, Irene; López-López, Javier; Pascual-Pascual, Samuel Ignacio

2018-01-01

The Hereditary Spastic Paraplegias (HSP) are a group of heterogeneous disorders with a wide spectrum of underlying neural pathology, and hence HSP patients express a variety of gait abnormalities. Classification of these phenotypes may help in monitoring disease progression and personalizing therapies. This is currently managed by measuring values of some kinematic and spatio-temporal parameters at certain moments during the gait cycle, either in the doctor´s surgery room or after very precise measurements produced by instrumental gait analysis (IGA). These methods, however, do not provide information about the whole structure of the gait cycle. Classification of the similarities among time series of IGA measured values of sagittal joint positions throughout the whole gait cycle can be achieved by hierarchical clustering analysis based on multivariate dynamic time warping (DTW). Random forests can estimate which are the most important isolated parameters to predict the classification revealed by DTW, since clinicians need to refer to them in their daily practice. We acquired time series of pelvic, hip, knee, ankle and forefoot sagittal angular positions from 26 HSP and 33 healthy children with an optokinetic IGA system. DTW revealed six gait patterns with different degrees of impairment of walking speed, cadence and gait cycle distribution and related with patient’s age, sex, GMFCS stage, concurrence of polyneuropathy and abnormal visual evoked potentials or corpus callosum. The most important parameters to differentiate patterns were mean pelvic tilt and hip flexion at initial contact. Longer time of support, decreased values of hip extension and increased knee flexion at initial contact can differentiate the mildest, near to normal HSP gait phenotype and the normal healthy one. Increased values of knee flexion at initial contact and delayed peak of knee flexion are important factors to distinguish GMFCS stages I from II-III and concurrence of polyneuropathy. PMID:29518090

Assessment and correction of skinfold thickness equations in estimating body fat in children with cerebral palsy.

PubMed

Gurka, Matthew J; Kuperminc, Michelle N; Busby, Marjorie G; Bennis, Jacey A; Grossberg, Richard I; Houlihan, Christine M; Stevenson, Richard D; Henderson, Richard C

2010-02-01

To assess the accuracy of skinfold equations in estimating percentage body fat in children with cerebral palsy (CP), compared with assessment of body fat from dual energy X-ray absorptiometry (DXA). Data were collected from 71 participants (30 females, 41 males) with CP (Gross Motor Function Classification System [GMFCS] levels I-V) between the ages of 8 and 18 years. Estimated percentage body fat was computed using established (Slaughter) equations based on the triceps and subscapular skinfolds. A linear model was fitted to assess the use of a simple correction to these equations for children with CP. Slaughter's equations consistently underestimated percentage body fat (mean difference compared with DXA percentage body fat -9.6/100 [SD 6.2]; 95% confidence interval [CI] -11.0 to -8.1). New equations were developed in which a correction factor was added to the existing equations based on sex, race, GMFCS level, size, and pubertal status. These corrected equations for children with CP agree better with DXA (mean difference 0.2/100 [SD=4.8]; 95% CI -1.0 to 1.3) than existing equations. A simple correction factor to commonly used equations substantially improves the ability to estimate percentage body fat from two skinfold measures in children with CP.

Quantifying weight bearing while in passive standers and a comparison of standers.

PubMed

Kecskemethy, Heidi H; Herman, Daniel; May, Ryan; Paul, Kathleen; Bachrach, Steven J; Henderson, Richard C

2008-07-01

Mechanical loading plays an important role in skeletal health, and this is a major reason standing devices are widely used with non-ambulatory persons. However, little is known about the true axial loading that occurs while in a stander, or the factors which may impact loading. The purpose of this study was to quantify weight borne while in a stander, and to directly compare different standers. Load measuring footplate adaptors were designed and fabricated specifically for this study. Weight bearing loads in 20 non-ambulatory persons with quadriplegic cerebral palsy aged 6 to 21 years (median 14 y) were continuously monitored during routine 30-minute standing sessions. Fourteen participants were female, six were male; one was Gross Motor Function Classification System (GMFCS) Level IV, and 19 were GMFCS Level V. Each participant was monitored on four to six occasions over an 8-week period, two to three times in each of two different standers (total 108 standing sessions). Weight bearing loads ranged widely from 37 to 101% of body weight. The difference between standers was as much as 29% body weight. There is wide variance in the actual weight borne while in passive standers. The type of stander utilized is one factor which can significantly affect the amount of weight borne.

Reliability and Applicability of the Bayley Scale of Infant Development-II for Children With Cerebral Palsy.

PubMed

Lee, Ji Hyun; Lim, Hye Kyung; Park, Eunyoung; Song, Junyoung; Lee, Hee Song; Ko, Jooyeon; Kim, Minyoung

2013-04-01

To obtain reliability and applicability of the Korean version Bayley Scale of Infant Development-II (BSID-II) in evaluating the developmental status of children with cerebral palsy (CP). The inter-rater reliability of BSID-II scores from 68 children with CP (46 boys and 22 girls; mean age, 32.54±16.76 months; age range, 4 to 78 months) was evaluated by 10 pediatric occupational therapists. Patients were classified in several ways according to age group, typology, and the severity of motor impairment by the level of the Gross Motor Function Classification System (GMFCS). The measures were performed by video analysis, and the results of intraclass correlation (ICC) were obtained for each of the above classifications. To evaluate the clinical applicability of BSID-II for CP, its correlation with the Gross Motor Function Measure (GMFM), which has been known as the standard motor assessment for CP, was investigated. ICC was 0.99 for the Mental scale and 0.98 for the Motor scale in all subjects. The values of ICC ranged from 0.92 to 0.99 for each age group, 0.93 to 0.99 for each typology, and 0.99 to 1.00 for each GMFCS level. A strong positive correlation was found between the BSID-II Motor raw score and the GMFM total score (r=0.84, p<0.001), and a moderate correlation was observed between the BSID-II Mental raw score and the GMFM total score (r=0.65, p<0.001). The Korean version of BSID-II is a reliable tool to measure the functional status of children with CP. The raw scores of BSID-II showed a great correlation with GMFM, indicating validity of this measure for children with CP on clinical basis.

Botulinum toxin injections for chronic sialorrhoea in children are effective regardless of the degree of neurological dysfunction: A single tertiary institution experience.

PubMed

Mahadevan, Murali; Gruber, Maayan; Bilish, Darin; Edwards, Kathryn; Davies-Payne, David; van der Meer, Graeme

2016-09-01

To determine the effectiveness of submandibular salivary gland Botulinum Toxin Type-A (BTX-A) injection in the treatment of drooling in children with varying degrees of neurological dysfunction. A retrospective review of pre- and post-procedure drooling frequency and severity scores of patients receiving BTX-A between January 2008 and January 2013. Stratification to different subgroups of neurological impairment was performed according to Gross Motor Function Classification System (GMFCS) score. Drooling severity was assessed using Thomas-Stonell and Greenberg symptom questionnaires administered at time of initial consultation and 3 months after treatment. 48 sets of BTX-A injections in 26 patients with an average age of 9.45 years (range 7 months-18 years) were included in the study. Marked improvement in drooling was seen in 60.4% of patients, a marginal or brief improvement was seen in 20.8% and there was no improvement in 18.8%. No adverse events were reported following any of the BTX-A injections. BTX-A was safe and effective in the eight patients with pre-existing swallowing dysfunction. Subsequent drooling surgery was performed in 15 (57.7%) of the cohort, all 15 patients responded to BTX-A injections. In patients with Cerebral Palsy, there was no correlation between the severity of the neurological dysfunction as measured by the Gross Motor Function Classification System (GMFCS) score and the response to BTX-A treatment. Injection of BTX-A to the submandibular glands of children with neurological disorders is a safe procedure and results in a reduction in drooling in the majority of patients. Children with severe neurological dysfunction respond to BTX-A injections as effectively as their less impaired peers and the degree of response does not appear to be associated with the severity of neurological disability. BTX-A injection is a good initial procedure when drooling surgery is being considered. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Depression and anxiety levels in mothers of children with cerebral palsy: a controlled study.

PubMed

Yilmaz, H; Erkin, G; Nalbant, L

2013-12-01

Studies investigating depression and anxiety levels in mothers of children with CP and related factors are limited, and controversial findings are reported in these studies. The study was aimed to determine depression and anxiety levels in mothers of children with cerebral palsy (CP) and to define factors related to depression and anxiety levels. A descriptive study. Outpatient physical medicine and rehabilitation clinic of an education and research hospital. The study was composed of two groups: group 1, 116 mothers of children with CP and group 2, 114 mothers of healthy children. Mothers of children with spastic-type CP were included into group 1. Functional levels in children with CP were investigated with The Gross Motor Function Classification System (GMFCS). Depression levels of mothers in both groups were assessed with Beck Depression Inventory (BDI), and anxiety levels with Beck Anxiety Inventory (BAI). BDI and BAI scores were statistically and significantly higher in group 1, compared to group 2. Among mothers in group 1, a positive correlation was determined between GMFCS score, and depression and anxiety levels. However, no correlation was detected between depression and anxiety levels, and body involvement of CP, education status, age and economic level among patients. In logistic regression analysis, the most significant risk factors of depressive symptoms were detected to be GMFCS score and speech defects. Our findings indicate that depression and anxiety levels of mothers with CP children are higher than those with healthy children and associated with speech defects and functional disability levels in children with CP. Healthcare professionals should take into account that depression and anxiety levels may be higher in mothers of children with CP. For an effective rehabilitation program related to children with CP, depression and anxiety levels in mothers of such children should be taken into account, and mothers should closely be followed and if necessary, psychologically supported.

Gait pathology subtypes are not associated with self-reported fall frequency in children with cerebral palsy.

PubMed

Boyer, Elizabeth R; Patterson, Aleksys

2018-05-05

Trips and falls are common concerns reported by parents of children with cerebral palsy. Specific gait pathologies (excessive internal hip rotation, intoeing, and stiff knee gait) are anecdotally associated with higher rates of falls. Is fall frequency higher for the aforementioned gait pathologies? Parent-reported fall frequency from 1063 children with cerebral palsy who also had a three-dimensional gait analysis was retrospectively reviewed. Frequency of 10 common gait pathologies was determined and fall frequency for the gait pathologies of interest were compared to matched control groups. Possible effects of Gross Motor Functional Classification System (GMFCS) level and age on fall frequency were also assessed and matched in the control group, as appropriate. In general, parent-reported fall frequency increased from GMFCS level I to II and then decreased until level IV. Moreover, younger children tended to report greater fall frequency, though children who reported never falling were of similar age as those who reported weekly falls, resulting in an inverted-U shaped relationship. Children with cerebral palsy who walked with excessive internal hip rotation, excessive intoeing, or stiff knee gait did not report increased fall frequencies compared to other children with cerebral palsy matched on GMFCS level and age that did not walk with those gait patterns. Approximately 35% of children reported never falling, 35% reported falling daily, and 30% reported falling monthly or weekly for each gait pattern. Therefore, elevated fall frequency appears to be a generic problem for most children with CP rather than a function of a specific gait pattern. Clinicians should be aware of these relationships, or lack thereof, when trying to decipher the cause of a child's falling and when determining appropriate interventions. Future studies may seek to more objectively quantify fall frequency, as self-report is the main limitation of this study. Copyright © 2018 Elsevier B.V. All rights reserved.

Reliability and responsiveness of the gross motor function measure-88 in children with cerebral palsy.

PubMed

Ko, Jooyeon; Kim, MinYoung

2013-03-01

The Gross Motor Function Measure (GMFM-88) is commonly used in the evaluation of gross motor function in children with cerebral palsy (CP). The relative reliability of GMFM-88 has been assessed in children with CP. However, little information is available regarding the absolute reliability or responsiveness of GMFM-88. The purpose of this study was to determine the absolute and relative reliability and the responsiveness of the GMFM-88 in evaluating gross motor function in children with CP. A clinical measurement design was used. Ten raters scored the GMFM-88 in 84 children (mean age=3.7 years, SD=1.9, range=10 months to 9 years 9 months) from video records across all Gross Motor Function Classification System (GMFCS) levels to establish interrater reliability. Two raters participated to assess intrarater reliability. Responsiveness was determined from 3 additional assessments after the baseline assessment. The interrater and intrarater intraclass correlation coefficients (ICCs) with 95% confidence intervals, standard error of measurement (SEM), smallest real difference (SRD), effect size (ES), and standardized response mean (SRM) were calculated. The relative reliability of the GMFM was excellent (ICCs=.952-1.000). The SEM and SRD for total score of the GMFM were acceptable (1.60 and 3.14, respectively). Additionally, the ES and SRM of the dimension goal scores increased gradually in the 3 follow-up assessments (GMFCS levels I and II: ES=0.5, 0.6, and 0.8 and SRM=1.3, 1.8, and 2.0; GMFCS levels III-V: ES=0.4, 0.7, and 0.9 and SRM=1.5, 1.7, and 2.0). Children over 10 years of age with CP were not included in this study, so the results should not be generalized to all children with CP. Both the reliability and the responsiveness of the GMFM-88 are reasonable for measuring gross motor function in children with CP.

Assessment and correction of skinfold thickness equations in estimating body fat in children with cerebral palsy

PubMed Central

GURKA, MATTHEW J; KUPERMINC, MICHELLE N; BUSBY, MARJORIE G; BENNIS, JACEY A; GROSSBERG, RICHARD I; HOULIHAN, CHRISTINE M; STEVENSON, RICHARD D; HENDERSON, RICHARD C

2010-01-01

AIM To assess the accuracy of skinfold equations in estimating percentage body fat in children with cerebral palsy (CP), compared with assessment of body fat from dual energy X-ray absorptiometry (DXA). METHOD Data were collected from 71 participants (30 females, 41 males) with CP (Gross Motor Function Classification System [GMFCS] levels I–V) between the ages of 8 and 18 years. Estimated percentage body fat was computed using established (Slaughter) equations based on the triceps and subscapular skinfolds. A linear model was fitted to assess the use of a simple correction to these equations for children with CP. RESULTS Slaughter’s equations consistently underestimated percentage body fat (mean difference compared with DXA percentage body fat −9.6/100 [SD 6.2]; 95% confidence interval [CI] −11.0 to −8.1). New equations were developed in which a correction factor was added to the existing equations based on sex, race, GMFCS level, size, and pubertal status. These corrected equations for children with CP agree better with DXA (mean difference 0.2/100 [SD=4.8]; 95% CI −1.0 to 1.3) than existing equations. INTERPRETATION A simple correction factor to commonly used equations substantially improves the ability to estimate percentage body fat from two skinfold measures in children with CP. PMID:19811518

The relationship between spasticity and gross motor capability in nonambulatory children with spastic cerebral palsy.

PubMed

Katusic, Ana; Alimovic, Sonja

2013-09-01

Spasticity has been considered as a major impairment in cerebral palsy (CP), but the relationship between this impairment and motor functions is still unclear, especially in the same group of patients with CP. The aim of this investigation is to determine the relationship between spasticity and gross motor capability in nonambulatory children with spastic CP. Seventy-one children (30 boys, 41 girls) with bilateral spastic cerebral palsy and with Gross Motor Function Classification System (GMFCS) levels IV (n=34) and V (n=37) were included in the study. The spasticity level in lower limbs was evaluated using the Modified Modified Ashworth Scale and the gross motor function with the Gross Motor Function Measure (GMFM-88). Spearman's correlation analysis was used to determine the nature and the strength of the relationship. The results showed a moderate correlation between spasticity and gross motor skills (ρ=0.52 for the GMFCS level; ρ=0.57 for the GMFM-88), accounting for less than 30% of the explained variance. It seems that spasticity is just one factor among many others that could interfere with gross motor skills, even in children with severe forms of spastic CP. Knowledge of the impact of spasticity on motor skills may be useful in the setting of adequate rehabilitation strategies for nonambulatory children with spastic CP.

Course of employment in adults with cerebral palsy over a 14-year period.

PubMed

Benner, Joyce L; Hilberink, Sander R; Veenis, Thessa; van der Slot, Wilma M A; Roebroeck, Marij E

2017-07-01

To explore the course of employment in adults with cerebral palsy (CP) over 14 years, and to identify subgroups at risk for unemployment. Sixty-five adults with CP (33 males, 32 females; baseline age 25y 8mo, standard deviation [SD] 3y 2mo; intellectual impairment 25%; bilateral CP 65%) participated in a prospective cohort study. Self-reports of employment and work hours per week in 1996, 2000, and 2010 were documented. The course of employment (including sheltered work) and work hours per week were analysed, using generalized estimating equations (GEE). Overall, employment rate was stable over time (38-45%, p=0.413), but lower than in the general population (75-86%, p<0.001). Employment rates were specifically low in adults with intellectual impairment, bilateral CP, and in adults with Gross Motor Function Classification System (GMFCS) levels IV and V. Work hours per week declined (35.0 [SD 7.9] to 31.2 [SD 10.3], p=0.033), especially among females (32.3 [SD 6.4] to 23.4 [SD 7.4], p<0.001). Similar to the general population, females often worked part-time. Employment was low compared with the general population, but remained stable in the long term; however, work hours per week decreased. Adults with intellectual impairment, bilateral CP, and GMFCS levels IV and V are subgroups at risk for unemployment. © 2017 Mac Keith Press.

[Neuromotor assessment of patients with spastic cerebral palsy treated with orthopedic surgery at the National Rehabilitation Institute].

PubMed

Piana, A R; Viñals, C L; Del Valle, M C; Arellano, M S; Redón, A T; Peralta, S C; León, S L

2010-01-01

Cerebral palsy (CP) is a static neurologic condition resulting from a brain lesion occurring before the completion of brain development. The goal of management is not cure, but increasing patients' functionality and improving their capabilities and maintaining their locomotion, cognitive development, social interaction and independence. The best results are obtained with an early and intensive management that includes physical and occupational therapy, medical and surgical treatments, mechanical aids and the management of concomitant conditions. To assess the neuromotor improvement in patients with spastic CP after surgical treatment at the National Rehabilitation Institute. Patients with a diagnosis of spastic CP who presented at the Pediatric Rehabilitation outpatient service were referred to the Joint CP Clinic from January 2007 to January 2008, and underwent surgical treatment of the pelvic limbs. They were assessed 3 times and underwent neuromotor tests with gross motor function measure (GMFM), which was rated with the gross motor function classification system (GMFCS). Most of the patients had improvement in the muscle tone and contracture assessments as well as in the GMFM, and their self-mobility increased one level. Significant improvements were seen in the muscle tone and contractures after surgery; the GMFM and the self-mobility levels in the GMFCS also improved. Multiple level surgery together with a postoperative physical therapy program results in considerable improvements in the gross motor function measure of patients with spastic CP.

Association between gross motor function and nutritional status in children with cerebral palsy: a cross-sectional study from Colombia.

PubMed

Herrera-Anaya, Elizabeth; Angarita-Fonseca, Adriana; Herrera-Galindo, Víctor M; Martínez-Marín, Rocío D P; Rodríguez-Bayona, Cindy N

2016-09-01

To determine the association between gross motor function and nutritional status in children with cerebral palsy (CP) residing in an urban area in a developing country. We conducted a cross-sectional study in 177 children (ages 2-12y, 59.3% male) with a diagnosis of CP who were attending rehabilitation centres in Bucaramanga, Colombia (2012-2013). A physiotherapist evaluated patients using the Gross Motor Function Classification System (GMFCS, levels I to V). Nutritional status was evaluated by nutritionists and classified according to the World Health Organization growth charts. We used linear and multinomial logistic regression methods to determine the associations. There were 39.5%, 6.8%, 5.6%, 16.4%, and 31.6% patients classified in levels I to V respectively. The mean adjusted differences for weight-for-age, height-for-age, BMI-for-age, and height-for-weight z-scores were significantly larger for children classified in levels II to V compared with those in level I. The children classified in levels IV and V were more likely to have malnutrition (adjusted odds ratio [OR] 5.64; 95% confidence interval [CI] 2.27-14.0) and stunting (OR 8.42; 95% CI 2.90-24.4) than those classified in GMFCS levels I to III. Stunting and malnutrition are prevalent conditions among paediatric patients with CP, and both are directly associated with higher levels of gross motor dysfunction. © 2016 Mac Keith Press.

Evaluation of group versus individual physiotherapy following lower limb intra-muscular Botulinum Toxin-Type A injections for ambulant children with cerebral palsy: A single-blind randomized comparison trial.

PubMed

Thomas, Rachel E; Johnston, Leanne M; Sakzewski, Leanne; Kentish, Megan J; Boyd, Roslyn N

2016-01-01

This study aimed to evaluate efficacy of group (GRP) versus individual (IND) physiotherapy rehabilitation following lower limb intramuscular injections of Botulinum Toxin-Type A (BoNT-A) for ambulant children with cerebral palsy (CP). Following lower limb BoNT-A injections, 34 children were randomly allocated to GRP (n=17; mean age 7y8m SD 2.0; 13 males; Gross Motor Function Classification System (GMFCS) I=5, II=8, III=4) or IND physiotherapy (n=17; mean age 8y7m SD 2.0; 11 males; GMFCS I=9, II=5, III=3). Primary outcomes were the Canadian Occupational Performance Measure (COPM) and Edinburgh Visual Gait Score (EVGS) assessed at baseline, 10 and 26 weeks post intervention. There were no baseline differences between groups. GRP intervention had greater, but not clinically meaningful, improvement in COPM satisfaction (estimated mean difference EMD 1.7, 95% CI 0.4-3.1; p<0.01) at 26 weeks. Both groups demonstrated clinically significant improvements in COPM performance and satisfaction, but minimal change in quality of gait (EVGS). Six hours of direct physiotherapy (either GRP or IND) with an additional indirect dose (median 16 episodes) of individualized home programme activities following lower limb BoNT-A injections, however, was inadequate to drive clinically meaningful changes in lower limb motor outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.

Apolipoprotein E polymorphisms and severity of cerebral palsy: a cross-sectional study in 255 children in Norway

PubMed Central

LIEN, ESPEN; ANDERSEN, GURO L; BAO, YONGDE; GORDISH-DRESSMAN, HEATHER; SKRANES, JON S; VIK, TORSTEIN; BLACKMAN, JAMES A

2012-01-01

Aim The aim of this study was to examine whether the presence of the apolipoprotein E (ApoE) allele APOEε4 is associated with less severe manifestations of cerebral palsy (CP), consistent with the suggested beneficial effect of this allele on neurodevelopment in children. Method ApoE genotyping was performed on buccal epithelial cells from 255 children (141 males 114 females; mean age 12y, SD 2y 3mo, range 9–17y) recorded in the Cerebral Palsy Register of Norway. The main outcome measure of CP severity was the Gross Motor Function Classification System (GMFCS). Secondary outcome measures were fine motor function, epilepsy, and the need for gastrostomy tube feeding (GTF). Results There was no association between the APOEε4 genotype and GMFCS levels (odds ratio [OR] 1.15; 95% confidence interval [CI] 0.66–1.99). However, the APOEε4 genotype was more often present among children with epilepsy (OR 2.2; 95% CI 1.1–4.2) and/or receiving GTF (OR 2.7; 95% CI 1.1–6.6). Among children with unilateral CP, the presence of APOEε4 was associated with more severe fine motor impairment (OR 2.6; 95% CI 1.3–6.9). Interpretation Our main hypothesis that APOEε4 would have a protective effect on neurodevelopment was not supported. Instead, subgroup analyses suggested an adverse effect of the APOEε4 genotype on the developing brain after injury. PMID:23384326

Brain magnetic resonance imaging and motor and intellectual functioning in 86 patients born at term with spastic diplegia.

PubMed

Numata, Yurika; Onuma, Akira; Kobayashi, Yasuko; Sato-Shirai, Ikuko; Tanaka, Soichiro; Kobayashi, Satoru; Wakusawa, Keisuke; Inui, Takehiko; Kure, Shigeo; Haginoya, Kazuhiro

2013-02-01

To investigate the association between magnetic resonance imaging (MRI) patterns and motor function, epileptic episodes, and IQ or developmental quotient in patients born at term with spastic diplegia. Eighty-six patients born at term with cerebral palsy (CP) and spastic diplegia (54 males, 32 females; median age 20 y, range 7-42 y) among 829 patients with CP underwent brain MRI between 1990 and 2008. The MRI and clinical findings were analysed retrospectively. Intellectual disability was classified according to the Enjoji developmental test or the Wechsler Intelligence Scale for Children (3rd edition). The median ages at diagnosis of CP, assignment of Gross Motor Function Classification System (GMFCS) level, cognitive assessment, and MRI were 2 years (range 5 mo-8 y), 6 years (2 y 8 mo-19 y), 6 years (1 y 4 mo-19 y), and 7 years (10 mo-30 y) respectively. MRI included normal findings (41.9%), periventricular leukomalacia, hypomyelination, and porencephaly/periventricular venous infarction. The frequency of patients in GMFCS levels III to V and intellectual disability did not differ between those with normal and abnormal MRI findings. Patients with normal MRI findings had significantly fewer epileptic episodes than those with abnormal ones (p=0.001). Varied MRI findings, as well as the presence of severe motor dysfunction and intellectual disability (despite normal MRI), suggest that patients born at term with spastic diplegia had heterogeneous and unidentified pathophysiology. © The Authors. Developmental Medicine & Child Neurology © 2012 Mac Keith Press.

Obstructive sleep apnea in children with cerebral palsy and epilepsy.

PubMed

Garcia, John; Wical, Beverly; Wical, William; Schaffer, Leah; Wical, Thomas; Wendorf, Heather; Roiko, Samuel

2016-10-01

To examine the risk of obstructive sleep apnea (OSA) in children with cerebral palsy (CP) and/or epilepsy. This cross-sectional study employs the Pediatric Sleep Questionnaire (PSQ), the Gross Motor Function Classification System (GMFCS), and chart review to identify symptoms of OSA in children presenting to a multi-specialty pediatric healthcare institution. Two-hundred and fifteen patients were grouped into those with epilepsy (n=54), CP (n=18), both (n=55), and neither (comparison group, n=88). The comparison group comprised children with developmental disabilities but not children with typical development. Significantly increased PSQ scores (indicating increased risk of OSA) were found among children with CP (58%) and CP with epilepsy (67%) than among the comparison group (27%; p<0.001 and p<0.0001 respectively). Children with both CP and epilepsy had a greater number of increased PSQ scores compared with CP alone (p<0.05). Increased PSQ scores were observed with increasing CP severity as measured using the GMFCS. The PSQ identified more children at risk of OSA (46%) than did the medical record review for symptoms of OSA (8.2%, p<0.001). Children with CP of greater severity or comorbid epilepsy are at increased risk of OSA. This study supports the routine questionnaire-based assessment for OSA as a regular part of the care of all children with CP, especially in those with more severe CP and those with epilepsy. © 2016 Mac Keith Press.

Predicting equipment needs of children with cerebral palsy using the Gross Motor Function Classification System: a cross-sectional study.

PubMed

Novak, Iona; Smithers-Sheedy, Hayley; Morgan, Cathy

2012-01-01

Children with cerebral palsy (CP) routinely use assistive equipment to improve their independence. Specialist equipment is expensive and therefore not always available to the child when needed. The aim of this study was to determine whether the assistive equipment needs of children with CP and the associated costs could be predicted. A cross-sectional study using a chart audit was completed. Two hundred forty-two children met eligibility criteria and were included in the study. Data abstracted from files pertained to the child's CP, associated impairments and assistive equipment prescribed. The findings were generated using linear regression modelling. Gross Motor Function Classification System (GMFCS) level [B = 3.01 (95% CI, 2.36-3.57), p = 0.000] and the presence of epilepsy [B = 2.35 (95% CI, 0.64-4.06), p = 0.008] predicted the prescription of assistive equipment. The more severely affected the gross motor function impairment, the more equipment that was required and the more the equipment cost. The equipment needs of children with CP can be predicted for the duration of childhood. This information may be useful for families and for budget and service planning.

Long-term outcomes five years after selective dorsal rhizotomy

PubMed Central

Nordmark, Eva; Josenby, Annika Lundkvist; Lagergren, Jan; Andersson, Gert; Strömblad, Lars-Göran; Westbom, Lena

2008-01-01

Background Selective dorsal rhizotomy (SDR) is a well accepted neurosurgical procedure performed for the relief of spasticity interfering with motor function in children with spastic cerebral palsy (CP). The goal is to improve function, but long-term outcome studies are rare. The aims of this study were to evaluate long-term functional outcomes, safety and side effects during five postoperative years in all children with diplegia undergoing SDR combined with physiotherapy. Methods This study group consisted of 35 children, consecutively operated, with spastic diplegia, of which 26 were Gross Motor Function Classification System (GMFCS) levels III–V. Mean age was 4.5 years (range 2.5–6.6). They were all assessed by the same multidisciplinary team at pre- and at 6, 12, 18 months, 3 and 5 years postoperatively. Clinical and demographic data, complications and number of rootlets cut were prospectively registered. Deep tendon reflexes and muscle tone were examined, the latter graded with the modified Ashworth scale. Passive range of motion (PROM) was measured with a goniometer. Motor function was classified according to the GMFCS and measured with the Gross Motor Function Measure (GMFM-88) and derived into GMFM-66. Parent's opinions about the children's performance of skills and activities and the amount of caregiver assistance were measured with Pediatric Evaluation Disability Inventory (PEDI). Results The mean proportion of rootlets cut in S2-L2 was 40%. Muscle tone was immediately reduced in adductors, hamstrings and dorsiflexors (p < 0.001) with no recurrence of spasticity over the 5 years. For GMFCS-subgroups I–II, III and IV–V significant improvements during the five years were seen in PROM for hip abduction, popliteal angle and ankle dorsiflexion (p = 0.001), capacity of gross motor function (GMFM) (p = 0.001), performance of functional skills and independence in self-care and mobility (PEDI) (p = 0.001). Conclusion SDR is a safe and effective method for reducing spasticity permanently without major negative side effects. In combination with physiotherapy, in a group of carefully selected and systematically followed young children with spastic diplegia, it provides lasting functional benefits over a period of at least five years postoperatively. PMID:19077294

Predicting respiratory hospital admissions in young people with cerebral palsy.

PubMed

Blackmore, Amanda Marie; Bear, Natasha; Blair, Eve; Langdon, Katherine; Moshovis, Lisa; Steer, Kellie; Wilson, Andrew C

2018-03-19

To determine the early predictors of respiratory hospital admissions in young people with cerebral palsy (CP). A 3-year prospective cohort study using linked data. Children and young people with CP, aged 1 to 26 years. Self-reported and carer-reported respiratory symptoms were linked to respiratory hospital admissions (as defined by the International Statistical Classification of Diseases and Related Health Problems 10th Revision codes) during the following 3 years. 482 participants (including 289 males) were recruited. They were aged 1 to 26 years (mean 10 years, 10 months; SD 5 years, 11 months) at the commencement of the study, and represented all Gross Motor Function Classification Scale (GMFCS) levels. During the 3-year period, 55 (11.4%) participants had a total of 186 respiratory hospital admissions, and spent a total of 1475 days in hospital. Statistically significant risk factors for subsequent respiratory hospital admissions over 3 years in univariate analyses were GMFCS level V, at least one respiratory hospital admission in the year preceding the survey, oropharyngeal dysphagia, seizures, frequent respiratory symptoms, gastro-oesophageal reflux disease, at least two courses of antibiotics in the year preceding the survey, mealtime respiratory symptoms and nightly snoring. Most risk factors for respiratory hospital admissions are potentially modifiable. Early identification of oropharyngeal dysphagia and the management of seizures may help prevent serious respiratory illness. One respiratory hospital admission should trigger further evaluation and management to prevent subsequent respiratory illness. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Intensity, perception, and descriptive characteristics of chronic pain in children with cerebral palsy.

PubMed

Houlihan, Christine M; Hanson, Amber; Quinlan, Nicole; Puryear, Carol; Stevenson, Richard D

2008-01-01

Children with cerebral palsy (CP) experience bodily pain, leading to functional impairment and decreased quality of life. The purpose of this study is to characterize subjective descriptors of chronic pain in children with CP. One hundred fifty-seven children were invited to participate in a quantitative pilot survey. Parents were mailed the Varni-Thompson Pediatric Pain Questionnaire, designed to assess three dimensions of pain: sensory (physical aspects), affective (emotional response), and evaluative (the combined intensity of the emotional and physical responses). Parents assessed their child's pain using non-verbal and verbal cues. Fifty-two families responded (33% return rate). Thirty-eight children ages 6-8 years with CP and Gross Motor Function Classification System (GMFCS) levels I-V were included. Ninety percent of families reported that their child was experiencing some pain at the time of the survey. At the time of assessment the children's pain was mild. Their pain, at its worst, was in the distressing range. The two largest GMFCS groups of children, levels I and IV, were compared in both severity and intensity of pain experienced. Increasing intensity of pain was reported in children in the level IV group compared to children classified as level I. Pain severity in all dimensions was reported as increasing in Level IV children compared to Level I. Children with CP experience frequent pain, which increases with worsening impairment. Descriptive qualifiers of pain help to elucidate the etiology of various types of pain which would lead to the development of more effective approaches to pain management and treatment.

Functional Capacity in Adults With Cerebral Palsy: Lower Limb Muscle Strength Matters.

PubMed

Gillett, Jarred G; Lichtwark, Glen A; Boyd, Roslyn N; Barber, Lee A

2018-05-01

To investigate the relation between lower limb muscle strength, passive muscle properties, and functional capacity outcomes in adults with cerebral palsy (CP). Cross-sectional study. Tertiary institution biomechanics laboratory. Adults with spastic-type CP (N=33; mean age, 25y; range, 15-51y; mean body mass, 70.15±21.35kg) who were either Gross Motor Function Classification System (GMFCS) level I (n=20) or level II (n=13). Not applicable. Six-minute walk test (6MWT) distance (m), lateral step-up (LSU) test performance (total repetitions), timed up-stairs (TUS) performance (s), maximum voluntary isometric strength of plantar flexors (PF) and dorsiflexors (DF) (Nm.kg -1 ), and passive ankle joint and muscle stiffness. Maximum isometric PF strength independently explained 61% of variance in 6MWT performance, 57% of variance in LSU test performance, and 50% of variance in TUS test performance. GMFCS level was significantly and independently related to all 3 functional capacity outcomes, and age was retained as a significant independent predictor of LSU and TUS test performance. Passive medial gastrocnemius muscle fascicle stiffness and ankle joint stiffness were not significantly related to functional capacity measures in any of the multiple regression models. Low isometric PF strength was the most important independent variable related to distance walked on the 6MWT, fewer repetitions on the LSU test, and slower TUS test performance. These findings suggest lower isometric muscle strength contributes to the decline in functional capacity in adults with CP. Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Cerebral palsy after neonatal encephalopathy: do neonates with suspected asphyxia have worse outcomes?

PubMed

Garfinkle, Jarred; Wintermark, Pia; Shevell, Michael I; Oskoui, Maryam

2016-02-01

We sought to investigate how brain injury and severity, and neurological subtype of cerebral palsy (CP) differed in term-born children with CP after neonatal encephalopathy, between those with suspected birth asphyxia and those without. Using the Canadian CP Registry, which included 1001 children, those with CP born at ≥ 36 wks after moderate or severe neonatal encephalopathy, were dichotomized according to the presence or absence of suspected birth asphyxia. Gross Motor Function Classification System (GMFCS) scores, neurological subtypes, comorbidities, and magnetic resonance imaging findings were compared. Of the 147 term-born children with CP (82 males, 65 females; median age 37 months, interquartile range [IQR] 26-52.5) who after moderate or severe neonatal encephalopathy had the required outcome data, 61 (41%) met criteria for suspected birth asphyxia. They had a higher frequency of non-ambulatory GMFCS status (odds ratio [OR] 3.4, 95% confidence interval [CI] 1.72-6.8), spastic quadriplegia (OR 2.8, 95% CI 1.4-5.6), non-verbal communication skills impairment (OR 4.2, 95% CI 2.0-8.6), isolated deep grey matter injury (OR 4.1, 95% CI 1.8-9.5), a lower frequency of spastic hemiplegia (OR 0.17, 95% CI 0.07-0.42), focal injury (OR 0.20; 95% CI 0.04-0.93), and more comorbidities (p=0.017) than those who did not meet criteria. Term-born children who develop CP after neonatal encephalopathy with suspected birth asphyxia have a greater burden of disability than those without suspected birth asphyxia. © 2015 Mac Keith Press.

Inactive and sedentary lifestyles amongst ambulatory adolescents and young adults with cerebral palsy

PubMed Central

2014-01-01

Background To assess physical behaviour, including physical activity and sedentary behaviour, of ambulatory adolescents and young adults with cerebral palsy (CP). We compared participant physical behaviour to that of able-bodied persons and assessed differences related to Gross Motor Functioning Classification System (GMFCS) level and CP distribution (unilateral/bilateral). Methods In 48 ambulatory persons aged 16 to 24 years with spastic CP and in 32 able-bodied controls, physical behaviour was objectively determined with an accelerometer-based activity monitor. Total duration, intensity and type of physical activity were assessed and sedentary time was determined (lying and sitting). Furthermore, distribution of walking bouts and sitting bouts was specified. Results Adolescents and young adults with CP spent 8.6% of 24 hours physically active and 79.5% sedentary, corresponding with respectively 123 minutes and 1147 minutes per 24 hours. Compared to able-bodied controls, persons with CP participated 48 minutes less in physical activities (p < 0.01) and spent 80 minutes more sedentary per 24 hours (p < 0.01). Physical behaviour was not different between persons with GMFCS level I and II and only number of short sitting bouts were significantly more prevalent in persons with bilateral CP compared to unilateral CP (p < 0.05). Conclusions Ambulatory adolescents and young adults with CP are less physically active and spend more time sedentary compared to able-bodied persons, suggesting that this group may be at increased risk for health problems related to less favourable physical behaviour. Trial registration Nederlands trial register: NTR1785 PMID:24708559

Children's perceptions of their cerebral palsy and their impact on life satisfaction.

PubMed

Chong, Jimmy; Mackey, Anna H; Broadbent, Elizabeth; Stott, N Susan

2012-01-01

To assess an individual child's cognitive and emotional perceptions of their cerebral palsy (CP) and how these are associated with their reported life satisfaction and their functional walking ability. Convenience sample of 48 children with cerebral palsy, GMFCS (Gross Motor Function Classification System) I-IV, mean age of 12.2 ± 2.5 years was recruited from tertiary level out-patient clinics. All children completed the Brief Illness Perception Questionnaire-Cerebral Palsy version (BIPQ-CP), Students' Life Satisfaction Scale (SLSS) and 1- and 6-min walk tests. Children with CP reported levels of global life satisfaction (mean score 31.4/42) equivalent to previous studies of typically developing children. Higher total SLSS scores were associated with lower concern about CP (rho = -0.61, p < 0.001), lower emotional impact (rho = -0.58, p < 0.001), fewer perceived consequences (rho = -0.53, p < 0.001) and perceptions of higher levels of personal control (rho = 0.40, p = 0.01). Multiple regression models using BIPQ-CP constructs found that a combination of lower level of concern and fewer perceived consequences predicted 46% of the variance in SLSS score (p < 0.001). GMFCS levels, walk distance and age were not significant predictors of life satisfaction. Life satisfaction in this group of children was strongly associated with a child's perceptions of their CP but was not associated with functional walking ability. Although the cross-sectional nature of the study precludes assumptions of causality, understanding children's cognitive and emotional beliefs about their cerebral palsy would seem to be an important adjunct to clinical management.

Severe hip displacement reduces health-related quality of life in children with cerebral palsy.

PubMed

Ramstad, Kjersti; Jahnsen, Reidun B; Terjesen, Terje

2017-04-01

Background and purpose - Hip displacement is common in children with severe cerebral palsy (CP) and can cause problems such as pain, contractures, and nursing difficulties. Caregiver priorities and child health index of life with disabilities (CPCHILD) is a recently developed measure of health-related quality of life (HRQL) in children with severe CP. The associations between CPCHILD scores and hip displacement have not been investigated. We explored the effect of hip displacement on HRQL. Patients and methods - 67 children were recruited from the population-based Norwegian CP register. Mean age was 9 (7-12) years. There were 40 boys. Gross motor function classification system (GMFCS) distribution was 12 level III, 17 level IV, and 38 level V. Hip displacement was assessed by radiographic migration percentage (MP). The criterion for hip displacement was MP of the worst hip of ≥40%. Primary caregivers responded to 5 of the 6 domains of the CPCHILD questionnaire. Results - Hip displacement was found in 18 children and it was significantly associated with lower scores on the CPCHILD domains 3 (Comfort and Emotions) and 5 (Health), but not with domains 1 (Activities of Daily Living/Personal Care), 2 (Positioning, Transfer, and Mobility), and 6 (Overall Quality of Life). GMFCS level V was a significant predictor of low scores in all the domains. Interpretation - For the assessment of HRQL in children with severe CP and hip problems, we propose a modified and simplified version of the CPCHILD consisting of 14 of 37 questions. This would reduce the responders' burden and probably increase the response rate in clinical studies without losing important information.

Therapeutic effects of a horse riding simulator in children with cerebral palsy.

PubMed

Silva e Borges, Maria Beatriz; Werneck, Maria José da Silva; da Silva, Maria de Lourdes; Gandolfi, Lenora; Pratesi, Riccardo

2011-10-01

To evaluate the efficacy of horse ridding simulator on the sitting postural control of children with spastic diplegia. Forty children were randomly divided in a group using the simulator (RS) and a group performing conventional physical therapy (CT). FScan/Fmat equipment was used to register maximal displacement in antero-posterior (AP) and medio-lateral (ML) directions with children in sitting position. At the pre and post intervention stage both groups were classified according to the Gross Motor Function Classification System (GMFCS) and, after intervention, by the AUQEI questionnaire (Autoquestionnaire Qualité de vie Enfant Image). Comparison between groups disclosed statistically significant pos-intervention improvement both in the AP (p<0.0001) as in the ML (p<0.0069) direction in the RS group. The horse ridding simulator produced significant improvement in the postural control of children in sitting position, additionally showing a higher motor functionality and a better acceptance of the therapeutic intervention.

Feeding and gastrointestinal problems in children with cerebral palsy.

PubMed

Erkin, Gulten; Culha, Canan; Ozel, Sumru; Kirbiyik, Eylem Gulsen

2010-09-01

The aim of our study was to identify feeding and gastrointestinal system (GIS) problems in children with cerebral palsy (CP), and to evaluate the relationship between these problems and the severity of CP. A total of 120 children with CP were enrolled consecutively into the study (67 males, 53 females; mean age: 6.0±2.4 years; range: 2-12 years). The children were classified according to the Swedish classification as diplegic, hemiplegic, or quadriplegic. Severity of CP was classified based on the Gross Motor Function Classification System. The amount of time that the caregiver allocated to mealtimes, modifications of the food, as well as feeding and GIS problems was evaluated. Feeding dysfunction was classified as mild, moderate, or severe. Comparisons of GIS and feeding disorders and the severity of CP were carried out using χ test. The results indicated lack of appetite in 46 of the 120 children (38.3%), sialorrhea in 37 (30.8%), constipation in 30 (25%), difficulty in swallowing in 23 (19.2%), and feeding dysfunction in 26 (21.7%). On the basis of the Gross Motor Function Classification System (GMFCS), the incidence of GIS problems and feeding dysfunction was found to be significantly higher in the children classified in the severe group. The time taken to consume meals was significantly longer among children with feeding dysfunction. Feeding and GIS problems are frequent in children with CP, and more marked in those with severe CP. Approximately one fourth of children with CP suffer from feeding dysfunction, and more time has to be allocated to consume meals.

Development and initial validation of the assessment of caregiver experience with neuromuscular disease.

PubMed

Matsumoto, Hiroko; Clayton-Krasinski, Debora A; Klinge, Stephen A; Gomez, Jaime A; Booker, Whitney A; Hyman, Joshua E; Roye, David P; Vitale, Michael G

2011-01-01

Orthopaedic intervention can have a wide range of functional and psychosocial effects on children with neuromuscular disease (NMD). In the multihandicapped child (Gross Motor Classification System IV/V), functional status, pain, psychosocial function, and health-related quality of life also have effects on the families of these child. The purpose of this study is to report the development and initial validation of an outcomes instrument specifically designed to assess the caregiver impact experienced by parents raising severely affected NMD children: the Assessment of Caregiver Experience with Neuromuscular Disease (ACEND). In the first part of this prospective study, 61 children with NMD and their parents were administered a range of earlier validated pediatric health measures. A framework technique was used to select the most appropriate and relevant subset of questions from this large set. Sensitivity analyses guided the development of a master question list measuring caregiver impact, excluding items with low relevance, and modifying unclear questions. In the second part of the study, the ACEND was administered to the caregivers of 46 children with moderate-to-severe NMD. Statistical analyses were conducted to determine validity of the instrument. The resulting ACEND instrument included 2 domains, 7 subdomains, and 41 items. Domain 1, examining physical impact, includes 4 subdomains: feeding/grooming/dressing (6 items), sitting/play (5 items), transfers (5 items), and mobility (7 items). Domain 2, which examines general caregiver impact, included 3 subdomains: time (4 items), emotion (9 items), and finance (5 items). Mean overall relevance rating was 6.21 ± 0.37 and clarity rating was 6.68 ± 0.52 (scale 0 to 7). Multiple floor effects in patients with GMFCS V and ceiling effects in patients with GMFCS III were identified almost exclusively in motor-based items. Virtually no floor or ceiling effects were identified in the time, emotion or finance domains across GMFCS level. The initial validation demonstrated that ACEND is a valid, disease-specific measure to quantify experience on caregivers of children with NMD. Larger groups of patients across NMD disease type are currently being tested to strengthen validity findings. Additionally, the ACEND is now being administered before and after orthopaedic interventions to determine responsiveness, which is critical to health outcomes research. LEVEL OF EVIDENCE/RELEVANCE: IIc.

Avascular necrosis in children with cerebral palsy after reconstructive hip surgery

PubMed Central

Phillips, L.; Hesketh, K.; Schaeffer, E. K.; Andrade, J.; Farr, J.; Mulpuri, K.

2017-01-01

Abstract Purpose Progressive hip displacement is one of the most common orthopaedic pathologies in children with cerebral palsy (CP). Reconstructive hip surgery has become the standard treatment of care. Reported avascular necrosis (AVN) rates for hip reconstructive surgery in these patients vary widely in the literature. The purpose of this study is to identify the frequency and associated risk factors of AVN for reconstructive hip procedures. Methods A retrospective analysis was performed of 70 cases of reconstructive hip surgery in 47 children with CP, between 2009 and 2013. All 70 cases involved varus derotation osteotomy (VDRO), with 60% having combined VDRO and pelvic osteotomies (PO), and 21% requiring open reductions. Mean age at time of surgery was 8.82 years and 90% of patients were Gross Motor Function Classification System (GMFCS) 4 and 5. Radiographic dysplasia parameters were analysed at selected intervals, to a minimum of one year post-operatively. Severity of AVN was classified by Kruczynski's method. Bivar- iate statistical analysis was conducted using Chi-square test and Student's t-test. Results There were 19 (27%) noted cases of AVN, all radio- graphically identifiable within the first post-operative year. The majority of AVN cases (63%) were mild to moderate in severity. Pre-operative migration percentage (MP) (p = 0.0009) and post-operative change in MP (p = 0.002) were the most significant predictors of AVN. Other risk factors were: GMFCS level (p = 0.031), post-operative change in NSA (p = 0.02) and concomitant adductor tenotomy (0.028). Conclusion AVN was observed in 27% of patients. Severity of displacement correlates directly with AVN risk and we suggest that hip reconstruction, specifically VDRO, be performed early in the 'hip at risk' group to avoid this complication. PMID:29081846

Avascular necrosis in children with cerebral palsy after reconstructive hip surgery.

PubMed

Phillips, L; Hesketh, K; Schaeffer, E K; Andrade, J; Farr, J; Mulpuri, K

2017-10-01

Progressive hip displacement is one of the most common orthopaedic pathologies in children with cerebral palsy (CP). Reconstructive hip surgery has become the standard treatment of care. Reported avascular necrosis (AVN) rates for hip reconstructive surgery in these patients vary widely in the literature. The purpose of this study is to identify the frequency and associated risk factors of AVN for reconstructive hip procedures. A retrospective analysis was performed of 70 cases of reconstructive hip surgery in 47 children with CP, between 2009 and 2013. All 70 cases involved varus derotation osteotomy (VDRO), with 60% having combined VDRO and pelvic osteotomies (PO), and 21% requiring open reductions. Mean age at time of surgery was 8.82 years and 90% of patients were Gross Motor Function Classification System (GMFCS) 4 and 5. Radiographic dysplasia parameters were analysed at selected intervals, to a minimum of one year post-operatively. Severity of AVN was classified by Kruczynski's method. Bivar- iate statistical analysis was conducted using Chi-square test and Student's t-test. There were 19 (27%) noted cases of AVN, all radio- graphically identifiable within the first post-operative year. The majority of AVN cases (63%) were mild to moderate in severity. Pre-operative migration percentage (MP) (p = 0.0009) and post-operative change in MP (p = 0.002) were the most significant predictors of AVN. Other risk factors were: GMFCS level (p = 0.031), post-operative change in NSA (p = 0.02) and concomitant adductor tenotomy (0.028). AVN was observed in 27% of patients. Severity of displacement correlates directly with AVN risk and we suggest that hip reconstruction, specifically VDRO, be performed early in the 'hip at risk' group to avoid this complication.

Severe hip displacement reduces health-related quality of life in children with cerebral palsy

PubMed Central

Ramstad, Kjersti; Jahnsen, Reidun B; Terjesen, Terje

2017-01-01

Background and purpose Hip displacement is common in children with severe cerebral palsy (CP) and can cause problems such as pain, contractures, and nursing difficulties. Caregiver priorities and child health index of life with disabilities (CPCHILD) is a recently developed measure of health-related quality of life (HRQL) in children with severe CP. The associations between CPCHILD scores and hip displacement have not been investigated. We explored the effect of hip displacement on HRQL. Patients and methods 67 children were recruited from the population-based Norwegian CP register. Mean age was 9 (7–12) years. There were 40 boys. Gross motor function classification system (GMFCS) distribution was 12 level III, 17 level IV, and 38 level V. Hip displacement was assessed by radiographic migration percentage (MP). The criterion for hip displacement was MP of the worst hip of ≥40%. Primary caregivers responded to 5 of the 6 domains of the CPCHILD questionnaire. Results Hip displacement was found in 18 children and it was significantly associated with lower scores on the CPCHILD domains 3 (Comfort and Emotions) and 5 (Health), but not with domains 1 (Activities of Daily Living/Personal Care), 2 (Positioning, Transfer, and Mobility), and 6 (Overall Quality of Life). GMFCS level V was a significant predictor of low scores in all the domains. Interpretation For the assessment of HRQL in children with severe CP and hip problems, we propose a modified and simplified version of the CPCHILD consisting of 14 of 37 questions. This would reduce the responders’ burden and probably increase the response rate in clinical studies without losing important information. PMID:27892753

Correlations between risk factors and functional evolution in patients with spastic quadriplegia

PubMed Central

Rogoveanu, OC; Tuțescu, NC; Kamal, D; Alexandru, DO; Kamal, C; Streba, L; Trăistaru, MR

2016-01-01

Cerebral palsy is the most common cause of developing neuro-motor disability in children, in many cases, the triggering cause remaining unknown. Quadriplegia is the most severe spastic cerebral palsy, characterized by severe mental retardation and bi-pyramidal syndrome. The purpose of this paper was to demonstrate the importance of knowing the risk factors and the psychosomatic ones, determining to what extent they influence the functional evolution in patients diagnosed with spastic quadriplegia. 23 children diagnosed with spastic quadriplegia were included in the study, being aged between 1 year and half and 12 years. Patients were assessed at baseline (T1), at one year (T2) and after two years at the end of the study (T3). Patients received a comprehensive rehabilitation program for the motor and sensory deficits throughout the study. Initially, a comprehensive evaluation (etiopathogenic, clinical and functional) that started from a thorough medical history of children (the older ones), was conducted but chose parents to identify the risk factors, and a complete physical exam. At each assessment, joint and muscle balance was conducted. To assess functionality, the gross motor function classification systems (GMFCS) and manual ability (MACS) were used. Many risk factors that were classified according to the timeline in prenatal factors, perinatal and postnatal, were identified from a thorough history. A direct correlation was noticed between the decrease of coarse functionality and manual ability, both initially and in dynamic and low APGAR scores, low gestational age, low birth weight and a higher body mass index of the mother. A direct link was observed between the gross motor function and the manual ability. A significant improvement in the MACS score was noticed in patients with a better GMFCS score. PMID:27453749

Correlations between risk factors and functional evolution in patients with spastic quadriplegia.

PubMed

Rogoveanu, O C; Tuțescu, N C; Kamal, D; Alexandru, D O; Kamal, C; Streba, L; Trăistaru, M R

2016-01-01

Cerebral palsy is the most common cause of developing neuro-motor disability in children, in many cases, the triggering cause remaining unknown. Quadriplegia is the most severe spastic cerebral palsy, characterized by severe mental retardation and bi-pyramidal syndrome. The purpose of this paper was to demonstrate the importance of knowing the risk factors and the psychosomatic ones, determining to what extent they influence the functional evolution in patients diagnosed with spastic quadriplegia. 23 children diagnosed with spastic quadriplegia were included in the study, being aged between 1 year and half and 12 years. Patients were assessed at baseline (T1), at one year (T2) and after two years at the end of the study (T3). Patients received a comprehensive rehabilitation program for the motor and sensory deficits throughout the study. Initially, a comprehensive evaluation (etiopathogenic, clinical and functional) that started from a thorough medical history of children (the older ones), was conducted but chose parents to identify the risk factors, and a complete physical exam. At each assessment, joint and muscle balance was conducted. To assess functionality, the gross motor function classification systems (GMFCS) and manual ability (MACS) were used. Many risk factors that were classified according to the timeline in prenatal factors, perinatal and postnatal, were identified from a thorough history. A direct correlation was noticed between the decrease of coarse functionality and manual ability, both initially and in dynamic and low APGAR scores, low gestational age, low birth weight and a higher body mass index of the mother. A direct link was observed between the gross motor function and the manual ability. A significant improvement in the MACS score was noticed in patients with a better GMFCS score.

myTREEHOUSE Self-Concept Assessment: preliminary psychometric analysis of a new self-concept assessment for children with cerebral palsy.

PubMed

Cheong, Sau Kuan; Lang, Cathryne P; Hemphill, Sheryl A; Johnston, Leanne M

2017-06-01

To evaluate the preliminary validity and reliability of the myTREEHOUSE Self-Concept Assessment for children with cerebral palsy (CP) aged 8 to 12 years. The myTREEHOUSE Self-Concept Assessment includes 26 items divided into eight domains, assessed across three Performance Perspectives (Personal, Social, and Perceived) and an additional Importance Rating. Face and content validity was assessed by semi-structured interviews with seven expert professionals regarding the assessment construct, content, and clinical utility. Reliability was assessed with 50 children aged 8 to 12 years with CP (29 males, 21 females; mean age 10y 2mo; Gross Motor Function Classification System [GMFCS] level I=35, II=8, III=5, IV=1; mean Wechsler Intelligence Scale for Children - Fourth Edition [WISC-IV]=104), whose data was used to calculate internal consistency of the scale, and a subset of 35 children (20 males, 15 females; mean age 10y 5mo; GMFCS level I=26, II=4, III=4, IV=1; mean WISC-IV=103) who participated in test-retest reliability within 14 to 28 days. Face and content validity was supported by positive expert feedback, with only minor adjustments suggested to clarify the wording of some items. After these amendments, strong internal consistency (Cronbach's α 0.84-0.91) and moderate to good test-retest reliability (intraclass correlation coefficient 0.64-0.75) was found for each component. The myTREEHOUSE Self-Concept Assessment is a valid and reliable assessment of self-concept for children with CP aged 8 to 12 years. © 2017 Mac Keith Press.

Neurogenic Lower Urinary Tract Dysfunction in Adults with Cerebral Palsy: Outcomes following a Conservative Management Approach.

PubMed

Goldfarb, Robert A; Pisansky, Andrew; Fleck, Joseph; Hoversten, Patrick; Cotter, Katherine J; Katorski, Jenna; Liberman, Daniel; Elliott, Sean P

2016-04-01

Cerebral palsy is characterized by motor impairment following injury to the developing brain. Neurogenic lower urinary tract dysfunction is estimated to affect at least a third of children with cerebral palsy. However there are limited data as patients transition to adulthood. We sought to describe the symptoms, sequelae and management of neurogenic lower urinary tract dysfunction in adults with cerebral palsy. We retrospectively reviewed the charts of adult patients with cerebral palsy between 2011 and 2014. Patients with prior bladder reconstruction or catheterization based bladder drainage were excluded from study. Cerebral palsy severity was determined using GMFCS (Gross Motor Function Classification System). A conservative evaluation and treatment paradigm was used. Noninvasive treatments were encouraged. Specifically clean intermittent catheterization, which is often not feasible, is avoided unless urinary retention, hydronephrosis or refractory lower urinary tract symptoms develop. There were 121 patients included in final analysis. Median age was 25 and 61 patients (50%) had GMFCS level V. Noninvasive management failed in 28 of 121 patients (23%) as defined by hydronephrosis in 9, persistent urinary retention in 10 and refractory lower urinary tract symptoms/incontinence in 9. Urethral clean intermittent catheterization was poorly tolerated. Of all patients 25% showed evidence of urolithiasis during the study period. Surgical intervention was rare and associated with significant morbidity. Adults with cerebral palsy may present with variable signs and symptoms of neurogenic lower urinary tract dysfunction. Conservative treatment was successful in more than 75% of patients. Clean intermittent catheterization was poorly tolerated in patients in whom conservative treatment failed. Surgical intervention was rarely indicated and it should be reserved for select individuals. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Drooling, saliva production, and swallowing in cerebral palsy.

PubMed

Senner, Jill E; Logemann, Jerilyn; Zecker, Steven; Gaebler-Spira, Deborah

2004-12-01

Fourteen participants (six females, eight males) ranging in age from 7 years 11 months to 18 years 2 months (mean 11y 7mo) with a confirmed diagnosis of spastic cerebral palsy (CP) were included in the study. Participants included those who drooled (CP+, n=14); age- and sex-matched children with spastic CP who were dry to mild and never to infrequent droolers (CP-, n=14) as well as typically developing peers (CTRL, n=14) served as controls. Frequency of swallowing was measured by using simultaneous cervical ausculation and videotaping of the head and neck. Saliva production was measured with the Saxon test, a simple gauze-chewing procedure. In addition, Pediatric Evaluation of Disability Inventory (PEDI), Test of Nonverbal Intelligence-3 (TONI-3), dysarthria severity scale, and Gross Motor Function Classification System (GMFCS) scores were obtained for each participant. Both groups of participants with CP tended to swallow less frequently than typically developing participants and tended to produce less saliva than typically developing controls; however, these differences were not statistically significant. No correlation was found between amount of saliva produced and amount drooled (r=0.245). An analysis of variance (ANOVA) conducted on the PEDI functional skills mean scores indicated significant differences between the three groups (F(2,39)=23.522,p<0.0001). Likewise, an ANOVA conducted on the TONI-3 scores revealed statistically significant differences between the three groups (F(2,39)=31.761, p<0.0001). A Spearman's rho correlation indicated that GMFCS scores were not significantly correlated with drooling severity (Spearman's rho correlation=0.3951,p=0.037). Drooling severity was found to be positively correlated with dysarthria severity (Spearman's rho correlation=0.82,p<0.0001). These findings suggest that drooling in patients with CP is related to swallowing difficulties rather than hypersalivation.

Three-dimensional lumbar segment movement characteristics during paediatric cerebral palsy gait.

PubMed

Kiernan, D; Malone, A; O'Brien, T; Simms, C K

2017-03-01

Kinematic analysis of the trunk during cerebral palsy (CP) gait has been well described. In contrast, movement of the lumbar spine is generally ignored. This is most likely due to the complex nature of the spine. As an alternative to using complex sensor protocols, this study modelled the lumbar region as a single segment and investigated characteristic patterns of movement during CP gait. In addition, the impact of functional level of impairment and the relationship with lower lumbar spinal loading were examined. Fifty-two children with CP (26 GMFCS I and 26 GMFCS II) and 26 controls were recruited. A full barefoot 3-dimensional kinematic and kinetic analysis were conducted. Lumbar segment movement demonstrated increased forward flexion for CP children. This movement became more pronounced according to GMFCS level with GMFCS II children demonstrating increases of up to 8°. In addition, a moderate correlation was present between lumbar flexion/extension and L5/S1 sagittal moments (r=0.427 in the global frame and r=0.448 with respect to the pelvis, p<0.01). Children with CP demonstrated increased movement of the lumbar region compared to TD, with movement becoming more excessive as GMFCS level increased. Excessive forward flexion and loading at the lumbar spine were linked. However, the moderate correlation suggests other contributors to increased loading were present. In conclusion, this study is a first step at identifying how lumbar segment movement is altered during CP gait. Copyright © 2017 Elsevier B.V. All rights reserved.

Amount and focus of physical therapy and occupational therapy for young children with cerebral palsy.

PubMed

Palisano, Robert J; Begnoche, Denise M; Chiarello, Lisa A; Bartlett, Doreen J; McCoy, Sarah Westcott; Chang, Hui-Ju

2012-11-01

The aims of this study were to describe physical therapy (PT) and occupational therapy (OT) services for a cohort of 399 children with cerebral palsy (CP), 2-6 years old, residing in the United States and Canada. Parents completed a services questionnaire by telephone interview. Therapists classified children's Gross Motor Function Classification System (GMFCS) level. Mean minutes per month of PT and OT were greater for children receiving services in both an educational and clinic setting. Mean minutes per month of PT and OT were greater for children in levels IV-V than children in level I and greater for children in the United States than children in Canada. Parents reported that interventions focused a moderate to great extent on primary impairments, secondary impairments, activity, and structured play activities, a moderate extent on environmental modifications and equipment; and a moderate to small extent on self-care routines. The results support the importance of coordination of PT and OT services.

Social Attitudes toward Cerebral Palsy and Potential Uses in Medical Education Based on the Analysis of Motion Pictures.

PubMed

Jóźwiak, Marek; Chen, Brian Po-Jung; Musielak, Bartosz; Fabiszak, Jacek; Grzegorzewski, Andrzej

2015-01-01

This study presents how motion pictures illustrate a person with cerebral palsy (CP), the social impact from the media, and the possibility of cerebral palsy education by using motion pictures. 937 motion pictures were reviewed in this study. With the criteria of nondocumentary movies, possibility of disability classification, and availability, the total number of motion pictures about CP was reduced to 34. The geographical distribution of movie number ever produced is as follows: North America 12, Europe 11, India 2, East Asia 6, and Australia 3. The CP incidences of different motor types in real world and in movies, respectively, are 78-86%, 65% (Spastic); 1.5-6%, 9% (Dyskinetic); 6.5-9%, 26% (Mixed); 3%, 0% (Ataxic); 3-4%, 0% (Hypotonic). The CP incidences of different Gross Motor Function Classification System (GMFCS) levels in real world and in movies, respectively, are 40-51%, 47% (Level I + II); 14-19%, 12% (Level III); 34-41%, 41% (Level IV + V). Comparisons of incidence between the real world and the movies are surprisingly matching. Motion pictures honestly reflect the general public's point of view to CP patients in our real world. With precise selection and medical professional explanations, motion pictures can play the suitable role making CP understood more clearly.

Effect of cerebrolysin on gross motor function of children with cerebral palsy: a clinical trial.

PubMed

Nasiri, Jafar; Safavifar, Faezeh

2017-06-01

Gross motor dysfunction is considered as the most challenging problem in cerebral palsy (CP). It is proven that improvement of gross motor function could reduce CP-related disabilities and provide better quality of life in this group of patients. Therefore, the aim of this trial is to evaluate the effectiveness of cerebrolysin (CBL) on gross motor function of children with CP who are undergoing treatment. In this clinical trial study, paediatric patients aged 18-75 months with spastic diplegic or quadriplegic cerebral palsy, who were under rehabilitation therapy, were selected and randomly allocated in control and CBL groups. Patients in CBL group underwent treatment with standard rehabilitation therapy plus CBL. The latter was administrated intramuscularly as a single daily dose of 0.1 cc/kg for 10 days and then continued weekly for 4 months. Gross motor function of participants in the two studied groups, before and after trial, was evaluated and compared using the validated Persian version of gross motor function classification system-expanded and revised (GMFCS-E&R). During this trial, 108 patients with CP were evaluated for eligibility. From these, 50 patients were enrolled and randomly allocated in the CBL and control groups. Four months after trial, the mean level of GMFCS decreased significantly in the two groups (P < 0.05). However, it was significantly lower in the CBL group than in the control group (2.1 vs. 3.16, P < 0.05). The results of this trial indicated that CBL could improve gross motor function in patients with CP. This finding is consistent with neurotrophic and neuroprotective effects of CBL, which have been reported in various clinical trials in other neurological disorders. Further studies are recommended to establish the value of continued neuroprotection and to determine the pharmacokinetics/dynamics of CBL in this group of patients.

Bone mineral density and nutritional status in children with quadriplegic cerebral palsy.

PubMed

Alvarez Zaragoza, Citlalli; Vasquez Garibay, Edgar Manuel; García Contreras, Andrea A; Larrosa Haro, Alfredo; Romero Velarde, Enrique; Rea Rosas, Alejandro; Cabrales de Anda, José Luis; Vega Olea, Israel

2018-03-04

This study demonstrated the relationship of low bone mineral density (BMD) with the degree of motor impairment, method of feeding, anthropometric indicators, and malnutrition in children with quadriplegic cerebral palsy (CP). The control of these factors could optimize adequate bone mineralization, avoid the risk of osteoporosis, and would improve the quality of life. The purpose of the study is to explore the relationship between low BMD and nutritional status in children with quadriplegic CP. A cross-sectional analytical study included 59 participants aged 6 to 18 years with quadriplegic CP. Weight and height were obtained with alternative measurements, and weight/age, height/age, and BMI/age indexes were estimated. The BMD measurement obtained from the lumbar spine was expressed in grams per square centimeter and Z score (Z). Unpaired Student's t tests, chi-square tests, odds ratios, Pearson's correlations, and linear regressions were performed. The mean of BMD Z score was lower in adolescents than in school-aged children (p = 0.002). Patients with low BMD were at the most affected levels of the Gross Motor Function Classification System (GMFCS). Participants at level V of the GMFCS were more likely to have low BMD than levels III and IV [odds ratio (OR) = 5.8 (confidence interval [CI] 95% 1.4, 24.8), p = 0.010]. There was a higher probability of low BMD in tube-feeding patients [OR = 8.6 (CI 95% 1.0, 73.4), p = 0.023]. The probability of low BMD was higher in malnourished children with weight/age and BMI indices [OR = 11.4 (1.3, 94), p = 0.009] and [OR = 9.4 (CI 95% 1.1, 79.7), p = 0.017], respectively. There was a significant relationship between low BMD, degree of motor impairment, method of feeding, and malnutrition. Optimizing these factors could reduce the risk of osteopenia and osteoporosis and attain a significant improvement of quality of life in children with quadriplegic CP.

Perceptual visual dysfunction, physical impairment and quality of life in Bangladeshi children with cerebral palsy.

PubMed

Mitry, D; Williams, C; Northstone, K; Akter, A; Jewel, J; Khan, N; Muhit, M; Gilbert, C E; Bowman, R

2016-09-01

Cerebral palsy (CP) is the most common cause of motor disability in children and is often accompanied by sensory and/or cognitive impairment. The aim of this study was to characterise visual acuity impairment, perceptual visual dysfunction (PVD) and physical disability in a community-based sample of Bangladeshi children with CP and to assess the impact of these factors on the quality of life of the children. A key informant study was used to recruit children with CP from Sirajganj district. Gross Motor Function Classification System (GMFCS) levels and visual impairment were assessed by a physiotherapist and an optometrist, respectively. Assessments of visual perception were performed and standardised questionnaires were administered to each child's main carer to elicit indicators of PVD and parent-reported health-related quality of life. A generalised linear regression analysis was conducted to assess the determinants of the quality of life scores. 180 children were recruited. The median age was 8 years (IQR: 6-11 years); 112 (62%) were male; 57 (32%) had visual acuity impairment and 95 (53%) had some parent-reported PVD. In analyses adjusted for age, sex, GMFCS and acuity impairment, visual attention (p<0.001) and recognition/navigation (p<0.001) were associated with total health-related quality of life, and there were similar trends for total PVD score (p=0.006) and visual search (p=0.020). PVD is an important contributor in reducing quality of life in children with CP, independent of motor disability and acuity impairment. Better characterisation of PVD is important to help design interventions for affected children, which may improve their quality of life. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Level of motivation in mastering challenging tasks in children with cerebral palsy.

PubMed

Majnemer, Annette; Shevell, Michael; Law, Mary; Poulin, Chantal; Rosenbaum, Peter

2010-12-01

the aim of this study was to describe and identify factors associated with motivation in children with cerebral palsy (CP). children with CP were recruited for this cross-sectional study. Children were assessed using the Leiter Intelligence Test, the Gross Motor Function Measure, and the Vineland Adaptive Behavior Scale. Parents completed the Dimensions of Mastery Questionnaire (DMQ) and questionnaires on demographics, child behaviour, and family functioning. the parents of 74 children (46 males, 28 females; mean age 9y 2mo, SD 2y 1mo, range 5y 10mo-12y 11mo) completed the DMQ. Just over half of the children (39/74) were classified at Gross Motor Function Classification System (GMFCS) level I, with 13 classified at GMFCS level II, one at level III, six at level IV, and 14 at level V; one child was not classified. The most common diagnoses were spastic hemiplegia and quadriplegia (23 each), followed by diplegia (14). The highest motivation scores were obtained for the dimensions of mastery pleasure and social persistence and the lowest for persistence with motor or cognitive tasks. Age and sex were not predictive of scores on the DMQ. Higher IQ (r=0.41), better motor ability (r=0.43), and fewer limitations in self-care, communication, and socialization (r=0.44-0.53) were positively associated with motivation total score. A negative impact of the child's disability on the family was associated with lower motivation (r=-0.44). Positive social behaviours were positively correlated with motivation (r=0.38-0.66), whereas hyperactivity and peer problems were negatively associated. high motivation was associated with fewer activity limitations and behavioural problems and reduced family burden. Low motivation may adversely influence a child's functional potential and the effectiveness of interventions. Strategies focusing on the child, peers, adults, or activities are proposed to enhance the children's motivation to engage in more challenging activities.

A home-based body weight supported treadmill training program for children with cerebral palsy: A case series.

PubMed

Kenyon, Lisa K; Westman, Marci; Hefferan, Ashley; McCrary, Peter; Baker, Barbara J

2017-07-01

Contemporary approaches to the treatment of cerebral palsy (CP) advocate a task-specific approach that emphasizes repetition and practice of specific tasks. Recent studies suggest that body-weight-supported treadmill training (BWSTT) programs may be beneficial in clinical settings. The purposes of this case series were to explore the outcomes and feasibility of a home-based BWSTT program for three children with CP. Three children with CP at Gross Motor Function Classification System (GMFCS) Levels III or IV participated in this case series. Examination included the Functional Assessment Questionnaire (FAQ), the 10-meter walk test, the Gross Motor Function Measure (GMFM-66), and the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT). A harness system was used to conduct the BWSTT program over an 8-12 week period. All of the families reported enjoying the BWSTT program and found the harness easy to use. Participant 2 increased from a 2 to a 4 on the FAQ, while Participant 3 increased from a 6 to a 7. Two of the participants demonstrated post-intervention improvements in functional mobility. In addition to mobility outcomes, future research should explore the potential health benefits of a home-based BWSTT program.

Social Attitudes toward Cerebral Palsy and Potential Uses in Medical Education Based on the Analysis of Motion Pictures

PubMed Central

Jóźwiak, Marek; Chen, Brian Po-Jung; Musielak, Bartosz; Fabiszak, Jacek; Grzegorzewski, Andrzej

2015-01-01

This study presents how motion pictures illustrate a person with cerebral palsy (CP), the social impact from the media, and the possibility of cerebral palsy education by using motion pictures. 937 motion pictures were reviewed in this study. With the criteria of nondocumentary movies, possibility of disability classification, and availability, the total number of motion pictures about CP was reduced to 34. The geographical distribution of movie number ever produced is as follows: North America 12, Europe 11, India 2, East Asia 6, and Australia 3. The CP incidences of different motor types in real world and in movies, respectively, are 78–86%, 65% (Spastic); 1.5–6%, 9% (Dyskinetic); 6.5–9%, 26% (Mixed); 3%, 0% (Ataxic); 3-4%, 0% (Hypotonic). The CP incidences of different Gross Motor Function Classification System (GMFCS) levels in real world and in movies, respectively, are 40–51%, 47% (Level I + II); 14–19%, 12% (Level III); 34–41%, 41% (Level IV + V). Comparisons of incidence between the real world and the movies are surprisingly matching. Motion pictures honestly reflect the general public's point of view to CP patients in our real world. With precise selection and medical professional explanations, motion pictures can play the suitable role making CP understood more clearly. PMID:26257472

Focus on function: a cluster, randomized controlled trial comparing child- versus context-focused intervention for young children with cerebral palsy

PubMed Central

LAW, MARY C; DARRAH, JOHANNA; POLLOCK, NANCY; WILSON, BRENDA; RUSSELL, DIANNE J; WALTER, STEPHEN D; ROSENBAUM, PETER; GALUPPI, BARB

2011-01-01

AIM This study evaluated the efficacy of a child-focused versus context-focused intervention in improving performance of functional tasks and mobility in young children with cerebral palsy. METHOD A randomized controlled trial cluster research design enrolled 128 children (49 females, 79 males; age range 12mo to 5y 11mo; mean age 3y 6mo, SD −1y 5mo) who were diagnosed with cerebral palsy. Children across levels I to V on the Gross Motor Classification System (GMFCS) were included in the study. Children were excluded if there were planned surgical or medication changes during the intervention period. Therapists from 19 children's rehabilitation centers were block randomized (by occupational therapist or physical therapist) to a treatment arm. Children from consenting families followed their therapists into their assigned group. Children received child-focused (n=71) or context-focused intervention (n=57) over 6 months, returning to their regular therapy schedule and approach between 6 and 9 months. The primary outcome measure was the Pediatric Evaluation of Disability Inventory (PEDI). Secondary outcome measures included the Gross Motor Function Measure (GMFM-66), range of motion of hip abduction, popliteal angle and ankle dorsiflexion, the Assessment of Preschool Children's Participation (APCP), and the Family Empowerment Scale (FES). Outcome evaluators were masked to group assignment and completed assessments at baseline, 6 months, and 9 months. RESULTS Ten children did not complete the full intervention, six in the child group and four in context group. GMFCS levels for children in the study were level I (n=37), level II (n=23), level III (n=21), level IV (n=21), and level V (n=26). There were no significant differences at baseline between the treatment groups for GMFCS level, parental education, or parental income. For the PEDI, there was no significant difference between the treatment groups, except for a small effect (p<0.03) on the Caregiver Assistance Mobility subscale between baseline and 9 months. The mean scores of both groups changed significantly on the Functional Skills Scales (p<0.001) and Caregiver Assistance Scales (p<0.02) of the PEDI after the 6-month intervention. There was no additional statistically significant change on the PEDI during the follow-up period from 6 to 9 months. A subgroup effect was found for age (p<0.001), with children younger than 3 years changing significantly more than older children. GMFCS level at baseline did not influence the amount of change on the PEDI scales. There were no significant differences between the treatment groups on the GMFM, range of motion measures, APCP or FES assessments. For the GMFM, there was a significant change over time from baseline to 6 months (p<0.001) and no significant change between 6 and 9 months. There was no adverse side effect as range of motion did not decrease in either group. Hip abduction increased significantly (p<0.01) at the 9-month assessment for both groups. For the APCP, significant changes for both treatment groups were found between baseline and 6 months for play intensity (p<0.04), physical activity intensity and diversity (p<0.001), and total score intensity (p<0.01). INTERPRETATION This study shows that child- or context-focused therapy approaches are equally effective and that frequency of intervention may be a critical component of successful intervention. Further evaluation is required to identify the various `dose-response' relations of amount of treatment and changes in functional abilities. PMID:21569012

Prevalence of cerebral palsy in Uganda: a population-based study.

PubMed

Kakooza-Mwesige, Angelina; Andrews, Carin; Peterson, Stefan; Wabwire Mangen, Fred; Eliasson, Ann Christin; Forssberg, Hans

2017-12-01

Few population-based studies of cerebral palsy have been done in low-income and middle-income countries. We aimed to examine cerebral palsy prevalence and subtypes, functional impairments, and presumed time of injury in children in Uganda. In this population-based study, we used a nested, three-stage, cross-sectional method (Iganga-Mayuge Health and Demographic Surveillance System [HDSS]) to screen for cerebral palsy in children aged 2-17 years in a rural eastern Uganda district. A specialist team confirmed the diagnosis and determined the subtype, motor function (according to the Gross Motor Function Classification System [GMFCS]), and possible time of brain injury for each child. Triangulation and interviews with key village informants were used to identify additional cases of suspected cerebral palsy. We estimated crude and adjusted cerebral palsy prevalence. We did χ 2 analyses to examine differences between the group screened at stage 1 and the entire population and regression analyses to investigate associations between the number of cases and age, GMFCS level, subtype, and time of injury. We used data from the March 1, 2015, to June 30, 2015, surveillance round of the Iganga-Mayuge HDSS. 31 756 children were screened for cerebral palsy, which was confirmed in 86 (19%) of 442 children who screened positive in the first screening stage. The crude cerebral palsy prevalence was 2·7 (95% CI 2·2-3·3) per 1000 children, and prevalence increased to 2·9 (2·4-3·6) per 1000 children after adjustment for attrition. The prevalence was lower in older (8-17 years) than in younger (<8 years) children. Triangulation added 11 children to the cohort. Spastic unilateral cerebral palsy was the most common subtype (45 [46%] of 97 children) followed by bilateral cerebral palsy (39 [40%] of 97 children). 14 (27%) of 51 children aged 2-7 years had severe cerebral palsy (GMFCS levels 4-5) compared with only five (12%) of 42 children aged 8-17 years. Few children (two [2%] of 97) diagnosed with cerebral palsy were born preterm. Post-neonatal events were the probable cause of cerebral palsy in 24 (25%) of 97 children. Cerebral palsy prevalence was higher in rural Uganda than in high-income countries (HICs), where prevalence is about 1·8-2·3 cases per 1000 children. Children younger than 8 years were more likely to have severe cerebral palsy than older children. Fewer older children than younger children with cerebral palsy suggested a high mortality in severely affected children. The small number of preterm-born children probably resulted from low preterm survival. About five times more children with post-neonatal cerebral palsy in Uganda than in HICs suggested that cerebral malaria and seizures were prevalent risk factors in this population. Swedish Research Council, Promobilia. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Profile of refractive errors in cerebral palsy: impact of severity of motor impairment (GMFCS) and CP subtype on refractive outcome.

PubMed

Saunders, Kathryn J; Little, Julie-Anne; McClelland, Julie F; Jackson, A Jonathan

2010-06-01

To describe refractive status in children and young adults with cerebral palsy (CP) and relate refractive error to standardized measures of type and severity of CP impairment and to ocular dimensions. A population-based sample of 118 participants aged 4 to 23 years with CP (mean 11.64 +/- 4.06) and an age-appropriate control group (n = 128; age, 4-16 years; mean, 9.33 +/- 3.52) were recruited. Motor impairment was described with the Gross Motor Function Classification Scale (GMFCS), and subtype was allocated with the Surveillance of Cerebral Palsy in Europe (SCPE). Measures of refractive error were obtained from all participants and ocular biometry from a subgroup with CP. A significantly higher prevalence and magnitude of refractive error was found in the CP group compared to the control group. Axial length and spherical refractive error were strongly related. This relation did not improve with inclusion of corneal data. There was no relation between the presence or magnitude of spherical refractive errors in CP and the level of motor impairment, intellectual impairment, or the presence of communication difficulties. Higher spherical refractive errors were significantly associated with the nonspastic CP subtype. The presence and magnitude of astigmatism were greater when intellectual impairment was more severe, and astigmatic errors were explained by corneal dimensions. Conclusions. High refractive errors are common in CP, pointing to impairment of the emmetropization process. Biometric data support this In contrast to other functional vision measures, spherical refractive error is unrelated to CP severity, but those with nonspastic CP tend to demonstrate the most extreme errors in refraction.

Nutritional status of children with cerebral palsy in Turkey.

PubMed

Tüzün, Emine Handan; Güven, Duygu Korkem; Eker, Levent; Elbasan, Bülent; Bülbül, Selda Fatma

2013-03-01

The aim of this study was to assess the nutritional status, and provide information regarding anthropometric measurements of cerebral-palsied children living in the city of Ankara, Turkey. A total of 447 children with cerebral palsy (CP) were participated in this cross-sectional study. Participants were assessed for functional motor impairment by the gross motor function classification system (GMFCS). Assesment of nutritional status was based on the triceps skinfold thickness (TSF), arm fat area (AFA) estimates derived from TSF and mid-upper arm circumference measurements. TSF and AFA Z-scores were computed using reference data. Cerebral-palsied children had lower TSF and AFA Z-scores compared to reference data from healthy children. The prevalence of underweight and overweight among boys was 8.3 and 9.5%, respectively, whereas it was 19.0 and 0.5% for girls. Underweight was more prevalent in the low functioning children than in moderate functioning children. The findings of this study indicate that cerebral-palsied children face nutritional challenges. Underweight is more prevalent than overweight among cerebral-palsied children. To optimize the outcomes of rehabilitation and prevention efforts, an understanding of the heterogeneity of nutritional status among children with CP is required.

Higher Levels of Caregiver Strain Perceived by Indian Mothers of Children and Young Adults with Cerebral Palsy Who have Limited Self-Mobility.

PubMed

Prakash, V; Patel, Anjali M; Hariohm, K; Palisano, Robert J

2017-02-01

Describe and compare the caregiver strain experienced among Indian mothers of children and young adults with cerebral palsy (CP) living in low resource settings. 62 consecutive children and young adults with spastic CP (mean age 6.0 ± 4.5, range 2-21) and their parents were recruited from an outpatient physiotherapy department for this cross-sectional study. Ability to walk was classified using the Gross Motor Function Classification System and mother's caregiver strain was measured using caregiver strain index (CSI). Mothers of children and young adults who have limited self-mobility perceived higher caregiver strain (mean CSI score 12.0 ± 1.3, p < 0.05) than mothers of children who can walk (mean CSI score 4.5 ± 3.0, p < 0.05). All 46 mothers of children and youth in GMFCS levels IV and V reported high levels of caregiver stress compared with only three of 16 mothers of children and youth who walk (levels I and II). Physiotherapists and occupational therapists serving children and youth with CP are encouraged to partner with families to identify goals for ease of caregiving, activity, and participation at home and in the community.

Energy expenditure during standing in children with cerebral palsy: A brief report1.

PubMed

Saxena, Shikha; Kumaran, Senthil; Rao, Bhamini K

2016-09-02

The aim of the study was to estimate the energy expenditure (EE) during a quiet standing task in children with bilateral spastic CP (BSCP) in comparison with typically developing (TD) children, using gas analyzer. The study was an observational cross-sectional study of children with BSCP (Gross Motor Function Classification System [GMFCS] levels II and III; n = 30; 10 males, 20 females; mean weight 27.46 kgs; mean age 10 years) and TD children (n = 30; 16 males, 14 females; mean weight 25.35 kgs; mean age 9 years, 9 months). The energy expenditure during quiet standing task was measured by using Cosmed K4b2 gas analyzer and expressed in terms of peak oxygen consumption (VO2 max, ml/kg body weight/min). Children with BSCP expended 1.4 times higher energy during standing than TD children (p< 0.0001). We identified that standing puts an additional energy demand in ambulant children with BSCP. Findings suggest that both dependant and independent ambulating children with BSCP might need to exert more effort to maintain a static standing position. Therefore, clinicians must evaluate standing position for balance control and energy expenditure to evaluate the efficiency of physical therapy and rehabilitation.

Biomechanics of Submaximal Recumbent Cycling in Adolescents With and Without Cerebral Palsy

PubMed Central

Johnston, Therese E; Barr, Ann E; Lee, Samuel CK

2011-01-01

Background and Purpose The purpose of this study was to compare the biomechanics of recumbent cycling between adolescents with cerebral palsy (CP) classified at Gross Motor Function Classification System (GMFCS) levels III and IV and adolescents with typical development (TD). Subjects Twenty subjects, ages (X̄±SD) 15.2±1.6 years (10 with TD, 10 with CP), participated. Methods Lower-extremity kinematics and muscle activity were measured at 30 and 60 rpm while subjects pedaled on a recumbent cycle. Energy expenditure and perceived exertion were measured during a 5-minute test, and efficiency was calculated. Noncircular data were analyzed with analyses of variance. Circular data were analyzed using circular t tests. Results Differences were found between groups for joint kinematics for all motions. Subjects with CP displayed earlier onsets and later offsets of muscle activity, increased co-contraction of agonist and antagonist muscles, and decreased efficiency compared with subjects with TD. There were no differences in perceived exertion. Discussion and Conclusion Differences in cycling biomechanics between children with CP and children with TD may be due to decreased strength and motor control in the children with CP. PMID:17405804

Morphometric analysis of the femur in cerebral palsy: 3-dimensional CT study.

PubMed

Gose, Shinichi; Sakai, Takashi; Shibata, Toru; Murase, Tsuyoshi; Yoshikawa, Hideki; Sugamoto, Kazuomi

2010-09-01

The cause of hip disorder in cerebral palsy (CP) has been thought to involve muscle imbalance, flexion, and adduction contracture of the hip joint, acetabular dysplasia, and femoral growth abnormalities. The aim of this study was to quantitatively evaluate the 3-dimensional femoral geometry and subluxation/dislocation of the hip in spastic CP using 3D-CT reconstructed images of the pelvis and the femur, focusing on the femoral growth abnormalities in CP. Between June 2006 and September 2009, 186 hips in 93 bilateral spastic CP patients, including spastic diplegia (SD) in 73 patients and spastic quadriplegia (SQ) in 20 patients, who had not received any surgical treatment, were investigated using 3D-CT at our hospital. There were 59 boys and 34 girls with an average age of 5.3 years (range: 2.6 to 6.8 y). As an index for the femoral geometry, the neck-shaft angle, the femoral anteversion, and the femoral offset were 3-dimensionally measured. The center of the acetabulum and the femoral head were determined to calculate the CT migration percentage as the distance between these centers divided by the femoral head diameter. To elucidate the factors related to hip subluxation/dislocation, the relationships between the neck-shaft angle, the femoral anteversion, the femoral offset, and the CT migration percentage were investigated. The mean neck-shaft angle was 150.4+/-9.4 degrees (range: 129.4 to 173.2 degrees). The mean femoral anteversion was 44.4+/-13.6 degrees (range: 5.8 to 84.0 degrees). The mean CT migration percentage was 22.4+/-22.7% (range: 3 to 129%). There was positive correlation between the CT migration percentage and the neck-shaft angle (r=0.49). Hips with large CT migration percentage tended to show coxa valga. There was an inverse correlation between the neck-shaft angle and the femoral offset (r=-0.90), but no correlation between the CT migration percentage and the femoral anteversion (r=0.26), between the femoral offset and the femoral anteversion (r=-0.25), or between the neck-shaft angle and the femoral anteversion (r=0.23). The neck-shaft angle, the femoral anteversion, and the CT migration percentage were significantly larger, and the femoral offset was significantly smaller, in patients with the Gross Motor Functional Classification System (GMFCS) level IV/V (nonwalking children) and SQ type, than in patients with GMFCS level II/III (mostly walking children) and SD type. The 3-dimensional femoral geometry in CP patients can be analyzed quantitatively using 3D-CT regardless of the abnormal spastic posture. Our data indicate that 3-dimensional evaluation is accurate and useful for analysis of the femur and acetabulum in CP, and that the extent of coxa valga and femoral anteversion is more severe in the patients with GMFCS level IV/V and SQ type. Level IV.

Focus on function: a cluster, randomized controlled trial comparing child- versus context-focused intervention for young children with cerebral palsy.

PubMed

Law, Mary C; Darrah, Johanna; Pollock, Nancy; Wilson, Brenda; Russell, Dianne J; Walter, Stephen D; Rosenbaum, Peter; Galuppi, Barb

2011-07-01

This study evaluated the efficacy of a child-focused versus context-focused intervention in improving performance of functional tasks and mobility in young children with cerebral palsy. A randomized controlled trial cluster research design enrolled 128 children (49 females, 79 males; age range 12 mo to 5 y 11 mo; mean age 3 y 6 mo, SD -1 y 5 mo) who were diagnosed with cerebral palsy. Children across levels I to V on the Gross Motor Classification System (GMFCS) were included in the study. Children were excluded if there were planned surgical or medication changes during the intervention period. Therapists from 19 children's rehabilitation centers were block randomized (by occupational therapist or physical therapist) to a treatment arm. Children from consenting families followed their therapists into their assigned group. Children received child-focused (n=71) or context-focused intervention (n=57) over 6 months, returning to their regular therapy schedule and approach between 6 and 9 months. The primary outcome measure was the Pediatric Evaluation of Disability Inventory (PEDI). Secondary outcome measures included the Gross Motor Function Measure (GMFM-66), range of motion of hip abduction, popliteal angle and ankle dorsiflexion, the Assessment of Preschool Children's Participation (APCP), and the Family Empowerment Scale (FES). Outcome evaluators were masked to group assignment and completed assessments at baseline, 6 months, and 9 months. Ten children did not complete the full intervention, six in the child group and four in context group. GMFCS levels for children in the study were level I (n=37), level II (n=23), level III (n=21), level IV (n=21), and level V (n=26). There were no significant differences at baseline between the treatment groups for GMFCS level, parental education, or parental income. For the PEDI, there was no significant difference between the treatment groups, except for a small effect (p<0.03) on the Caregiver Assistance Mobility subscale between baseline and 9 months. The mean scores of both groups changed significantly on the Functional Skills Scales (p<0.001) and Caregiver Assistance Scales (p<0.02) of the PEDI after the 6-month intervention. There was no additional statistically significant change on the PEDI during the follow-up period from 6 to 9 months. A subgroup effect was found for age (p<0.001), with children younger than 3 years changing significantly more than older children. GMFCS level at baseline did not influence the amount of change on the PEDI scales. There were no significant differences between the treatment groups on the GMFM, range of motion measures, APCP or FES assessments. For the GMFM, there was a significant change over time from baseline to 6 months (p<0.001) and no significant change between 6 and 9 months. There was no adverse side effect as range of motion did not decrease in either group. Hip abduction increased significantly (p<0.01) at the 9-month assessment for both groups. For the APCP, significant changes for both treatment groups were found between baseline and 6 months for play intensity (p<0.04), physical activity intensity and diversity (p<0.001), and total score intensity (p<0.01). This study shows that child- or context-focused therapy approaches are equally effective and that frequency of intervention may be a critical component of successful intervention. Further evaluation is required to identify the various 'dose-response' relations of amount of treatment and changes in functional abilities. © The Authors. Developmental Medicine & Child Neurology © 2011 Mac Keith Press.

Avascular necrosis as a complication of the treatment of dislocation of the hip in children with cerebral palsy.

PubMed

Koch, A; Jozwiak, M; Idzior, M; Molinska-Glura, M; Szulc, A

2015-02-01

We investigated the incidence and risk factors for the development of avascular necrosis (AVN) of the femoral head in the course of treatment of children with cerebral palsy (CP) and dislocation of the hip. All underwent open reduction, proximal femoral and Dega pelvic osteotomy. The inclusion criteria were: a predominantly spastic form of CP, dislocation of the hip (migration percentage, MP > 80%), Gross Motor Function Classification System, (GMFCS) grade IV to V, a primary surgical procedure and follow-up of > one year. There were 81 consecutive children (40 girls and 41 boys) in the study. Their mean age was nine years (3.5 to 13.8) and mean follow-up was 5.5 years (1.6 to 15.1). Radiological evaluation included measurement of the MP, the acetabular index (AI), the epiphyseal shaft angle (ESA) and the pelvic femoral angle (PFA). The presence and grade of AVN were assessed radiologically according to the Kruczynski classification. Signs of AVN (grades I to V) were seen in 79 hips (68.7%). A total of 23 hips (18%) were classified between grades III and V. Although open reduction of the hip combined with femoral and Dega osteotomy is an effective form of treatment for children with CP and dislocation of the hip, there were signs of avascular necrosis in about two-thirds of the children. There was a strong correlation between post-operative pain and the severity of the grade of AVN. ©2015 The British Editorial Society of Bone & Joint Surgery.

Association between isometric muscle strength and gait joint kinetics in adolescents and young adults with cerebral palsy.

PubMed

Dallmeijer, A J; Baker, R; Dodd, K J; Taylor, N F

2011-03-01

The purpose of this study was to determine the association between isometric muscle strength of the lower limbs and gait joint kinetics in adolescents and young adults with cerebral palsy (CP). Twenty-five participants (11 males) with bilateral spastic CP, aged 14-22 years (mean: 18.9, sd: 2.0 yr) and Gross Motor Function Classification System (GMFCS) level II (n=19) and III (n=6) were tested. Hand held dynamometry was used to measure isometric strength (expressed in Nm/kg) of the hip, knee, and ankle muscles using standardized testing positions and procedures. 3D gait analysis was performed with a VICON system to calculate joint kinetics in the hip, knee and ankle during gait. Ankle peak moments exceeded by far the levels of isometric strength of the plantar flexors, while the knee and hip peak moments were just at or below maximal isometric strength of knee and hip muscles. Isometric muscle strength showed weak to moderate correlations with peak ankle and hip extension moment and power during walking. Despite considerable muscle weakness, joint moment curves were similar to norm values. Results suggest that passive stretch of the muscle-tendon complex of the triceps surae contributes to the ankle moment during walking and that muscle strength assessment may provide additional information to gait kinetics. Copyright © 2010 Elsevier B.V. All rights reserved.

Cerebral palsy in a total population of 4-11 year olds in southern Sweden. Prevalence and distribution according to different CP classification systems.

PubMed

Westbom, Lena; Hagglund, Gunnar; Nordmark, Eva

2007-12-05

The aim of this study was to investigate the prevalence of cerebral palsy (CP) as well as to characterize the CP population, its participation in a secondary prevention programme (CPUP) and to validate the CPUP database. The study population was born 1990-1997 and resident in Skåne/Blekinge on Jan 1st 2002. Multiple sources were used. Irrespective of earlier diagnoses, neuropaediatrician and other professional medical records were evaluated for all children at the child habilitation units. The CPUP database and diagnosis registers at hospital departments were searched for children with CP or psychomotor retardation, whose records were then evaluated. To enhance early prevention, CP/probable CP was searched for also in children below four years of age born 1998-2001. The prevalence of CP was 2.4/1,000 (95% CI 2.1-2.6) in children 4-11 years of age born in Sweden, excluding post-neonatally acquired CP. Children born abroad had a higher prevalence of CP with more severe functional limitations. In the total population, the prevalence of CP was 2.7/1,000 (95% CI 2.4-3.0) and 48% were GMFCS-level I (the mildest limitation of gross motor function). One third of the children with CP, who were born or had moved into the area after a previous study in 1998, were not in the CPUP database. The subtype classification in the CPUP database was adjusted in the case of every fifth child aged 4-7 years not previously reviewed. The prevalence of CP and the subtype distribution did not differ from that reported in other studies, although the proportion of mild CP tended to be higher. The availability of a second opinion about the classification of CP/CP subtypes is necessary in order to keep a CP register valid, as well as an active search for undiagnosed CP among children with other impairments.

Bone mineral density and insulin-like growth factor-1 in children with spastic cerebral palsy.

PubMed

Nazif, H; Shatla, R; Elsayed, R; Tawfik, E; Osman, N; Korra, S; Ibrahim, A

2017-04-01

Children with cerebral palsy (CP) have significant decrease linear growth rate and low bone mineral density (BMD). This study is to evaluate BMD in children with CP and its relation to the levels of insulin-like growth factor-1 (IGF-1). This cross-sectional study was carried out on 58 children suffering from spastic CP with the age range 4-12 years compared to 19 controls. All assessed by dual energy x-ray absorptiometry (DXA) to measure BMD, serum level of IGF-1, and serum vitamin D. The patients were classified according to their GMFCS. Fractures were reported in seven (12.1%) of cases. Our study demonstrated that, IGF-1 level and BMD decrease in correlation with the severity of CP. IGF-1correlates positively with serum vitamin D, BMI, and BMD. CP children with severe GMFCS level or who use anticonvulsive drugs are at a high risk for low BMD and low levels of IGF-1. Both BMD and IGF-1 were significantly in low children with spastic CP; IGF-1 negatively correlates with the severity of osteopenia in children with spastic. Children with CP who are not independently ambulant or with severe GMFCS level or who use anticonvulsive drugs are at a high risk for developing low BMD.

Questionnaire about the adverse events and side effects following botulinum toxin A treatment in patients with cerebral palsy.

PubMed

Blaszczyk, Izabela; Foumani, Nazli Poorsafar; Ljungberg, Christina; Wiberg, Mikael

2015-11-06

Botulinum toxin A (BoNT-A) injections for treatment of spasticity in patients with cerebral palsy (CP) have been used for about two decades. The treatment is considered safe but a low frequency of adverse events (AE) has been reported. A good method to report AEs is necessary to verify the safety of the treatment. We decided to use an active surveillance of treatment-induced harm using a questionnaire we created. We studied the incidence of reported AEs and side effects in patients with CP treated with BoNT-A. We investigated the relationship between the incidence of AEs or side effects and gender, age, weight, total dose, dose per body weight, Gross Motor Function Classification System (GMFCS) and number of treated body parts. Seventy-four patients with CP participated in our study. In 54 (51%) of 105 BoNT-A treatments performed in 45 (61%) patients, there were 95 AEs and side effects reported, out of which 50 were generalized and/or focal distant. Severe AEs occurred in three patients (4%), and their BoNT-A treatment was discontinued. Consecutive collection of the AE and side-effect incidence using our questionnaire can increase the safety of BoNT-A treatment in patients with CP.

Exploring issues of participation among adolescents with cerebral palsy: what's important to them?

PubMed

Livingston, Michael H; Stewart, Debra; Rosenbaum, Peter L; Russell, Dianne J

2011-08-01

The purpose of this cross-sectional study was to determine what participation issues are important to adolescents with cerebral palsy (CP). Two hundred and three adolescents with CP (mean age 16.0 ± 1.8 years) were assessed using the Canadian Occupational Performance Measure (COPM). This was done through semistructured interviews by trained physical and occupational therapists. Adolescents responded either directly (n = 144) or through a parent or a caregiver (n = 59) if they were unable to communicate. Issues were extracted from completed questionnaires and coded under three COPM categories (self-care, productivity, and leisure) and 16 subcategories. There was no association between the total number of issues identified and gender (p = .99), age (p = .88), type of respondent (adolescents versus parent) (p = .27), Gross Motor Function Classification System (GMFCS) level (p = .93), or 66-item Gross Motor Function Measure (GMFM-66) score (p = .45). The issues identified most frequently were related to active leisure (identified by 57% of participants), mobility (55%), school (48%), and socialization (44%). Interventions aimed at improving participation among adolescents with physical disabilities, such as CP, should be directed towards these four key areas. Health care professionals should also recognize and consider the interaction of person and environment when addressing issues related to participation.

Sleep disturbances in preschool age children with cerebral palsy: a questionnaire study.

PubMed

Romeo, Domenico M; Brogna, Claudia; Musto, Elisa; Baranello, Giovanni; Pagliano, Emanuela; Casalino, Tiziana; Ricci, Daniela; Mallardi, Maria; Sivo, Serena; Cota, Francesco; Battaglia, Domenica; Bruni, Oliviero; Mercuri, Eugenio

2014-09-01

The study aimed to analyze (i) the prevalence of sleep disorders in pre-school children with cerebral palsy (CP) using the Sleep Disturbance Scale for Children (SDSC), (ii) the possible association with motor, cognitive and behavioral problems, and (iii) the possible differences with typically developing children matched for age and gender. One-hundred children with CP (age range: 3-5 years, mean: 3.8 years) were assessed using the SDSC, the Gross Motor Function Classification System (GMFCS), the Wechsler Preschool and Primary Scale of Intelligence, and the Child Behaviour Check List (CBCL) to assess sleep, motor, cognitive, and behavioral problems, respectively. Further 100 healthy children matched for age and sex were assessed using the SDSC. An abnormal total sleep score was found in 13% of children with CP while 35% had an abnormal score on at least one SDSC factor. SDSC total score was significantly associated with pathological internalizing scores on CBCL and active epilepsy on multivariate analysis. CP group reported higher significant median scores on SDSC total, parasomnias, and difficulty in initiating and maintaining sleep factors. In pre-school children sleep disorders are more common in children with CP than in healthy control group and are often associated with epilepsy and behavioral problems. Copyright © 2014 Elsevier B.V. All rights reserved.

Neurodevelopmental long-term outcome in children with hydrocephalus requiring neonatal surgical treatment.

PubMed

Melot, A; Labarre, A; Vanhulle, C; Rondeau, S; Brasseur, M; Gilard, V; Castel, H; Marret, S; Proust, F

2016-04-01

To assess long-term neurodevelopmental outcome in children with hydrocephalus requiring neurosurgical treatment during the neonatal period. This prospective longitudinal population-based study included 43 children with neonatal shunted hydrocephalus. The 43 children were prospectively reviewed in the presence of their parents at the outpatient clinic. Cognitive and motor outcomes were assessed respectively using different Wechsler scales according to age and Gross Motor Function Classification System (GMFCS). Postoperative MRI was routinely performed. The mean gestational age at birth of the 43 consecutive children with neonatal hydrocephalus (sex ratio M/F: 1.39) was 34.5±5.4 weeks of gestation. At mean follow-up of 10.4±4 years, mean total IQ was 73±27.7, with equivalent results in mean verbal and mean performance IQ. Of the 33 children with IQ evaluation, 18 presented an IQ≥85 (41.9%). Efficiency in walking without a mobility device (GMFCS≤2) was obtained in 37 children (86%). Only severity of postoperative ventricular dilation was significantly associated with unfavorable outcome (Evans index>0.37; odds ratio: 0.16, P=0.03). This information could be provided to those families concerned who often experience anxiety when multi-disciplinary management of neonatal hydrocephalus is required. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Theory of mind, emotional and social functioning, and motor severity in children and adolescents with dystonic cerebral palsy.

PubMed

Adegboye, Dolapo; Sterr, Annette; Lin, Jean-Pierre; Owen, Tamsin J

2017-05-01

This cross-sectional study aimed to investigate whether children and adolescents with dystonic cerebral palsy (CP) present with emotional and social difficulties along side motor limitations. Twenty-two verbal and nonverbal children and adolescents with dystonic CP were compared with a normative sample of twenty children and adolescents on measures of theory of mind (ToM), emotion regulation (ER), and social difficulties (SD). Higher social and emotional difficulties were found in the dystonic CP group compared to the control group. Nonverbal participants with dystonic CP were found to present with greater social impairment and lower ToM ability than their verbal counterparts. Emotional regulation and hyperactivity and attentional difficulties (HAD) significantly predicted ToM ability and social difficulties. Lower Gross Motor Function Classification System (GMFCS) level and IQ also contributed to differences in ToM ability. Findings support the need for greater attention to the emotional health and social development of children/adolescents with dystonic CP, along with assessments of motor difficulties in the planning and implementation of interventions and individual care plans. Further research is needed to explore links between motor disorder and mental state understanding in this clinical group. Copyright © 2017 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

What is the Best Configuration of Wearable Sensors to Measure Spatiotemporal Gait Parameters in Children with Cerebral Palsy?

PubMed Central

Carcreff, Lena; Paraschiv-Ionescu, Anisoara; De Coulon, Geraldo; Armand, Stéphane; Aminian, Kamiar

2018-01-01

Wearable inertial devices have recently been used to evaluate spatiotemporal parameters of gait in daily life situations. Given the heterogeneity of gait patterns in children with cerebral palsy (CP), the sensor placement and analysis algorithm may influence the validity of the results. This study aimed at comparing the spatiotemporal measurement performances of three wearable configurations defined by different sensor positioning on the lower limbs: (1) shanks and thighs, (2) shanks, and (3) feet. The three configurations were selected based on their potential to be used in daily life for children with CP and typically developing (TD) controls. For each configuration, dedicated gait analysis algorithms were used to detect gait events and compute spatiotemporal parameters. Fifteen children with CP and 11 TD controls were included. Accuracy, precision, and agreement of the three configurations were determined in comparison with an optoelectronic system as a reference. The three configurations were comparable for the evaluation of TD children and children with a low level of disability (CP-GMFCS I) whereas the shank-and-thigh-based configuration was more robust regarding children with a higher level of disability (CP-GMFCS II–III). PMID:29385700

Subtalar fusion for pes valgus in cerebral palsy: results of a modified technique in the setting of single event multilevel surgery.

PubMed

Shore, Benjamin J; Smith, Katherine R; Riazi, Arash; Symons, Sean B V; Khot, Abhay; Graham, Kerr

2013-06-01

We studied the use of cortico-cancellous circular allograft combined with cannulated screw fixation for the correction of dorsolateral peritalar subluxation in a series of children with bilateral spastic cerebral palsy undergoing single event multilevel surgery. Forty-six children who underwent bilateral subtalar fusion between January 1999 and December 2004 were retrospectively reviewed. Gait laboratory records, Gross Motor Function Classification System (GMFCS) levels, Functional Mobility Scale (FMS) scores, and radiographs were reviewed. The surgical technique used an Ollier type incision with a precut cortico-cancellous allograft press-fit into the prepared sinus tarsi. One or two 7.3 mm fully threaded cancellous screws were used to fix the subtalar joint. Radiographic analysis included preoperative and postoperative standing lateral radiographs measuring the lateral talocalcaneal angle, lateral talo-first metatarsal angle, and navicular cuboid overlap. Fusion rate was assessed with radiographs >12 months after surgery. The mean patient age was 12.9 years (range, 7.8 to 18.4 y) with an average follow-up of 55 months. Statistically significant improvement postoperatively was found for all 3 radiographic indices: lateral talocalcaneal angle, mean improvement 20 degrees (95% CI, 17.5-22.1; P<0.001); lateral talo-first metatarsal angle, mean improvement 21 degrees (95% CI, 19.2-23.4; P<0.001); and navicular cuboid overlap, mean improvement 29% (95% CI, 25.7%-32.6%; P<0.001). FMS improved across all patients, with Gross Motor Function Classification System III children experiencing a 70% improvement across all 3 FMS distances (5, 50, and 500 m). All 3 radiographic measures improved significantly (P<0.001). Fusion was achieved in 45 patients and there were no wound complications. With this study, we demonstrate significant improvement in radiographic segmental alignment and overall function outcome with this modified subtalar fusion technique. We conclude that this technique is an effective complement for children with dorsolateral peritalar subluxation undergoing single event multilevel surgery. Level IV.

Responsiveness of the ACTIVLIM-CP questionnaire measuring global activity performance in children with cerebral palsy.

PubMed

Paradis, Julie; Arnould, Carlyne; Thonnard, Jean-Louis; Houx, Laëtitia; Pons-Becmeur, Christelle; Renders, Anne; Brochard, Sylvain; Bleyenheuft, Yannick

2018-06-04

To investigate the responsiveness of the ACTIVLIM-CP questionnaire after two evidence-based interventions for children with cerebral palsy (CP). Seventy-five children with CP either participated in an intensive motor-skill learning intervention (hand-arm bimanual intensive therapy including lower extremities [HABIT-ILE], n=47) or received botulinum neurotoxin-A (BoNT-A) injection(s) into lower extremities combined with conventional physical therapy (n=28). All children were assessed three times: at baseline (T 0 ; before HABIT-ILE/the day of BoNT-A injection), at T 1 (last day of HABIT-ILE/6wks after BoNT-A injection), and at follow-up (T 2 ; 3-4mo after the beginning of intervention). Parents completed ACTIVLIM-CP and three other activity questionnaires. Responsiveness was analysed using group (based on intervention), subgroup (based on gross motor function level), and individual approaches. For the HABIT-ILE group, significant improvements in ACTIVLIM-CP were observed for the T 0 -T 1 period (p<0.001) but not for the T 1 -T 2 period. No significant changes were found in the BoNT-A group during assessments (p=0.84). In the subgroup analysis for the HABIT-ILE group (T 0 -T 1 ), greater changes were demonstrated for children in Gross Motor Function Classification System levels III and IV (p<0.001, effect size=1.36). The individual approach was congruent with the group approach. ACTIVLIM-CP demonstrated high responsiveness after HABIT-ILE, showing that this scale may be used to investigate global activity performance in clinical trials focusing on improving daily life activities. Good responsiveness of ACTIVLIM-CP questionnaire during intensive motor-skill learning intervention. Higher responsiveness for children in Gross Motor Function Classification System (GMFCS) levels III and IV versus I and II after intensive intervention. ACTIVLIM-CP is useful to identify children improving their performance after botulinum neurotoxin-A injection. © 2018 Mac Keith Press.

Effects of interactive games on motor performance in children with spastic cerebral palsy

PubMed Central

AlSaif, Amer A.; Alsenany, Samira

2015-01-01

[Purpose] Motor control and muscle strength impairments are the prime reasons for motor behavior disorders in children with spastic cerebral palsy. These impairments lead to histological changes in muscle growth and the learning of motor skills. Therefore, such children experience reduced muscle force generation and decreased muscle flexibility. We investigated the effect of training with Nintendo Wii Fit games on motor performance in children with spastic cerebral palsy. [Subjects and Methods] Forty children with cerebral palsy spastic diplegia aged 6–10 years diagnosed with level-3 functional capabilities according to the Gross Motor Classification System (GMFCS) were enrolled. Participants were divided randomly into equal groups: group (A) that practiced with the Nintendo Wii Fit game for at least 20 minutes/day for 12 weeks and group (B) that underwent no training (control group). The Movement Assessment Battery for Children-2 (mABC-2) was used to assess motor performance, because it mainly involves motor tasks very similar to those involved in playing Nintendo Wii Fit games, e.g., goal-directed arm movements, balancing, and jumping. [Results] There were significant improvements in the subscales of the motor performance test of those who practiced with the Nintendo Wii, while the control group showed no significant changes. [Conclusion] Using motion interactive games in home rehabilitation is feasible for children with cerebral palsy. PMID:26180367

Similarities and differences between infantile and early childhood onset vanishing white matter disease.

PubMed

Zhou, Ling; Zhang, Haihua; Chen, Na; Zhang, Zhongbin; Liu, Ming; Dai, Lifang; Wang, Jingmin; Jiang, Yuwu; Wu, Ye

2018-06-01

Vanishing white matter disease (VWM) is one of the most prevalent inherited leukoencephalopathies in childhood. Infantile VWM is more severe but less understood than the classic early childhood type. We performed a follow-up study on 14 infantile and 26 childhood patients to delineate the natural history and neuroimaging features of VWM. Infantile and childhood patients shared similarities in the incidence of epileptic seizure (35.7 vs. 38.5%) and episodic aggravation (92.9 vs. 84.6%). Developmental delay before disease onset was more common in infantile patients. Motor disability was earlier and more severe in infantile VWM. In survivors with disease durations of 1-3 years, the Gross Motor Function Classification System (GMFCS) was classified as IV-V in 66.7% of infantile and only 29.4% of childhood patients. Kaplan-Meier survival curve analysis indicated that the 5-year survival rates were 21.6 and 91.3% in infantile and childhood VWM, respectively. In terms of MRI, infantile patients showed more extensive involvement and earlier rarefaction, with more common involvement of subcortical white matter, internal capsule, brain stem and dentate nuclei of the cerebellum. Restricted diffusion was more diffuse or extensive in infantile patients. In addition, four novel mutations were identified. In conclusion, we identified some similarities and differences in the natural history and neuroimaging features between infantile and early childhood VWM.

Effects of interactive games on motor performance in children with spastic cerebral palsy.

PubMed

AlSaif, Amer A; Alsenany, Samira

2015-06-01

[Purpose] Motor control and muscle strength impairments are the prime reasons for motor behavior disorders in children with spastic cerebral palsy. These impairments lead to histological changes in muscle growth and the learning of motor skills. Therefore, such children experience reduced muscle force generation and decreased muscle flexibility. We investigated the effect of training with Nintendo Wii Fit games on motor performance in children with spastic cerebral palsy. [Subjects and Methods] Forty children with cerebral palsy spastic diplegia aged 6-10 years diagnosed with level-3 functional capabilities according to the Gross Motor Classification System (GMFCS) were enrolled. Participants were divided randomly into equal groups: group (A) that practiced with the Nintendo Wii Fit game for at least 20 minutes/day for 12 weeks and group (B) that underwent no training (control group). The Movement Assessment Battery for Children-2 (mABC-2) was used to assess motor performance, because it mainly involves motor tasks very similar to those involved in playing Nintendo Wii Fit games, e.g., goal-directed arm movements, balancing, and jumping. [Results] There were significant improvements in the subscales of the motor performance test of those who practiced with the Nintendo Wii, while the control group showed no significant changes. [Conclusion] Using motion interactive games in home rehabilitation is feasible for children with cerebral palsy.

Australian Cerebral Palsy Child Study: protocol of a prospective population based study of motor and brain development of preschool aged children with cerebral palsy.

PubMed

Boyd, Roslyn N; Jordan, Rachel; Pareezer, Laura; Moodie, Anne; Finn, Christine; Luther, Belinda; Arnfield, Evyn; Pym, Aaron; Craven, Alex; Beall, Paula; Weir, Kelly; Kentish, Megan; Wynter, Meredith; Ware, Robert; Fahey, Michael; Rawicki, Barry; McKinlay, Lynne; Guzzetta, Andrea

2013-06-11

Cerebral palsy (CP) results from a static brain lesion during pregnancy or early life and remains the most common cause of physical disability in children (1 in 500). While the brain lesion is static, the physical manifestations and medical issues may progress resulting in altered motor patterns. To date, there are no prospective longitudinal studies of CP that follow a birth cohort to track early gross and fine motor development and use Magnetic Resonance Imaging (MRI) to determine the anatomical pattern and likely timing of the brain lesion. Existing studies do not consider treatment costs and outcomes. This study aims to determine the pathway(s) to motor outcome from diagnosis at 18 months corrected age (c.a.) to outcome at 5 years in relation to the nature of the brain lesion (using structural MRI). This prospective cohort study aims to recruit a total of 240 children diagnosed with CP born in Victoria (birth years 2004 and 2005) and Queensland (birth years 2006-2009). Children can enter the study at any time between 18 months to 5 years of age and will be assessed at 18, 24, 30, 36, 48 and 60 months c.a. Outcomes include gross motor function (GMFM-66 & GMFM-88), Gross Motor Function Classification System (GMFCS); musculoskeletal development (hip displacement, spasticity, muscle contracture), upper limb function (Manual Ability Classification System), communication difficulties using Communication and Symbolic Behaviour Scales-Developmental Profile (CSBS-DP), participation using the Paediatric Evaluation of Disability Inventory (PEDI), parent reported quality of life and classification of medical and allied health resource use and determination of the aetiology of CP using clinical evaluation combined with MRI. The relationship between the pathways to motor outcome and the nature of the brain lesion will be analysed using multiple methods including non-linear modelling, multilevel mixed-effects models and generalised estimating equations. This protocol describes a large population-based study of early motor development and brain structure in a representative sample of preschool aged children with CP, using direct clinical assessment. The results of this study will be published in peer reviewed journals and presented at relevant international conferences. Australia and New Zealand Clinical Trials Register (ACTRN1261200169820).

Australian Cerebral Palsy Child Study: protocol of a prospective population based study of motor and brain development of preschool aged children with cerebral palsy

PubMed Central

2013-01-01

Background Cerebral palsy (CP) results from a static brain lesion during pregnancy or early life and remains the most common cause of physical disability in children (1 in 500). While the brain lesion is static, the physical manifestations and medical issues may progress resulting in altered motor patterns. To date, there are no prospective longitudinal studies of CP that follow a birth cohort to track early gross and fine motor development and use Magnetic Resonance Imaging (MRI) to determine the anatomical pattern and likely timing of the brain lesion. Existing studies do not consider treatment costs and outcomes. This study aims to determine the pathway(s) to motor outcome from diagnosis at 18 months corrected age (c.a.) to outcome at 5 years in relation to the nature of the brain lesion (using structural MRI). Methods This prospective cohort study aims to recruit a total of 240 children diagnosed with CP born in Victoria (birth years 2004 and 2005) and Queensland (birth years 2006–2009). Children can enter the study at any time between 18 months to 5 years of age and will be assessed at 18, 24, 30, 36, 48 and 60 months c.a. Outcomes include gross motor function (GMFM-66 & GMFM-88), Gross Motor Function Classification System (GMFCS); musculoskeletal development (hip displacement, spasticity, muscle contracture), upper limb function (Manual Ability Classification System), communication difficulties using Communication and Symbolic Behaviour Scales-Developmental Profile (CSBS-DP), participation using the Paediatric Evaluation of Disability Inventory (PEDI), parent reported quality of life and classification of medical and allied health resource use and determination of the aetiology of CP using clinical evaluation combined with MRI. The relationship between the pathways to motor outcome and the nature of the brain lesion will be analysed using multiple methods including non-linear modelling, multilevel mixed-effects models and generalised estimating equations. Discussion This protocol describes a large population-based study of early motor development and brain structure in a representative sample of preschool aged children with CP, using direct clinical assessment. The results of this study will be published in peer reviewed journals and presented at relevant international conferences. Trial registration Australia and New Zealand Clinical Trials Register (ACTRN1261200169820) PMID:23758951

Construct Validity and Reliability of the SARA Gait and Posture Sub-scale in Early Onset Ataxia

PubMed Central

Lawerman, Tjitske F.; Brandsma, Rick; Verbeek, Renate J.; van der Hoeven, Johannes H.; Lunsing, Roelineke J.; Kremer, Hubertus P. H.; Sival, Deborah A.

2017-01-01

Aim: In children, gait and posture assessment provides a crucial marker for the early characterization, surveillance and treatment evaluation of early onset ataxia (EOA). For reliable data entry of studies targeting at gait and posture improvement, uniform quantitative biomarkers are necessary. Until now, the pediatric test construct of gait and posture scores of the Scale for Assessment and Rating of Ataxia sub-scale (SARA) is still unclear. In the present study, we aimed to validate the construct validity and reliability of the pediatric (SARAGAIT/POSTURE) sub-scale. Methods: We included 28 EOA patients [15.5 (6–34) years; median (range)]. For inter-observer reliability, we determined the ICC on EOA SARAGAIT/POSTURE sub-scores by three independent pediatric neurologists. For convergent validity, we associated SARAGAIT/POSTURE sub-scores with: (1) Ataxic gait Severity Measurement by Klockgether (ASMK; dynamic balance), (2) Pediatric Balance Scale (PBS; static balance), (3) Gross Motor Function Classification Scale -extended and revised version (GMFCS-E&R), (4) SARA-kinetic scores (SARAKINETIC; kinetic function of the upper and lower limbs), (5) Archimedes Spiral (AS; kinetic function of the upper limbs), and (6) total SARA scores (SARATOTAL; i.e., summed SARAGAIT/POSTURE, SARAKINETIC, and SARASPEECH sub-scores). For discriminant validity, we investigated whether EOA co-morbidity factors (myopathy and myoclonus) could influence SARAGAIT/POSTURE sub-scores. Results: The inter-observer agreement (ICC) on EOA SARAGAIT/POSTURE sub-scores was high (0.97). SARAGAIT/POSTURE was strongly correlated with the other ataxia and functional scales [ASMK (rs = -0.819; p < 0.001); PBS (rs = -0.943; p < 0.001); GMFCS-E&R (rs = -0.862; p < 0.001); SARAKINETIC (rs = 0.726; p < 0.001); AS (rs = 0.609; p = 0.002); and SARATOTAL (rs = 0.935; p < 0.001)]. Comorbid myopathy influenced SARAGAIT/POSTURE scores by concurrent muscle weakness, whereas comorbid myoclonus predominantly influenced SARAKINETIC scores. Conclusion: In young EOA patients, separate SARAGAIT/POSTURE parameters reveal a good inter-observer agreement and convergent validity, implicating the reliability of the scale. In perspective of incomplete discriminant validity, it is advisable to interpret SARAGAIT/POSTURE scores for comorbid muscle weakness. PMID:29326569

Family ecology of young children with cerebral palsy.

PubMed

LaForme Fiss, A; Chiarello, L A; Bartlett, D; Palisano, R J; Jeffries, L; Almasri, N; Chang, H-J

2014-07-01

Family ecology in early childhood may influence children's activity and participation in daily life. The aim of this study was to describe family functioning, family expectations of their children, family support to their children, and supports for families of young children with cerebral palsy (CP) based on children's gross motor function level. Participants were 398 children with CP (mean age = 44.9 months) and their parents residing in the USA and Canada. Parents completed four measures of family ecology, the Family Environment Scale (FES), Family Expectations of Child (FEC), Family Support to Child (FSC) and Family Support Scale (FSS). The median scores on the FES indicated average to high family functioning and the median score on the FSS indicated that families had helpful family supports. On average, parents reported high expectations of their children on the FEC and strong support to their children on the FSC. On the FES, higher levels of achievement orientation were reported by parents of children in Gross Motor Function Classification System (GMFCS) level II than parents of children in level I, and higher levels of control were reported by parents of children in level I than parents of children in level IV. On the FEC, parents of children with limited gross motor function (level V) reported lower expectations than parents of children at all other levels. Family ecology, including family strengths, expectations, interests, supports and resources, should be discussed when providing interventions and supports for young children with CP and their families. © 2013 John Wiley & Sons Ltd.

Relationships between developmental profiles and ambulatory ability in A follow-up study of preschool children with spastic quadriplegic cerebral palsy.

PubMed

Chen, Chia-Ling; Chen, Chung-Yao; Lin, Keh-Chung; Chen, Kai-Hua; Wu, Ching-Yi; Lin, Chu-Hsu; Liu, Wen-Yu; Hsu, Hung-Chih

2010-01-01

To investigate the follow-up course of developmental profiles in preschool children with spastic quadriplegic (SQ) cerebral palsy (CP) who had varying ambulatory abilities. Forty-eight children with SQ CP between 1 and 5 years old were classified into 2 groups, the ambulatory and non-ambulatory groups, based on Gross Motor Function Classification System (GMFCS) levels during the initial assessment. The developmental profiles, consisting of development quotients (DQs) of 8 domains, were evaluated during the initial assessment and the final assessment one year later. The DQ change index (%) was calculated as 100% X (final DQ-initial DQ)/initial DQ. The DQs of all developmental domains in the non-ambulatory group were lower than those in the ambulatory group on both initial and final assessments (p<0.01). As indicated by the DQ change indices, most DQs in the ambulatory group decreased slightly, whereas those in the non-ambulatory group decreased considerably (p<0.05). Furthermore, fine motor function increased proportionally with age in the ambulatory group, but not in the non-ambulatory group. The DQs of the developmental profiles varied in preschool CP children with different ambulatory abilities. The course of developmental profiles in preschool children with SQ CP evolves with age and relates to the degree of ambulatory function. Knowledge of these developmental profiles may be helpful in understanding, predicting, and managing the developmental problems of these children.

Gross motor function is an important predictor of daily physical activity in young people with bilateral spastic cerebral palsy.

PubMed

Bania, Theofani A; Taylor, Nicholas F; Baker, Richard J; Graham, H Kerr; Karimi, Leila; Dodd, Karen J

2014-12-01

The aim of the study was to describe daily physical activity levels of adolescents and young adults with bilateral spastic cerebral palsy (CP) and to identify factors that help predict these levels. Daily physical activity was measured using an accelerometer-based activity monitor in 45 young people with bilateral spastic CP (23 males, 22 females; mean age 18y 6mo [SD 2y 5mo] range 16y 1mo-20y 11mo); classified as Gross Motor Function Classification System (GMFCS) level II or III and with contractures of <20° at hip and knee. Predictor variables included demographic characteristics (age, sex, weight) and physical characteristics (gross motor function, lower limb muscle strength, 6min walk distance). Data were analyzed using the information-theoretic approach, using the Akaike information criterion (AIC) and linear regression. Daily activity levels were low compared with published norms. Gross Motor Function Measure Dimension-E (GMFM-E; walking, running, and jumping) was the only common predictor variable in models that best predicted energy expenditure, number of steps, and time spent sitting/lying. GMFM Dimension-D (standing) and bilateral reverse leg press strength contributed to the models that predicted daily physical activity. Adolescents and young adults with bilateral spastic CP and mild to moderate walking disabilities have low levels of daily activity. The GMFM-E was an important predictor of daily physical activity. © 2014 Mac Keith Press.

Gastrostomy feeding in cerebral palsy: enough and no more.

PubMed

Vernon-Roberts, Angharad; Wells, Jonathan; Grant, Hugh; Alder, Nicola; Vadamalayan, Babu; Eltumi, Muftah; Sullivan, Peter B

2010-12-01

gastrostomy feeding children with spastic quadriplegic cerebral palsy (SQCP) improves weight gain but may cause excess deposition of body fat. This study was designed to investigate whether weight gain could be achieved without an adverse effect on body composition by using a low-energy feed in gastrostomy-fed children with SQCP. ourteen children (seven male; seven female; median age 2y; range 10mo-11y) with SQCP were studied, 13 of whom were classified as Gross Motor Function Classification Score (GMFCS) level V and one as GMFCS level IV. Children were eligible for the study if they weighed between 8 and 30kg with a diagnosis of severe SQCP and significant feeding difficulties in whom a clinical decision had been made to insert a gastrostomy feeding tube. The feed used in the study had an energy concentration of 0.75kcal/mL (Nutrini Low Energy Multi Fibre). Assessments were performed before gastrostomy insertion (baseline) and after 6months, and included body composition, growth, nutritional intake, and gastrointestinal symptoms. there was a significant increase in weight (median difference 1.9kg; 95% confidence interval [CI] 0.85-3.03kg; p=0.012), mid-upper arm circumference (median difference 1.45cm; 95% CI -0.36cm to 3.47cm; p=0.043), and lower leg length (median difference 1.62cm; 95% CI 0.44-3.95cm; p=0.012) over the 6 months. There was no significant increase in fat mass index (median diff 1.21, 95% CI -1.15 to 2.94, p=0.345) or fat free mass index (median diff -1.43, 95% CI -1.15 to 2.94, p=0.249). Micronutrient levels remained within reference ranges with the exception of elevated chromium. The median percentage intake of the estimated average requirements for energy (kcal) was 43% at the beginning of the study and 48.8% after 6 months on the low-energy feed. children with SQCP who are fed a low-energy, micronutrient-complete, high-fibre feed continue to grow even with energy intakes below 75% of the estimated average requirements. This was not associated with a disproportionate rise in fat mass or fat percentage, and the majority of micronutrient levels remained within the reference range.

What makes children with cerebral palsy vulnerable to malnutrition? Findings from the Bangladesh cerebral palsy register (BCPR).

PubMed

Jahan, Israt; Muhit, Mohammad; Karim, Tasneem; Smithers-Sheedy, Hayley; Novak, Iona; Jones, Cheryl; Badawi, Nadia; Khandaker, Gulam

2018-04-16

To assess the nutritional status and underlying risk factors for malnutrition among children with cerebral palsy in rural Bangladesh. We used data from the Bangladesh Cerebral Palsy Register; a prospective population based surveillance of children with cerebral palsy aged 0-18 years in a rural subdistrict of Bangladesh (i.e., Shahjadpur). Socio-demographic, clinical and anthropometric measurements were collected using Bangladesh Cerebral Palsy Register record form. Z scores were calculated using World Health Organization Anthro and World Health Organization AnthroPlus software. A total of 726 children with cerebral palsy were registered into the Bangladesh Cerebral Palsy Register (mean age 7.6 years, standard deviation 4.5, 38.1% female) between January 2015 and December 2016. More than two-third of children were underweight (70.0%) and stunted (73.1%). Mean z score for weight for age, height for age and weight for height were -2.8 (standard deviation 1.8), -3.1 (standard deviation 2.2) and -1.2 (standard deviation 2.3) respectively. Moderate to severe undernutrition (i.e., both underweight and stunting) were significantly associated with age, monthly family income, gross motor functional classification system and neurological type of cerebral palsy. The burden of undernutrition is high among children with cerebral palsy in rural Bangladesh which is augmented by both poverty and clinical severity. Enhancing clinical nutritional services for children with cerebral palsy should be a public health priority in Bangladesh. Implications for Rehabilitation Population-based surveillance data on nutritional status of children with cerebral palsy in Bangladesh indicates substantially high burden of malnutrition among children with CP in rural Bangladesh. Children with severe form of cerebral palsy, for example, higher Gross Motor Function Classification System (GMFCS) level, tri/quadriplegic cerebral palsy presents the highest proportion of severe malnutrition; hence, these vulnerable groups should be focused in designing nutrition intervention and rehabilitation programs. Disability inclusive and focused nutrition intervention programme need to be kept as priority in national nutrition policies and nutrition action plans specially in low- and middle-income countries. Community-based management of malnutrition has the potential to overcome this poor nutritional scenario of children with disability (i.e., cerebral palsy). The global leaders such as World Health Organization, national and international organizations should take this in account and conduct further research to develop nutritional guidelines for this vulnerable group of population.

Energy expenditure in adults with cerebral palsy playing Wii Sports.

PubMed

Hurkmans, Henri L; van den Berg-Emons, Rita J; Stam, Henk J

2010-10-01

To determine energy expenditure of adults with bilateral spastic cerebral palsy while playing Wii Sports tennis and boxing. Cross-sectional study. University medical center. Five men and 3 women with bilateral spastic cerebral palsy and ambulatory ability (Gross Motor Function Classification System level I or II) participated. The mean participant age ± SD was 36±7 years. Exclusion criteria were comorbidities that affected daily physical activity and fitness, contraindications to exercise, or inability to understand study instructions owing to cognitive disorders or language barriers. Participants played Wii Sports tennis and boxing, each for 15 minutes in random order. By using a portable gas analyzer, we assessed energy expenditure by oxygen uptake (Vo(2)) while sitting and during Wii Sports game play. Energy expenditure is expressed in metabolic equivalents (METs), which were calculated as Vo(2) during Wii Sports play divided by Vo(2) during sitting. Mean ± SD energy expenditure during Wii Sports game play was 4.5±1.1METs for tennis and 5.0±1.1METs for boxing (P=.024). All participants attained energy expenditures greater than 3METs, and 2 participants attained energy expenditures greater than 6METs while playing Wii Sports tennis or boxing. Both Wii Sports tennis and boxing seem to provide at least moderate-intensity exercise in adults with bilateral spastic cerebral palsy (GMFCS level I or II). These games, therefore, may be useful as treatment to promote more active and healthful lifestyles in these patients. Further research is needed to determine the energy expenditures of other physically disabled patient groups while playing active video games, and to determine the effectiveness of these games in improving health and daily activity levels. Copyright © 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Gross motor function change after multilevel soft tissue release in children with cerebral palsy.

PubMed

Chang, Chia-Hsieh; Chen, Yu-Ying; Yeh, Kuo-Kuang; Chen, Chia-Ling

2017-06-01

Improving motor function is a major goal of therapy for children with cerebral palsy (CP). However, changes in motor function after orthopedic surgery for gait disorders are seldom discussed. This study aimed to evaluate the postoperative changes in gross motor function and to investigate the prognostic factors for such changes. We prospectively studied 25 children with CP (4-12 years) who were gross motor function classification system (GMFCS) level II to IV and and underwent bilateral multilevel soft-tissue release for knee flexion gait. Patients were evaluated preoperatively and at 6 weeks and 3 and 6 months postoperatively for Gross Motor Function Measure (GMFM-66), range of motion, spasticity, and selective motor control. The associations between change in GMFM-66 score and possible factors were analyzed. 25 children with gross motor function level II to IV underwent surgery at a mean age of 8.6 years (range, 4-12 years). Mean GMFM-66 score decreased from 55.9 at baseline to 54.3 at 6-weeks postoperatively and increased to 57.5 at 6-months postoperatively (p < 0.05). Regression analysis revealed better gross motor function level and greater surgical reduction of spasticity were predictors for decreased GMFM-66 score at 6-weeks postoperatively. Younger age was a predictor for increased GMFM-66 score at 6-months postoperatively. Reduction of contracture and spasticity and improvement of selective motor control were noted after surgery in children with CP. However, a down-and-up course of GMFM-66 score was noted. It is emphasized that deterioration of motor function in children with ambulatory ability and the improvement in young children after orthopedic surgery for gait disorders. case series, therapeutic study, level 4. Copyright © 2017 Chang Gung University. Published by Elsevier B.V. All rights reserved.

Determinants of responsiveness to botulinum toxin, casting, and bracing in the treatment of spastic equinus in children with cerebral palsy.

PubMed

Yap, Rita; Majnemer, Annette; Benaroch, Thierry; Cantin, Marie-Andree

2010-02-01

The objective was to determine whether specific intrinsic (age, pattern of cerebral palsy [CP], child's motivation) and extrinsic (number of treatments, parenting stress) characteristics were associated with responsiveness to botulinum toxin A (BoNT-A) injections in children with CP 3 months after injection into the gastrocnemius muscle. Children with hemiplegia or diplegia recruited from a BoNT-A programme were evaluated before and 3 months following injection of BoNT-A into the gastrocnemius. Outcome measures included muscle tone, range of motion, gait pattern, level of ambulation, gross motor function, and functional independence. Determinants of responsiveness to BoNT-A considered were age, number of treatments, distribution of CP, parenting stress, and motivation. Thirty-one children were recruited (17 males, 14 females)--22 with hemiplegia and nine with diplegia. Twenty-eight were classified at Gross Motor Function Classification System (GMFCS) level I and three at level III. The mean age was 6 years 4 months (SD 2y 11mo). Younger age (p=0.015) and fewer number (p=0.024) of BoNT-A treatments were associated with greater change in gross motor function. Child's motivation and parenting stress were significantly associated with improvements in muscle tone (p=0.006-0.017), passive range of motion (p=0.008-0.033), gait pattern (p=0.005-0.042), level of ambulation (p=0.001-0.043), and functional independence (p=0.004-0.027). The results indicate that child, family, and treatment characteristics influence the degree of responsiveness to BoNT-A treatment. The contribution of contextual factors (personal and environmental) on responsiveness may be underappreciated in children with CP.

Accuracy of skinfold and bioelectrical impedance assessments of body fat percentage in ambulatory individuals with cerebral palsy.

PubMed

Oeffinger, Donna J; Gurka, Matthew J; Kuperminc, Michelle; Hassani, Sahar; Buhr, Neeley; Tylkowski, Chester

2014-05-01

This study assessed the accuracy of measurements of body fat percentage in ambulatory individuals with cerebral palsy (CP) from bioelectrical impedance analysis (BIA) and skinfold equations. One hundred and twenty-eight individuals (65 males, 63 females; mean age 12y, SD 3, range 6-18y) with CP (Gross Motor Function Classification System [GMFCS] levels I (n=6), II (n=46), and III (n=19) participated. Body fat percentage was estimated from (1) BIA using standing height and estimated heights (knee height and tibial length) and (2) triceps and subscapular skinfolds using standard and CP-specific equations. All estimates of body fat percentage were compared with body fat percentage from dual-energy X-ray absorptiometry (DXA) scans. Differences between DXA, BIA, and skinfold body fat percentage were analyzed by comparing mean differences. Agreement was assessed by Bland-Altman plots and concordance correlation coefficients (CCC). BMI was moderately correlated with DXA (Pearson's r=0.53). BIA body fat percentage was significantly different from DXA when using estimated heights (95% confidence intervals [CIs] do not contain 0) but not standing height (95% CI -1.9 to 0.4). CCCs for all BIA comparisons indicated good to excellent agreement (0.75-0.82) with DXA. Body fat percentage from skinfold measurements and CP-specific equations was not significantly different from DXA (mean 0.8%; SD 5.3%; 95% CI -0.2 to 1.7) and demonstrated strong agreement with DXA (CCC 0.86). Accurate measures of body fat percentage can be obtained using BIA and two skinfold measurements (CP-specific equations) in ambulatory individuals with CP. These findings should encourage assessments of body fat in clinical and research practices. © 2013 Mac Keith Press.

Reliability and Validity of Objective Measures of Physical Activity in Youth With Cerebral Palsy Who Are Ambulatory.

PubMed

O'Neil, Margaret E; Fragala-Pinkham, Maria; Lennon, Nancy; George, Ameeka; Forman, Jeffrey; Trost, Stewart G

2016-01-01

Physical therapy for youth with cerebral palsy (CP) who are ambulatory includes interventions to increase functional mobility and participation in physical activity (PA). Thus, reliable and valid measures are needed to document PA in youth with CP. The purpose of this study was to evaluate the inter-instrument reliability and concurrent validity of 3 accelerometer-based motion sensors with indirect calorimetry as the criterion for measuring PA intensity in youth with CP. Fifty-seven youth with CP (mean age=12.5 years, SD=3.3; 51% female; 49.1% with spastic hemiplegia) participated. Inclusion criteria were: aged 6 to 20 years, ambulatory, Gross Motor Function Classification System (GMFCS) levels I through III, able to follow directions, and able to complete the full PA protocol. Protocol activities included standardized activity trials with increasing PA intensity (resting, writing, household chores, active video games, and walking at 3 self-selected speeds), as measured by weight-relative oxygen uptake (in mL/kg/min). During each trial, participants wore bilateral accelerometers on the upper arms, waist/hip, and ankle and a portable indirect calorimeter. Intraclass coefficient correlations (ICCs) were calculated to evaluate inter-instrument reliability (left-to-right accelerometer placement). Spearman correlations were used to examine concurrent validity between accelerometer output (activity and step counts) and indirect calorimetry. Friedman analyses of variance with post hoc pair-wise analyses were conducted to examine the validity of accelerometers to discriminate PA intensity across activity trials. All accelerometers exhibited excellent inter-instrument reliability (ICC=.94-.99) and good concurrent validity (rho=.70-.85). All accelerometers discriminated PA intensity across most activity trials. This PA protocol consisted of controlled activity trials. Accelerometers provide valid and reliable measures of PA intensity among youth with CP. © 2016 American Physical Therapy Association.

Social adjustment of children with cerebral palsy in mainstream classes: peer perception.

PubMed

Nadeau, Line; Tessier, Réjean

2006-05-01

The aim of this study was to describe the social experience of children with cerebral palsy (CP) in mainstream classes in Canada and compare it with that of their classmates without disability. The CP group included 25 females and 35 males (mean age 10 y 5 mo [SD 0.95], range 10 y 4 mo-10 y 10 mo) diagnosed as having hemiplegia (n=44) or diplegia (n=16) and classified as Level I on the Gross Motor Function Classification System (GMFCS). Fifty-seven comparison children, born at term and without any motor and/or sensory impairment, were recruited from the classes of the children with CP during a school visit (mean age 10 y 3 mo, [SD 1.0], range 10 y-10 y 6 mo). They were matched to children with CP for sex, age, parents' education level, and family income. Social adjustment measures (social status, reciprocated friendships, social isolation, aggression, sociability/leadership, and verbal and/or physical victimization) were obtained by conducting a class-wide sociometric interview (n=943) in the classes of the children with CP. Findings showed that children with CP (specifically females with CP and irrespective of their type of disability) had fewer reciprocated friendships, exhibited fewer sociable/leadership behaviours, and were more isolated and victimized by their peers than their classmates without a disability. This seems to suggest that females and males with CP are perceived differently from their peers in a mainstreaming context. The discussion addresses the issue of age- and sex-related differences and provides avenues of intervention relating to personal and environmental factors that could facilitate or interfere with the social experience of children with CP in a mainstream environment.

[Refractive errors in patients with cerebral palsy].

PubMed

Mrugacz, Małgorzata; Bandzul, Krzysztof; Kułak, Wojciech; Poppe, Ewa; Jurowski, Piotr

2013-04-01

Ocular changes are common in patients with cerebral palsy (CP) and they exist in about 50% of cases. The most common are refractive errors and strabismus disease. The aim of the paper was to estimate the relativeness between refractive errors and neurological pathologies in patients with selected types of CP. MATERIAL AND METHODS. The subject of the analysis was showing refractive errors in patients within two groups of CP: diplegia spastica and tetraparesis, with nervous system pathologies taken into account. Results. This study was proven some correlations between refractive errors and type of CP and severity of the CP classified in GMFCS scale. Refractive errors were more common in patients with tetraparesis than with diplegia spastica. In the group with diplegia spastica more common were myopia and astigmatism, however in tetraparesis - hyperopia.

Effects of Botulinum Toxin-A and Goal-Directed Physiotherapy in Children with Cerebral Palsy GMFCS Levels I & II.

PubMed

Löwing, Kristina; Thews, Karin; Haglund-Åkerlind, Yvonne; Gutierrez-Farewik, Elena M

2017-08-01

To evaluate short and long-term effects of botulinum toxin-A combined with goal-directed physiotherapy in children with cerebral palsy (CP). A consecutive selection of 40 children, ages 4-12 years, diagnosed with unilateral or bilateral CP, and classified in GMFCS levels I-II. During the 24 months, 9 children received one BoNT-A injection, 10 children two injections, 11 children three injections, and 10 children received four injections. 3D gait analysis, goal-attainment scaling, and body function assessments were performed before and at 3, 12, and 24 months after initial injections. A significant but clinically small long-term improvement in gait was observed. Plantarflexor spasticity was reduced after three months and remained stable, while passive ankle dorsiflexion increased after 3 months but decreased slightly after 12 months. Goal-attainment gradually increased, reached the highest levels at 12 months, and levels were maintained at 24 months. The treatments' positive effect on spasticity reduction was identified, but did not relate to improvement in gait or goal-attainment. No long-term positive change in passive ankle dorsiflexion was observed. Goal attainment was achieved in all except four children. The clinical significance of the improved gait is unclear. Further studies are recommended to identify predictors for positive treatment outcome.

Modified constraint-induced therapy for children with hemiplegic cerebral palsy: a randomized trial.

PubMed

Wallen, Margaret; Ziviani, Jenny; Naylor, Olivia; Evans, Ruth; Novak, Iona; Herbert, Robert D

2011-12-01

Conventional constraint-based therapies are intensive and demanding to implement, particularly for children. Modified forms of constraint-based therapies that are family-centred may be more acceptable and feasible for families of children with cerebral palsy (CP)-but require rigorous evaluation using randomized trials. The aim of this study was to determine the effects of modified constraint-induced therapy compared with intensive occupational therapy on activities of daily living and upper limb outcomes in children with hemiplegic CP. In this assessor-blinded pragmatic randomized trial, 50 children (27 males, 23 females; age range 19 mo-7 y 10 mo) with hemiplegic CP were randomized using a concealed allocation procedure to one of two 8-week interventions: intensive occupational therapy (n = 25), or modified constraint-induced therapy (n = 25). Manual Ability Classification System (MACS) levels of the participants were, level I n = 2, II n = 37, III n = 8, and level IV n = 1; Gross Motor Function Classification System (GMFCS) levels were, level I n = 33, level II n = 15, and level III n = 1. Participants were recruited through three specialist CP centres in Australia and randomized between January 2008 and April 2010. Children randomized to modified constraint-induced therapy wore a mitt on the unaffected hand for 2 hours each day, during which time the children participated in targeted therapy. The primary outcome was the Canadian Occupational Performance Measure (COPM--measured on a 10-point scale) at completion of therapy. Other outcome measures were Goal Attainment Scaling, Assisting Hand Assessment, Pediatric Motor Activity Log, Modified Ashworth Scale, Modified Tardieu Scale, and a parent questionnaire. Assessments were carried out at 10 weeks and 6 months following randomization. All participants were included in the analysis. Between-group differences for all outcomes were neither clinically important nor statistically significant. The mean difference in COPM was 0.3 (95% confidence interval [CI] -0.8 to 1.4; p=0.61) and mean difference in COPM satisfaction was 0.1 (95% CI -1.1 to 1.2; p=0.90). Minor adverse events were reported by five of the 25 participants in the modified constraint-induced therapy group and by one of the 25 in the intensive occupational therapy group. All adverse events were related to participants' lack of acceptance of therapy. Modified constraint-induced therapy is no more effective than intensive occupational therapy for improving completion of activities of daily living or upper limb function in children with hemiplegic CP. © The Authors. Developmental Medicine & Child Neurology © 2011 Mac Keith Press.

Effect of Depth and Duration of Cooling on Death or Disability at Age 18 Months Among Neonates With Hypoxic-Ischemic Encephalopathy: A Randomized Clinical Trial.

PubMed

Shankaran, Seetha; Laptook, Abbot R; Pappas, Athina; McDonald, Scott A; Das, Abhik; Tyson, Jon E; Poindexter, Brenda B; Schibler, Kurt; Bell, Edward F; Heyne, Roy J; Pedroza, Claudia; Bara, Rebecca; Van Meurs, Krisa P; Huitema, Carolyn M Petrie; Grisby, Cathy; Devaskar, Uday; Ehrenkranz, Richard A; Harmon, Heidi M; Chalak, Lina F; DeMauro, Sara B; Garg, Meena; Hartley-McAndrew, Michelle E; Khan, Amir M; Walsh, Michele C; Ambalavanan, Namasivayam; Brumbaugh, Jane E; Watterberg, Kristi L; Shepherd, Edward G; Hamrick, Shannon E G; Barks, John; Cotten, C Michael; Kilbride, Howard W; Higgins, Rosemary D

2017-07-04

Hypothermia for 72 hours at 33.5°C for neonatal hypoxic-ischemic encephalopathy reduces death or disability, but rates continue to be high. To determine if cooling for 120 hours or to a temperature of 32.0°C reduces death or disability at age 18 months in infants with hypoxic-ischemic encephalopathy. Randomized 2 × 2 factorial clinical trial in neonates (≥36 weeks' gestation) with hypoxic-ischemic encephalopathy at 18 US centers in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network between October 2010 and January 2016. A total of 364 neonates were randomly assigned to 4 hypothermia groups: 33.5°C for 72 hours (n = 95), 32.0°C for 72 hours (n = 90), 33.5°C for 120 hours (n = 96), or 32.0°C for 120 hours (n = 83). The primary outcome was death or moderate or severe disability at 18 to 22 months of age adjusted for center and level of encephalopathy. Severe disability included any of Bayley Scales of Infant Development III cognitive score less than 70, Gross Motor Function Classification System (GMFCS) level of 3 to 5, or blindness or hearing loss despite amplification. Moderate disability was defined as a cognitive score of 70 to 84 and either GMFCS level 2, active seizures, or hearing with amplification. The trial was stopped for safety and futility in November 2013 after 364 of the planned 726 infants were enrolled. Among 347 infants (95%) with primary outcome data (mean age at follow-up, 20.7 [SD, 3.5] months; 42% female), death or disability occurred in 56 of 176 (31.8%) cooled for 72 hours and 54 of 171 (31.6%) cooled for 120 hours (adjusted risk ratio, 0.92 [95% CI, 0.68-1.25]; adjusted absolute risk difference, -1.0% [95% CI, -10.2% to 8.1%]) and in 59 of 185 (31.9%) cooled to 33.5°C and 51 of 162 (31.5%) cooled to 32.0°C (adjusted risk ratio, 0.92 [95% CI, 0.68-1.26]; adjusted absolute risk difference, -3.1% [95% CI, -12.3% to 6.1%]). A significant interaction between longer and deeper cooling was observed (P = .048), with primary outcome rates of 29.3% at 33.5°C for 72 hours, 34.5% at 32.0°C for 72 hours, 34.4% at 33.5°C for 120 hours, and 28.2% at 32.0°C for 120 hours. Among term neonates with moderate or severe hypoxic-ischemic encephalopathy, cooling for longer than 72 hours, cooling to lower than 33.5°C, or both did not reduce death or moderate or severe disability at 18 months of age. However, the trial may be underpowered, and an interaction was found between longer and deeper cooling. These results support the current regimen of cooling for 72 hours at 33.5°C. clinicaltrials.gov Identifier: NCT01192776.

Dynamical structure of center-of-pressure trajectories with and without functional taping in children with cerebral palsy level I and II of GMFCS.

PubMed

Pavão, Silvia Leticia; Ledebt, Annick; Savelsbergh, Geert J P; Rocha, Nelci Adriana C F

2017-08-01

Postural control during quiet standing was examined in typical children (TD) and children with cerebral palsy (CP) level I and II of GMFCS. The immediate effect on postural control of functional taping on the thighs was analyzed. We evaluated 43 TD, 17 CP children level I, and 10 CP children level II. Participants were evaluated in two conditions (with and without taping). The trajectories of the center of pressure (COP) were analyzed by means of conventional posturography (sway amplitude, sway-path-length) and dynamic posturography (degree of twisting-and-turning, sway regularity). Both CP groups showed larger sway amplitude than the TD while only the CP level II showed more regular COP trajectories with less twisting-and-turning. Functional taping didn't affect sway amplitude or sway-path-length. TD children exhibited more twisting-and-turning with functional taping, whereas no effects on postural sway dynamics were observed in CP children. Functional taping doesn't result in immediate changes in quiet stance in CP children, whereas in TD it resulted in faster sway corrections. Children level II invest more attention in postural control than level I, and TD. While quiet standing was more automatized in children level I than in level II, both CP groups showed a less stable balance than TD. Copyright © 2017 Elsevier B.V. All rights reserved.

The integration of probabilistic information during sensorimotor estimation is unimpaired in children with Cerebral Palsy

PubMed Central

Sokhey, Taegh; Gaebler-Spira, Deborah; Kording, Konrad P.

2017-01-01

Background It is important to understand the motor deficits of children with Cerebral Palsy (CP). Our understanding of this motor disorder can be enriched by computational models of motor control. One crucial stage in generating movement involves combining uncertain information from different sources, and deficits in this process could contribute to reduced motor function in children with CP. Healthy adults can integrate previously-learned information (prior) with incoming sensory information (likelihood) in a close-to-optimal way when estimating object location, consistent with the use of Bayesian statistics. However, there are few studies investigating how children with CP perform sensorimotor integration. We compare sensorimotor estimation in children with CP and age-matched controls using a model-based analysis to understand the process. Methods and findings We examined Bayesian sensorimotor integration in children with CP, aged between 5 and 12 years old, with Gross Motor Function Classification System (GMFCS) levels 1–3 and compared their estimation behavior with age-matched typically-developing (TD) children. We used a simple sensorimotor estimation task which requires participants to combine probabilistic information from different sources: a likelihood distribution (current sensory information) with a prior distribution (learned target information). In order to examine sensorimotor integration, we quantified how participants weighed statistical information from the two sources (prior and likelihood) and compared this to the statistical optimal weighting. We found that the weighing of statistical information in children with CP was as statistically efficient as that of TD children. Conclusions We conclude that Bayesian sensorimotor integration is not impaired in children with CP and therefore, does not contribute to their motor deficits. Future research has the potential to enrich our understanding of motor disorders by investigating the stages of motor processing set out by computational models. Therapeutic interventions should exploit the ability of children with CP to use statistical information. PMID:29186196

Physiotherapeutic interventions and physical activity for children in Northern Sweden with cerebral palsy: a register study from equity and gender perspectives.

PubMed

Degerstedt, Frida; Wiklund, Maria; Enberg, Birgit

Young people with disabilities, especially physical disabilities, report worse health than others. This may be because of the disability, lower levels of physical activity, and discrimination. For children with cerebral palsy, access to physiotherapy and physical activity is a crucial prerequisite for good health and function. To date, there is limited knowledge regarding potential gender bias and inequity in habilitation services. To map how physiotherapeutic interventions (PTI), physical leisure activity, and physical education are allocated for children with cerebral palsy regarding sex, age, level of gross motor function, and county council affiliation. This was done from a gender and equity perspective. A register study using data from the Cerebral Palsy follow-Up Program (CPUP). Data included 313 children ≤18 years with cerebral palsy from the five northern counties in Sweden during 2013. Motor impairment of the children was classified according to the expanded and revised Gross Motor Function Classification System (GMFCS). In three county councils, boys received more physiotherapy interventions and received them more frequently than girls did. Differences between county councils were seen for frequency and reasons for physiotherapy interventions (p < 0.001). The physiotherapist was involved more often with children who had lower motor function and with children who had low physical leisure activity. Children with lower motor function level participated in physical leisure activity less often than children with less motor impairment (p < 0.001). Boys participated more frequently in physical education than did girls (p = 0.028). Gender and county council affiliation affect the distribution of physiotherapy interventions for children with cerebral palsy, and there are associations between gender and physical activity. Thus, the intervention is not always determined by the needs of the child or the degree of impairment. A gender-bias is indicated. Further studies are needed to ensure fair interventions.

Pediatric endurance and limb strengthening for children with cerebral palsy (PEDALS) – a randomized controlled trial protocol for a stationary cycling intervention

PubMed Central

Fowler, Eileen G; Knutson, Loretta M; DeMuth, Sharon K; Sugi, Mia; Siebert, Kara; Simms, Victoria; Azen, Stanley P; Winstein, Carolee J

2007-01-01

Background In the past, effortful exercises were considered inappropriate for children with spastic cerebral palsy (CP) due to concern that they would escalate abnormalities including spasticity and abnormal movement patterns. Current scientific evidence indicates that these concerns were unfounded and that therapeutic interventions focused on muscle strengthening can lead to improved functional ability. However, few studies have examined the potential benefits of cardiorespiratory fitness exercises in this patient population. Methods/design The rationale and design of a randomized controlled trial examining the effects of a stationary cycling intervention for children with CP are outlined here. Sixty children with spastic diplegic CP between the ages of 7 and 18 years and Gross Motor Function Classification System (GMFCS) levels of I, II, or III will be recruited for this study. Participants will be randomly assigned to either an intervention (cycling) or a control (no cycling) group. The cycling intervention will be divided into strengthening and cardiorespiratory endurance exercise phases. During the strengthening phase, the resistance to lower extremity cycling will be progressively increased using a uniquely designed limb-loaded mechanism. The cardiorespiratory endurance phase will focus on increasing the intensity and duration of cycling. Children will be encouraged to exercise within a target heart rate (HR) range (70 – 80% maximum HR). Thirty sessions will take place over a 10–12 week period. All children will be evaluated before (baseline) and after (follow-up) the intervention period. Primary outcome measures are: knee joint extensor and flexor moments, or torque; the Gross Motor Function Measure (GMFM); the 600 Yard Walk-Run test and the Thirty-Second Walk test (30 sec WT). Discussion This paper presents the rationale, design and protocol for Pediatric Endurance and Limb Strengthening (PEDALS); a Phase I randomized controlled trial evaluating the efficacy of a stationary cycling intervention for children with spastic diplegic cerebral palsy. PMID:17374171

Use of the Measure of Processes of Care (MPOC-20) to evaluate health service delivery for children with cerebral palsy and their families in Jordan: validation of Arabic-translated version (AR-MPOC-20).

PubMed

Saleh, M; Almasri, N A

2014-09-01

Family-centred service (FCS) is widely accepted now as best practice in paediatric rehabilitation. The Measure of Processes of Care-20 items set (MPOC-20) is a valid and reliable self-report measure of parents' perceptions of the extent to which health services are family-centred. Arabic-translated and validated version of the MPOC-20 (AR-MPOC-20) is used to examine Jordanian families' perception of service providers' caregiving behaviours as they receive rehabilitation services for their children with cerebral palsy (CP). Parents of 114 children with CP who are receiving services at different settings in Jordan were interviewed using the AR-MPOC-20. Participating children aged 4.1 ± 4.4 years, 53.5% were males. Children varied across gross motor functional classification system (GMFCS). Parents were mostly mothers (76.3%), with at least high school education (71.9%). Factor analyses of the AR-MPOC-20 yielded a five-factor solution with items loaded differently from the original measure. All items correlated best and significantly with their own Arabic scale score (rs: 0.91-0.26, P < 0.01). Internal consistency values of AR-MPOC-20 scales were acceptable (Cronbach's α: 0.69-0.82). Scale 'Providing Written Information' has the lowest average score (1.9 ± 1.6), while scale 'Respectful & Coordinated Care' has the highest average score (5.2 ± 1.5). The AR-MPOC-20 is found to be a valid and reliable measure for use with Arabic-Jordanian families of children with CP. FCS is not yet well implemented in Jordan, with parents reporting more need for information about their children's health and available services. Service providers are encouraged to apply FCS in paediatric rehabilitation, and giving more attention to effective communication and information exchange with families. AR-MPOC-20 is recommended for use for program evaluation.

Physiotherapeutic interventions and physical activity for children in Northern Sweden with cerebral palsy: a register study from equity and gender perspectives

PubMed Central

Degerstedt, Frida; Wiklund, Maria; Enberg, Birgit

2017-01-01

ABSTRACT Background: Young people with disabilities, especially physical disabilities, report worse health than others. This may be because of the disability, lower levels of physical activity, and discrimination. For children with cerebral palsy, access to physiotherapy and physical activity is a crucial prerequisite for good health and function. To date, there is limited knowledge regarding potential gender bias and inequity in habilitation services. Objectives: To map how physiotherapeutic interventions (PTI), physical leisure activity, and physical education are allocated for children with cerebral palsy regarding sex, age, level of gross motor function, and county council affiliation. This was done from a gender and equity perspective. Methods: A register study using data from the Cerebral Palsy follow-Up Program (CPUP). Data included 313 children ≤18 years with cerebral palsy from the five northern counties in Sweden during 2013. Motor impairment of the children was classified according to the expanded and revised Gross Motor Function Classification System (GMFCS). Results: In three county councils, boys received more physiotherapy interventions and received them more frequently than girls did. Differences between county councils were seen for frequency and reasons for physiotherapy interventions (p < 0.001). The physiotherapist was involved more often with children who had lower motor function and with children who had low physical leisure activity. Children with lower motor function level participated in physical leisure activity less often than children with less motor impairment (p < 0.001). Boys participated more frequently in physical education than did girls (p = 0.028). Conclusion: Gender and county council affiliation affect the distribution of physiotherapy interventions for children with cerebral palsy, and there are associations between gender and physical activity. Thus, the intervention is not always determined by the needs of the child or the degree of impairment. A gender-bias is indicated. Further studies are needed to ensure fair interventions. PMID:28219314

Does Nintendo Wii Balance Board improve standing balance? A randomized controlled trial in children with cerebral palsy.

PubMed

Gatica-Rojas, Valeska; Méndez-Rebolledo, Guillermo; Guzman-Muñoz, Eduardo; Soto-Poblete, Alex; Cartes-Velásquez, Ricardo; Elgueta-Cancino, Edith; Cofré Lizama, L Eduardo

2017-08-01

Evidence on the effect of systemic exercise programs to improve the standing balance with the Nintendo Wii system is very limited and its post-treatment effectiveness is unknown in cerebral palsy (CP) patients. Primary aim was to compare the effect of Nintendo Wii balance board (Wii-therapy) and standard physiotherapy (SPT), on the performance of standing balance in children and adolescents with CP. Secondary aim was to determine the post-treatment effectiveness of Wii-therapy and SPT. Two-arm, matched-pairs, parallel-groups, randomized, controlled clinical trial. Outpatient Rehabilitation Centre in the city of Talca. Patients with CP type spastic hemiplegia (SHE) and spastic diplegia (SDI), aged 7 to 14 years, and level I or II of GMFCS or GMFCS-ER. Were excluded patients with FSIQ<80, epilepsy, previous surgeries and application of Botulinum Toxin-A in the lower limb, uncorrected vision and hearing disorders. Thirty-two CP patients (10.7±3.2 years old) were randomly assigned to either Wii-therapy (SDI=7; SHE=9) or SPT intervention (SDI=7; SHE=9). In each group, patients received three sessions per week over a period of 6 weeks. Standing balance was assessed at baseline and every 2 weeks. Additionally, two follow-up assessments (4 additional weeks) were performed to determine post-treatment effectiveness. Standing balance was quantified on force platform obtaining the outcomes area of center-of-pressure (CoP) sway (CoPSway), standard deviation in the medial-lateral (SDML) and the anterior-posterior (SDAP) directions, and velocity in both directions (VML and VAP). Compared to SPT, Wii-therapy significantly reduced the CoPSway (P=0.02) and SDAP in the eyes-open condition (P=0.01). However, the effects wane after 2-4 weeks. Post-hoc analysis revealed that only SHE children benefited from Wii-therapy. Wii-therapy was better than SPT in improving standing balance in patients with CP, but improves the balance only in SHE patients. Also, Wii-therapy effectiveness waned 2-4 weeks after the end the intervention. A systematic exercise program like Wii-therapy using the Nintendo Wii Balance Board device can be considered to improves the standing balance in patients with CP, specifically in the SHE type. This program is easy to transfer to physiotherapists and rehabilitation centers.

Effect of Depth and Duration of Cooling on Death or Disability at Age 18 Months Among Neonates With Hypoxic-Ischemic Encephalopathy

PubMed Central

Laptook, Abbot R.; Pappas, Athina; McDonald, Scott. A.; Das, Abhik; Tyson, Jon E.; Poindexter, Brenda B.; Schibler, Kurt; Bell, Edward F.; Heyne, Roy J.; Pedroza, Claudia; Bara, Rebecca; Van Meurs, Krisa P.; Huitema, Carolyn M. Petrie; Grisby, Cathy; Devaskar, Uday; Ehrenkranz, Richard A.; Harmon, Heidi M.; Chalak, Lina F.; DeMauro, Sara B.; Garg, Meena; Hartley-McAndrew, Michelle E.; Khan, Amir M.; Walsh, Michele C.; Ambalavanan, Namasivayam; Brumbaugh, Jane E.; Watterberg, Kristi L.; Shepherd, Edward G.; Hamrick, Shannon E. G.; Barks, John; Cotten, C. Michael; Kilbride, Howard W.; Higgins, Rosemary D.

2017-01-01

Importance Hypothermia for 72 hours at 33.5°C for neonatal hypoxic-ischemic encephalopathy reduces death or disability, but rates continue to be high. Objective To determine if cooling for 120 hours or to a temperature of 32.0°C reduces death or disability at age 18 months in infants with hypoxic-ischemic encephalopathy. Design, Setting, and Participants Randomized 2 × 2 factorial clinical trial in neonates (≥36 weeks’ gestation) with hypoxic-ischemic encephalopathy at 18 US centers in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network between October 2010 and January 2016. Interventions A total of 364 neonates were randomly assigned to 4 hypothermia groups: 33.5°C for 72 hours (n = 95), 32.0°C for 72 hours (n = 90), 33.5°C for 120 hours (n = 96), or 32.0°C for 120 hours (n = 83). Main Outcomes and Measures The primary outcome was death or moderate or severe disability at 18 to 22 months of age adjusted for center and level of encephalopathy. Severe disability included any of Bayley Scales of Infant Development III cognitive score less than 70, Gross Motor Function Classification System (GMFCS) level of 3 to 5, or blindness or hearing loss despite amplification. Moderate disability was defined as a cognitive score of 70 to 84 and either GMFCS level 2, active seizures, or hearing with amplification. Results The trial was stopped for safety and futility in November 2013 after 364 of the planned 726 infants were enrolled. Among 347 infants (95%) with primary outcome data (mean age at follow-up, 20.7 [SD, 3.5] months; 42% female), death or disability occurred in 56 of 176 (31.8%) cooled for 72 hours and 54 of 171 (31.6%) cooled for 120 hours (adjusted risk ratio, 0.92 [95% CI, 0.68-1.25]; adjusted absolute risk difference, −1.0% [95% CI, −10.2% to 8.1%]) and in 59 of 185 (31.9%) cooled to 33.5°C and 51 of 162 (31.5%) cooled to 32.0°C (adjusted risk ratio, 0.92 [95% CI, 0.68-1.26]; adjusted absolute risk difference, −3.1% [95% CI, −12.3% to 6.1%]). A significant interaction between longer and deeper cooling was observed (P = .048), with primary outcome rates of 29.3% at 33.5°C for 72 hours, 34.5% at 32.0°C for 72 hours, 34.4% at 33.5°C for 120 hours, and 28.2% at 32.0°C for 120 hours. Conclusions and Relevance Among term neonates with moderate or severe hypoxic-ischemic encephalopathy, cooling for longer than 72 hours, cooling to lower than 33.5°C, or both did not reduce death or moderate or severe disability at 18 months of age. However, the trial may be underpowered, and an interaction was found between longer and deeper cooling. These results support the current regimen of cooling for 72 hours at 33.5°C. Trial Registration clinicaltrials.gov Identifier: NCT01192776 PMID:28672318

Effects of whole-body vibration training on physical function, bone and muscle mass in adolescents and young adults with cerebral palsy.

PubMed

Gusso, Silmara; Munns, Craig F; Colle, Patrícia; Derraik, José G B; Biggs, Janene B; Cutfield, Wayne S; Hofman, Paul L

2016-03-03

We performed a clinical trial on the effects of whole-body vibration training (WBVT) on muscle function and bone health of adolescents and young adults with cerebral palsy. Forty participants (11.3-20.8 years) with mild to moderate cerebral palsy (GMFCS II-III) underwent 20-week WBVT on a vibration plate for 9 minutes/day 4 times/week at 20 Hz (without controls). Assessments included 6-minute walk test, whole-body DXA, lower leg pQCT scans, and muscle function (force plate). Twenty weeks of WBVT were associated with increased lean mass in the total body (+770 g; p = 0.0003), trunk (+410 g; p = 0.004), and lower limbs (+240 g; p = 0.012). Bone mineral content increased in total body (+48 g; p = 0.0001), lumbar spine (+2.7 g; p = 0.0003), and lower limbs (+13 g; p < 0.0001). Similarly, bone mineral density increased in total body (+0.008 g/cm(2); p = 0.013), lumbar spine (+0.014 g/cm(2); p = 0.003), and lower limbs (+0.023 g/cm(2); p < 0.0001). Participants reduced the time taken to perform the chair test, and improved the distance walked in the 6-minute walk test by 11% and 35% for those with GMFCS II and III, respectively. WBVT was associated with increases in muscle mass and bone mass and density, and improved mobility of adolescents and young adults with cerebral palsy.

The effect of different physiotherapy interventions in post-BTX-A treatment of children with cerebral palsy.

PubMed

Desloovere, K; De Cat, J; Molenaers, G; Franki, I; Himpens, E; Van Waelvelde, H; Fagard, K; Van den Broeck, C

2012-01-01

To distinguish the effects of different physiotherapeutic programs in a post BTX-A regime for children with Cerebral Palsy (CP). Retrospective, controlled intervention study. A group of 38 children (X¯ = 7y7m, GMFCS I-III, 27 bilateral, 11 unilateral CP) receiving an individually defined Neurodevelopment Treatment (NDT) program, was matched and compared to a group of children with the same age, GMFCS and diagnosis, receiving more conventional physiotherapy treatment. All patients received selective tone-reduction by means of multilevel BTX-A injections and adequate follow-up treatment, including physiotherapy. Three-dimensional gait analyses and clinical examination was performed pre and two months post-injection. Treatment success was defined using the Goal Attainment Scale (GAS). Both groups' mean converted GAS scores were above 50. The average converted GAS score was higher in the group of children receiving NDT than in the group receiving conventional physiotherapy (p < 0.05). In the NDT group, overall treatment success was achieved in 76% of the goals, compared to 67% of the goals defined for the conventional physiotherapy group. Especially for the goals based on gait analyses (p < 0.05) and in the group of children with bilateral CP (p < 0.05), treatment success was higher in the NDT group. In a post-BTX-A regime, the short-term effects of an NDT approach are more pronouncedthan these from a conventional physiotherapy approach. Copyright © 2011 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

Effects of whole-body vibration training on physical function, bone and muscle mass in adolescents and young adults with cerebral palsy

PubMed Central

Gusso, Silmara; Munns, Craig F; Colle, Patrícia; Derraik, José G B; Biggs, Janene B; Cutfield, Wayne S; Hofman, Paul L

2016-01-01

We performed a clinical trial on the effects of whole-body vibration training (WBVT) on muscle function and bone health of adolescents and young adults with cerebral palsy. Forty participants (11.3–20.8 years) with mild to moderate cerebral palsy (GMFCS II–III) underwent 20-week WBVT on a vibration plate for 9 minutes/day 4 times/week at 20 Hz (without controls). Assessments included 6-minute walk test, whole-body DXA, lower leg pQCT scans, and muscle function (force plate). Twenty weeks of WBVT were associated with increased lean mass in the total body (+770 g; p = 0.0003), trunk (+410 g; p = 0.004), and lower limbs (+240 g; p = 0.012). Bone mineral content increased in total body (+48 g; p = 0.0001), lumbar spine (+2.7 g; p = 0.0003), and lower limbs (+13 g; p < 0.0001). Similarly, bone mineral density increased in total body (+0.008 g/cm2; p = 0.013), lumbar spine (+0.014 g/cm2; p = 0.003), and lower limbs (+0.023 g/cm2; p < 0.0001). Participants reduced the time taken to perform the chair test, and improved the distance walked in the 6-minute walk test by 11% and 35% for those with GMFCS II and III, respectively. WBVT was associated with increases in muscle mass and bone mass and density, and improved mobility of adolescents and young adults with cerebral palsy. PMID:26936535

Reliability and validity of Edinburgh visual gait score as an evaluation tool for children with cerebral palsy.

PubMed

Del Pilar Duque Orozco, Maria; Abousamra, Oussama; Church, Chris; Lennon, Nancy; Henley, John; Rogers, Kenneth J; Sees, Julieanne P; Connor, Justin; Miller, Freeman

2016-09-01

Assessment of gait abnormalities in cerebral palsy (CP) is challenging, and access to instrumented gait analysis is not always feasible. Therefore, many observational gait analysis scales have been devised. This study aimed to evaluate the interobserver reliability, intraobserver reliability, and validity of Edinburgh visual gait score (EVGS). Video of 30 children with spastic CP were reviewed by 7 raters (10 children each in GMFCS levels I, II, and III, age 6-12 years). Three observers had high level of experience in gait analysis (10+ years), two had medium level (2-5 years) and two had no previous experience (orthopedic fellows). Interobserver reliability was evaluated using percentage of complete agreement and kappa values. Criterion validity was evaluated by comparing EVGS scores with 3DGA data taken from the same video visit. Interobserver agreement was 60-90% and Kappa values were 0.18-0.85 for the 17 items in EVGS. Reliability was higher for distal segments (foot/ankle/knee 63-90%; trunk/pelvis/hip 60-76%), with greater experience (high 66-91%, medium 62-90%, no-experience 41-87%), with more EVGS practice (1st 10 videos 52-88%, last 10 videos 64-97%) and when used with higher functioning children (GMFCS I 65-96%, II 58-90%, III 35-65%). Intraobserver agreement was 64-92%. Agreement between EVGS and 3DGA was 52-73%. We believe that having EVGS as part of the standardized gait evaluation is helpful in optimizing the visual scoring. EVGS can be a supportive tool that adds quantitative data instead of only qualitative assessment to a video only gait evaluation. Copyright © 2016 Elsevier B.V. All rights reserved.

A multiple camera tongue switch for a child with severe spastic quadriplegic cerebral palsy.

PubMed

Leung, Brian; Chau, Tom

2010-01-01

The present study proposed a video-based access technology that facilitated a non-contact tongue protrusion access modality for a 7-year-old boy with severe spastic quadriplegic cerebral palsy (GMFCS level 5). The proposed system featured a centre camera and two peripheral cameras to extend coverage of the frontal face view of this user for longer durations. The child participated in a descriptive case study. The participant underwent 3 months of tongue protrusion training while the multiple camera tongue switch prototype was being prepared. Later, the participant was brought back for five experiment sessions where he worked on a single-switch picture matching activity, using the multiple camera tongue switch prototype in a controlled environment. The multiple camera tongue switch achieved an average sensitivity of 82% and specificity of 80%. In three of the experiment sessions, the peripheral cameras were associated with most of the true positive switch activations. These activations would have been missed by a centre-camera-only setup. The study demonstrated proof-of-concept of a non-contact tongue access modality implemented by a video-based system involving three cameras and colour video processing.

Transcultural adaptation and validation of the Korean version of Caregiver Priorities & Child Health Index of Life with Disabilities (CPCHILD).

PubMed

Sung, Ki Hyuk; Kwon, Soon-Sun; Narayanan, Unni G; Chung, Chin Youb; Lee, Kyoung Min; Lee, Seung Yeol; Lee, Damian J; Park, Moon Seok

2015-01-01

The aim of this study was to translate and transculturally adapt the Caregiver Priorities & Child Health Index of Life with Disabilities (CPCHILD) questionnaire into Korean language, and to test the reliability and validity, including the internal consistency, known-group validity and factor analysis of the Korean version of the CPCHILD. A Korean version of CPCHILD was produced according to internationally accepted guidelines. For validity testing, 194 consecutive parents or caregivers of children with cerebral palsy (CP) were recruited and completed the questionnaire. Internal consistency, test-retest reliability, and known-groups validity were evaluated and factor analysis was performed to validate the Korean version of the CPCHILD. In terms of internal consistency, a Cronbach's alpha was above 0.90 in all domains of the CPCHILD (range 0.921 to 0.966), except the 5th domain (0.628). In terms of known-groups validity, the total score of the CPCHILD was significantly different according to the Gross Motor Function Classification System (GMFCS) level (p < 0.001). Intra-class correlation coefficient spanned from 0.517 to 0.801. Factor analysis showed that the five-factor solution of the CPCHILD explained 76.7% of the variance with 59.0, 6.5, 5.1, 4.2 and 3.2% of variance by each components number. The Korean version of CPCHILD was found to be a reliable and valid questionnaire of caregivers' perspectives on the health-related quality of life in severely affected children with CP. However, the Korean version of CPCHILD contains some redundant items, and factor analysis suggested a five-domain questionnaire. Implication for Rehabilitation The Korean version of CPCHILD is a reliable, internally consistent, valid instrument for assessing the health-related quality of life in severely affected children with CP from the perspective of caregivers. After the transcultural adaptation and validation of the Korean CPCHILD, it can be reliably used in clinical and research settings to evaluate the health-related quality of life in Korean patients with CP.

The effect of the ketogenic diet on the developing skeleton.

PubMed

Simm, Peter J; Bicknell-Royle, Jillian; Lawrie, Jock; Nation, Judy; Draffin, Kellie; Stewart, Karen G; Cameron, Fergus J; Scheffer, Ingrid E; Mackay, Mark T

2017-10-01

The ketogenic diet (KD) is a medically supervised, high fat, low carbohydrate and restricted protein diet which has been used successfully in patients with refractory epilepsy. Only one published report has explored its effect on the skeleton. We postulated that the KD impairs skeletal health parameters in patients on the KD. Patients commenced on the KD were enrolled in a prospective, longitudinal study, with monitoring of Dual-energy X-ray absorptiometry (DXA) derived bone parameters including bone mineral content and density (BMD). Areal BMD was converted to bone mineral apparent density (BMAD) where possible. Biochemical parameters, including Vitamin D, and bone turnover markers, including osteocalcin, were assessed. Patients were stratified for level of mobility using the gross motor functional classification system (GMFCS). 29 patients were on the KD for a minimum of 6 months (range 0.5-6.5 years, mean 2.1 years). There was a trend towards a reduction in lumbar spine (LS) BMD Z score of 0.1562 (p=0.071) per year and 20 patients (68%) had a lower BMD Z score at the end of treatment. While less mobile patients had lower baseline Z scores, the rate of bone loss on the diet was greater in the more mobile patients (0.28 SD loss per year, p=0.026). Height adjustment of DXA data was possible for 13 patients, with a mean reduction in BMAD Z score of 0.19 SD. Only two patients sustained fractures. Mean urinary calcium-creatinine ratios were elevated (0.77), but only 1 patient developed renal calculi. Children on the KD exhibited differences in skeletal development that may be related to the diet. The changes were independent of height but appear to be exaggerated in patients who are ambulant. Clinicians should be aware of potential skeletal side effects and monitor bone health during KD treatment. Longer term follow up is required to determine adult/peak bone mass and fracture risk throughout life. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

Is head-shaft angle a valuable continuous risk factor for hip migration in cerebral palsy?

PubMed

Chougule, Sanjay; Dabis, John; Petrie, Aviva; Daly, Karen; Gelfer, Yael

2016-12-01

Reimer's migration percentage (MP) is the most established radiographic risk factor for hip migration in cerebral palsy (CP), and it assists surgical decision-making. The head-shaft angle (HSA) measures the valgus of the head and neck in relation to the shaft and may also be a useful predictor of hip migration at a young age. This study first defined normal values and investigated whether the head-shaft angle (HSA) is a continuous risk factor for hip migration in CP. Three hundred and fifty AP pelvic radiographs of 100 consecutive children comprising the hip surveillance programme in our region were analysed for MP and HSA. Inclusion criteria were children with spastic CP and Gross Motor Function Classification System (GMFCS) levels of III-V, along with a minimum follow-up of 5 years. The mean age was 8.8 (range 3-18) years and the mean follow-up time was 7.5 (range 5-10) years. Radiographs of 103 typically developing children (TDC) were selected for the control group. The reliability of the measurements was determined. A random effects analysis was used to assess the relationship between MP and HSA for all data and for MP > 40 %. The TDC cohort had a mean HSA of 157.7° whilst that for the CP cohort was 161.7°. The value declined with age in both groups but remained consistently higher in the CP group. A random effects analysis considering the longitudinal data showed that there was no significant effect of HSA on MP. Similarly, when excluding CP patients with MP < 40 %, there was no significant effect of HSA on MP. This study found no correlation between HSA and hip migration in children with CP in this age group. Using the HSA as a routine radiographic measure in the management pathway across childhood does not offer any added value. Early enrolment onto the hip surveillance programme could offer a better prediction of hip migration using the HSA at a very young age. II retrospective prognostic study.

How are actual needs recognized in the content and goals of written rehabilitation plans?

PubMed

Jeglinsky, Ira; Brogren Carlberg, Eva; Autti-Rämö, Ilona

2014-01-01

The primary aim of the study was to investigate the interrelation between needs and functional difficulties and the therapeutic goals in children with cerebral palsy (CP) as documented in individual written rehabilitation plans. The study was a retrospective cross-sectional register study. The data consisted of randomly chosen register documents for 77 children and adolescents with CP in different predetermined age ranges. The International Classification of Functioning, Disability and Health-Child and Youth version (ICF-CY) was used as a reference for analyzing the content of the written statements. The rehabilitation plans for 70 children, 1-16 years of age, representing all GMFCS levels were analyzed. Goals were not well reflected in the children's needs and functional difficulties. The needs, functional difficulties and goals mainly encompassed the components of body functions and activity/participation. In half of the plans the presence of the parents was mentioned, and the plans were made in multidisciplinary collaboration. The results of this study indicate deficiencies in the content and goals of the written rehabilitation plans. The ICF-CY could serve as a framework to help professionals and parents identify the child's needs and those areas where the goals should be targeted. Implications for Rehabilitation Documenting the child's and family's needs in relation to activity and participation preferences is critical to rehabilitation and intervention planning. Goals, based on the child's needs, should be identified in collaboration with all parties involved, and focus on the child's functioning in meaningful everyday activities. The ICF-CY could serve as a framework for the family and professionals to identify needs and to communicate rehabilitation goals.

A Trunk Support System to Identify Posture Control Mechanisms in Populations Lacking Independent Sitting

PubMed Central

Goodworth, Adam D.; Wu, Yen-Hsun; Felmlee, Duffy; Dunklebarger, Ellis; Saavedra, Sandra

2016-01-01

Populations with moderate-to-severe motor control impairments often exhibit degraded trunk control and/or lack the ability to sit unassisted. These populations need more research, yet their underdeveloped trunk control complicates identification of neural mechanisms behind their movements. The purpose of this study was to overcome this barrier by developing the first multi-articulated trunk support system to identify visual, vestibular, and proprioception contributions to posture in populations lacking independent sitting. The system provided external stability at a user-specific level on the trunk, so that body segments above the level of support required active posture control. The system included a tilting surface (controlled via servomotor) as a stimulus to investigate sensory contributions to postural responses. Frequency response and coherence functions between the surface tilt and trunk support were used to characterize system dynamics and indicated that surface tilts were accurately transmitted up to 5Hz. Feasibility of collecting kinematic data in participants lacking independent sitting was demonstrated in two populations: two typically developing infants, ~2-8 months, in a longitudinal study (8 sessions each) and four children with moderate-to-severe cerebral palsy (GMFCS III-V). Adaptability in the system was assessed by testing 16 adults (ages 18-63). Kinematic responses to continuous pseudorandom surface tilts were evaluated across 0.046–2Hz and qualitative feedback indicated that the trunk support and stimulus were comfortable for all subjects. Concepts underlying the system enable both research for, and rehabilitation in, populations lacking independent sitting. PMID:27046877

Creating a Canonical Scientific and Technical Information Classification System for NCSTRL+

NASA Technical Reports Server (NTRS)

Tiffany, Melissa E.; Nelson, Michael L.

1998-01-01

The purpose of this paper is to describe the new subject classification system for the NCSTRL+ project. NCSTRL+ is a canonical digital library (DL) based on the Networked Computer Science Technical Report Library (NCSTRL). The current NCSTRL+ classification system uses the NASA Scientific and Technical (STI) subject classifications, which has a bias towards the aerospace, aeronautics, and engineering disciplines. Examination of other scientific and technical information classification systems showed similar discipline-centric weaknesses. Traditional, library-oriented classification systems represented all disciplines, but were too generalized to serve the needs of a scientific and technically oriented digital library. Lack of a suitable existing classification system led to the creation of a lightweight, balanced, general classification system that allows the mapping of more specialized classification schemes into the new framework. We have developed the following classification system to give equal weight to all STI disciplines, while being compact and lightweight.

A web-based land cover classification system based on ontology model of different classification systems

NASA Astrophysics Data System (ADS)

Lin, Y.; Chen, X.

2016-12-01

Land cover classification systems used in remote sensing image data have been developed to meet the needs for depicting land covers in scientific investigations and policy decisions. However, accuracy assessments of a spate of data sets demonstrate that compared with the real physiognomy, each of the thematic map of specific land cover classification system contains some unavoidable flaws and unintended deviation. This work proposes a web-based land cover classification system, an integrated prototype, based on an ontology model of various classification systems, each of which is assigned the same weight in the final determination of land cover type. Ontology, a formal explication of specific concepts and relations, is employed in this prototype to build up the connections among different systems to resolve the naming conflicts. The process is initialized by measuring semantic similarity between terminologies in the systems and the search key to produce certain set of satisfied classifications, and carries on through searching the predefined relations in concepts of all classification systems to generate classification maps with user-specified land cover type highlighted, based on probability calculated by votes from data sets with different classification system adopted. The present system is verified and validated by comparing the classification results with those most common systems. Due to full consideration and meaningful expression of each classification system using ontology and the convenience that the web brings with itself, this system, as a preliminary model, proposes a flexible and extensible architecture for classification system integration and data fusion, thereby providing a strong foundation for the future work.

42 CFR 412.620 - Patient classification system.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Patient classification system. 412.620 Section 412... Inpatient Rehabilitation Hospitals and Rehabilitation Units § 412.620 Patient classification system. (a) Classification methodology. (1) A patient classification system is used to classify patients in inpatient...

42 CFR 412.620 - Patient classification system.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Patient classification system. 412.620 Section 412... Inpatient Rehabilitation Hospitals and Rehabilitation Units § 412.620 Patient classification system. (a) Classification methodology. (1) A patient classification system is used to classify patients in inpatient...

Intra- and Interobserver Reliability of Three Classification Systems for Hallux Rigidus.

PubMed

Dillard, Sarita; Schilero, Christina; Chiang, Sharon; Pham, Peter

2018-04-18

There are over ten classification systems currently used in the staging of hallux rigidus. This results in confusion and inconsistency with radiographic interpretation and treatment. The reliability of hallux rigidus classification systems has not yet been tested. The purpose of this study was to evaluate intra- and interobserver reliability using three commonly used classifications for hallux rigidus. Twenty-one plain radiograph sets were presented to ten ACFAS board-certified foot and ankle surgeons. Each physician classified each radiograph based on clinical experience and knowledge according to the Regnauld, Roukis, and Hattrup and Johnson classification systems. The two-way mixed single-measure consistency intraclass correlation was used to calculate intra- and interrater reliability. The intrarater reliability of individual sets for the Roukis and Hattrup and Johnson classification systems was "fair to good" (Roukis, 0.62±0.19; Hattrup and Johnson, 0.62±0.28), whereas the intrarater reliability of individual sets for the Regnauld system bordered between "fair to good" and "poor" (0.43±0.24). The interrater reliability of the mean classification was "excellent" for all three classification systems. Conclusions Reliable and reproducible classification systems are essential for treatment and prognostic implications in hallux rigidus. In our study, Roukis classification system had the best intrarater reliability. Although there are various classification systems for hallux rigidus, our results indicate that all three of these classification systems show reliability and reproducibility.

Effects of gross motor function and manual function levels on performance-based ADL motor skills of children with spastic cerebral palsy.

PubMed

Park, Myoung-Ok

2017-02-01

[Purpose] The purpose of this study was to determine effects of Gross Motor Function Classification System and Manual Ability Classification System levels on performance-based motor skills of children with spastic cerebral palsy. [Subjects and Methods] Twenty-three children with cerebral palsy were included. The Assessment of Motor and Process Skills was used to evaluate performance-based motor skills in daily life. Gross motor function was assessed using Gross Motor Function Classification Systems, and manual function was measured using the Manual Ability Classification System. [Results] Motor skills in daily activities were significantly different on Gross Motor Function Classification System level and Manual Ability Classification System level. According to the results of multiple regression analysis, children categorized as Gross Motor Function Classification System level III scored lower in terms of performance based motor skills than Gross Motor Function Classification System level I children. Also, when analyzed with respect to Manual Ability Classification System level, level II was lower than level I, and level III was lower than level II in terms of performance based motor skills. [Conclusion] The results of this study indicate that performance-based motor skills differ among children categorized based on Gross Motor Function Classification System and Manual Ability Classification System levels of cerebral palsy.

78 FR 18252 - Prevailing Rate Systems; North American Industry Classification System Based Federal Wage System...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-26

...-AM78 Prevailing Rate Systems; North American Industry Classification System Based Federal Wage System... 2007 North American Industry Classification System (NAICS) codes currently used in Federal Wage System... (OPM) issued a final rule (73 FR 45853) to update the 2002 North American Industry Classification...

Are we there yet? Evaluating commercial grade brain-computer interface for control of computer applications by individuals with cerebral palsy.

PubMed

Taherian, Sarvnaz; Selitskiy, Dmitry; Pau, James; Claire Davies, T

2017-02-01

Using a commercial electroencephalography (EEG)-based brain-computer interface (BCI), the training and testing protocol for six individuals with spastic quadriplegic cerebral palsy (GMFCS and MACS IV and V) was evaluated. A customised, gamified training paradigm was employed. Over three weeks, the participants spent two sessions exploring the system, and up to six sessions playing the game which focussed on EEG feedback of left and right arm motor imagery. The participants showed variable inconclusive results in the ability to produce two distinct EEG patterns. Participant performance was influenced by physical illness, motivation, fatigue and concentration. The results from this case study highlight the infancy of BCIs as a form of assistive technology for people with cerebral palsy. Existing commercial BCIs are not designed according to the needs of end-users. Implications for Rehabilitation Mood, fatigue, physical illness and motivation influence the usability of a brain-computer interface. Commercial brain-computer interfaces are not designed for practical assistive technology use for people with cerebral palsy. Practical brain-computer interface assistive technologies may need to be flexible to suit individual needs.

Understanding the use of standardized nursing terminology and classification systems in published research: A case study using the International Classification for Nursing Practice(®).

PubMed

Strudwick, Gillian; Hardiker, Nicholas R

2016-10-01

In the era of evidenced based healthcare, nursing is required to demonstrate that care provided by nurses is associated with optimal patient outcomes, and a high degree of quality and safety. The use of standardized nursing terminologies and classification systems are a way that nursing documentation can be leveraged to generate evidence related to nursing practice. Several widely-reported nursing specific terminologies and classifications systems currently exist including the Clinical Care Classification System, International Classification for Nursing Practice(®), Nursing Intervention Classification, Nursing Outcome Classification, Omaha System, Perioperative Nursing Data Set and NANDA International. However, the influence of these systems on demonstrating the value of nursing and the professions' impact on quality, safety and patient outcomes in published research is relatively unknown. This paper seeks to understand the use of standardized nursing terminology and classification systems in published research, using the International Classification for Nursing Practice(®) as a case study. A systematic review of international published empirical studies on, or using, the International Classification for Nursing Practice(®) were completed using Medline and the Cumulative Index for Nursing and Allied Health Literature. Since 2006, 38 studies have been published on the International Classification for Nursing Practice(®). The main objectives of the published studies have been to validate the appropriateness of the classification system for particular care areas or populations, further develop the classification system, or utilize it to support the generation of new nursing knowledge. To date, most studies have focused on the classification system itself, and a lesser number of studies have used the system to generate information about the outcomes of nursing practice. Based on the published literature that features the International Classification for Nursing Practice, standardized nursing terminology and classification systems appear to be well developed for various populations, settings and to harmonize with other health-related terminology systems. However, the use of the systems to generate new nursing knowledge, and to validate nursing practice is still in its infancy. There is an opportunity now to utilize the well-developed systems in their current state to further what is know about nursing practice, and how best to demonstrate improvements in patient outcomes through nursing care. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Ecological Land Classification: Applications to Identify the Productive Potential of Southern Forests

Treesearch

Dennis L. Mengel; D. Thompson Tew; [Editors

1991-01-01

Eighteen papers representing four categories-Regional Overviews; Classification System Development; Classification System Interpretation; Mapping/GIS Applications in Classification Systems-present the state of the art in forest-land classification and evaluation in the South. In addition, nine poster papers are presented.

42 CFR 412.513 - Patient classification system.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Patient classification system. 412.513 Section 412... Long-Term Care Hospitals § 412.513 Patient classification system. (a) Classification methodology. CMS...-DRGs. (1) The classification of a particular discharge is based, as appropriate, on the patient's age...

42 CFR 412.513 - Patient classification system.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Patient classification system. 412.513 Section 412... Long-Term Care Hospitals § 412.513 Patient classification system. (a) Classification methodology. CMS...-DRGs. (1) The classification of a particular discharge is based, as appropriate, on the patient's age...

Pathohistological classification systems in gastric cancer: Diagnostic relevance and prognostic value

PubMed Central

Berlth, Felix; Bollschweiler, Elfriede; Drebber, Uta; Hoelscher, Arnulf H; Moenig, Stefan

2014-01-01

Several pathohistological classification systems exist for the diagnosis of gastric cancer. Many studies have investigated the correlation between the pathohistological characteristics in gastric cancer and patient characteristics, disease specific criteria and overall outcome. It is still controversial as to which classification system imparts the most reliable information, and therefore, the choice of system may vary in clinical routine. In addition to the most common classification systems, such as the Laurén and the World Health Organization (WHO) classifications, other authors have tried to characterize and classify gastric cancer based on the microscopic morphology and in reference to the clinical outcome of the patients. In more than 50 years of systematic classification of the pathohistological characteristics of gastric cancer, there is no sole classification system that is consistently used worldwide in diagnostics and research. However, several national guidelines for the treatment of gastric cancer refer to the Laurén or the WHO classifications regarding therapeutic decision-making, which underlines the importance of a reliable classification system for gastric cancer. The latest results from gastric cancer studies indicate that it might be useful to integrate DNA- and RNA-based features of gastric cancer into the classification systems to establish prognostic relevance. This article reviews the diagnostic relevance and the prognostic value of different pathohistological classification systems in gastric cancer. PMID:24914328

How should children with speech sound disorders be classified? A review and critical evaluation of current classification systems.

PubMed

Waring, R; Knight, R

2013-01-01

Children with speech sound disorders (SSD) form a heterogeneous group who differ in terms of the severity of their condition, underlying cause, speech errors, involvement of other aspects of the linguistic system and treatment response. To date there is no universal and agreed-upon classification system. Instead, a number of theoretically differing classification systems have been proposed based on either an aetiological (medical) approach, a descriptive-linguistic approach or a processing approach. To describe and review the supporting evidence, and to provide a critical evaluation of the current childhood SSD classification systems. Descriptions of the major specific approaches to classification are reviewed and research papers supporting the reliability and validity of the systems are evaluated. Three specific paediatric SSD classification systems; the aetiologic-based Speech Disorders Classification System, the descriptive-linguistic Differential Diagnosis system, and the processing-based Psycholinguistic Framework are identified as potentially useful in classifying children with SSD into homogeneous subgroups. The Differential Diagnosis system has a growing body of empirical support from clinical population studies, across language error pattern studies and treatment efficacy studies. The Speech Disorders Classification System is currently a research tool with eight proposed subgroups. The Psycholinguistic Framework is a potential bridge to linking cause and surface level speech errors. There is a need for a universally agreed-upon classification system that is useful to clinicians and researchers. The resulting classification system needs to be robust, reliable and valid. A universal classification system would allow for improved tailoring of treatments to subgroups of SSD which may, in turn, lead to improved treatment efficacy. © 2012 Royal College of Speech and Language Therapists.

5 CFR 9701.231 - Conversion of positions and employees to the DHS classification system.

Code of Federal Regulations, 2011 CFR

2011-01-01

... the DHS classification system. 9701.231 Section 9701.231 Administrative Personnel DEPARTMENT OF... MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Classification Transitional Provisions § 9701.231 Conversion of positions and employees to the DHS classification system. (a) This...

Gynecomastia Classification for Surgical Management: A Systematic Review and Novel Classification System.

PubMed

Waltho, Daniel; Hatchell, Alexandra; Thoma, Achilleas

2017-03-01

Gynecomastia is a common deformity of the male breast, where certain cases warrant surgical management. There are several surgical options, which vary depending on the breast characteristics. To guide surgical management, several classification systems for gynecomastia have been proposed. A systematic review was performed to (1) identify all classification systems for the surgical management of gynecomastia, and (2) determine the adequacy of these classification systems to appropriately categorize the condition for surgical decision-making. The search yielded 1012 articles, and 11 articles were included in the review. Eleven classification systems in total were ascertained, and a total of 10 unique features were identified: (1) breast size, (2) skin redundancy, (3) breast ptosis, (4) tissue predominance, (5) upper abdominal laxity, (6) breast tuberosity, (7) nipple malposition, (8) chest shape, (9) absence of sternal notch, and (10) breast skin elasticity. On average, classification systems included two or three of these features. Breast size and ptosis were the most commonly included features. Based on their review of the current classification systems, the authors believe the ideal classification system should be universal and cater to all causes of gynecomastia; be surgically useful and easy to use; and should include a comprehensive set of clinically appropriate patient-related features, such as breast size, breast ptosis, tissue predominance, and skin redundancy. None of the current classification systems appears to fulfill these criteria.

The groningen laryngomalacia classification system--based on systematic review and dynamic airway changes.

PubMed

van der Heijden, Martijn; Dikkers, Frederik G; Halmos, Gyorgy B

2015-12-01

Laryngomalacia is the most common cause of dyspnea and stridor in newborn infants. Laryngomalacia is a dynamic change of the upper airway based on abnormally pliable supraglottic structures, which causes upper airway obstruction. In the past, different classification systems have been introduced. Until now no classification system is widely accepted and applied. Our goal is to provide a simple and complete classification system based on systematic literature search and our experiences. Retrospective cohort study with literature review. All patients with laryngomalacia under the age of 5 at time of diagnosis were included. Photo and video documentation was used to confirm diagnosis and characteristics of dynamic airway change. Outcome was compared with available classification systems in literature. Eighty-five patients were included. In contrast to other classification systems, only three typical different dynamic changes have been identified in our series. Two existing classification systems covered 100% of our findings, but there was an unnecessary overlap between different types in most of the systems. Based on our finding, we propose a new a classification system for laryngomalacia, which is purely based on dynamic airway changes. The groningen laryngomalacia classification is a new, simplified classification system with three types, based on purely dynamic laryngeal changes, tested in a tertiary referral center: Type 1: inward collapse of arytenoids cartilages, Type 2: medial displacement of aryepiglottic folds, and Type 3: posterocaudal displacement of epiglottis against the posterior pharyngeal wall. © 2015 Wiley Periodicals, Inc.

Designing and Implementation of River Classification Assistant Management System

NASA Astrophysics Data System (ADS)

Zhao, Yinjun; Jiang, Wenyuan; Yang, Rujun; Yang, Nan; Liu, Haiyan

2018-03-01

In an earlier publication, we proposed a new Decision Classifier (DCF) for Chinese river classification based on their structures. To expand, enhance and promote the application of the DCF, we build a computer system to support river classification named River Classification Assistant Management System. Based on ArcEngine and ArcServer platform, this system implements many functions such as data management, extraction of river network, river classification, and results publication under combining Client / Server with Browser / Server framework.

42 CFR 412.10 - Changes in the DRG classification system.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Changes in the DRG classification system. 412.10... § 412.10 Changes in the DRG classification system. (a) General rule. CMS issues changes in the DRG classification system in a Federal Register notice at least annually. Except as specified in paragraphs (c) and...

42 CFR 412.10 - Changes in the DRG classification system.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Changes in the DRG classification system. 412.10... § 412.10 Changes in the DRG classification system. (a) General rule. CMS issues changes in the DRG classification system in a Federal Register notice at least annually. Except as specified in paragraphs (c) and...

Correlation of the Rock Mass Rating (RMR) System with the Unified Soil Classification System (USCS): Introduction of the Weak Rock Mass Rating System (W-RMR)

NASA Astrophysics Data System (ADS)

Warren, Sean N.; Kallu, Raj R.; Barnard, Chase K.

2016-11-01

Underground gold mines in Nevada are exploiting increasingly deeper ore bodies comprised of weak to very weak rock masses. The Rock Mass Rating (RMR) classification system is widely used at underground gold mines in Nevada and is applicable in fair to good-quality rock masses, but is difficult to apply and loses reliability in very weak rock mass to soil-like material. Because very weak rock masses are transition materials that border engineering rock mass and soil classification systems, soil classification may sometimes be easier and more appropriate to provide insight into material behavior and properties. The Unified Soil Classification System (USCS) is the most likely choice for the classification of very weak rock mass to soil-like material because of its accepted use in tunnel engineering projects and its ability to predict soil-like material behavior underground. A correlation between the RMR and USCS systems was developed by comparing underground geotechnical RMR mapping to laboratory testing of bulk samples from the same locations, thereby assigning a numeric RMR value to the USCS classification that can be used in spreadsheet calculations and geostatistical analyses. The geotechnical classification system presented in this paper including a USCS-RMR correlation, RMR rating equations, and the Geo-Pick Strike Index is collectively introduced as the Weak Rock Mass Rating System (W-RMR). It is the authors' hope that this system will aid in the classification of weak rock masses and more usable design tools based on the RMR system. More broadly, the RMR-USCS correlation and the W-RMR system help define the transition between engineering soil and rock mass classification systems and may provide insight for geotechnical design in very weak rock masses.

Overweight and Obesity Prevalence Among School-Aged Nunavik Inuit Children According to Three Body Mass Index Classification Systems.

PubMed

Medehouenou, Thierry Comlan Marc; Ayotte, Pierre; St-Jean, Audray; Meziou, Salma; Roy, Cynthia; Muckle, Gina; Lucas, Michel

2015-07-01

Little is known about the suitability of three commonly used body mass index (BMI) classification system for Indigenous children. This study aims to estimate overweight and obesity prevalence among school-aged Nunavik Inuit children according to International Obesity Task Force (IOTF), Centers for Disease Control and Prevention (CDC), and World Health Organization (WHO) BMI classification systems, to measure agreement between those classification systems, and to investigate whether BMI status as defined by these classification systems is associated with levels of metabolic and inflammatory biomarkers. Data were collected on 290 school-aged children (aged 8-14 years; 50.7% girls) from the Nunavik Child Development Study with data collected in 2005-2010. Anthropometric parameters were measured and blood sampled. Participants were classified as normal weight, overweight, and obese according to BMI classification systems. Weighted kappa (κw) statistics assessed agreement between different BMI classification systems, and multivariate analysis of variance ascertained their relationship with metabolic and inflammatory biomarkers. The combined prevalence rate of overweight/obesity was 26.9% (with 6.6% obesity) with IOTF, 24.1% (11.0%) with CDC, and 40.4% (12.8%) with WHO classification systems. Agreement was the highest between IOTF and CDC (κw = .87) classifications, and substantial for IOTF and WHO (κw = .69) and for CDC and WHO (κw = .73). Insulin and high-sensitivity C-reactive protein plasma levels were significantly higher from normal weight to obesity, regardless of classification system. Among obese subjects, higher insulin level was observed with IOTF. Compared with other systems, IOTF classification appears to be more specific to identify overweight and obesity in Inuit children. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Stroke subtyping for genetic association studies? A comparison of the CCS and TOAST classifications.

PubMed

Lanfranconi, Silvia; Markus, Hugh S

2013-12-01

A reliable and reproducible classification system of stroke subtype is essential for epidemiological and genetic studies. The Causative Classification of Stroke system is an evidence-based computerized algorithm with excellent inter-rater reliability. It has been suggested that, compared to the Trial of ORG 10172 in Acute Stroke Treatment classification, it increases the proportion of cases with defined subtype that may increase power in genetic association studies. We compared Trial of ORG 10172 in Acute Stroke Treatment and Causative Classification of Stroke system classifications in a large cohort of well-phenotyped stroke patients. Six hundred ninety consecutively recruited patients with first-ever ischemic stroke were classified, using review of clinical data and original imaging, according to the Trial of ORG 10172 in Acute Stroke Treatment and Causative Classification of Stroke system classifications. There was excellent agreement subtype assigned by between Trial of ORG 10172 in Acute Stroke Treatment and Causative Classification of Stroke system (kappa = 0·85). The agreement was excellent for the major individual subtypes: large artery atherosclerosis kappa = 0·888, small-artery occlusion kappa = 0·869, cardiac embolism kappa = 0·89, and undetermined category kappa = 0·884. There was only moderate agreement (kappa = 0·41) for the subjects with at least two competing underlying mechanism. Thirty-five (5·8%) patients classified as undetermined by Trial of ORG 10172 in Acute Stroke Treatment were assigned to a definite subtype by Causative Classification of Stroke system. Thirty-two subjects assigned to a definite subtype by Trial of ORG 10172 in Acute Stroke Treatment were classified as undetermined by Causative Classification of Stroke system. There is excellent agreement between classification using Trial of ORG 10172 in Acute Stroke Treatment and Causative Classification of Stroke systems but no evidence that Causative Classification of Stroke system reduced the proportion of patients classified to undetermined subtypes. The excellent inter-rater reproducibility and web-based semiautomated nature make Causative Classification of Stroke system suitable for multicenter studies, but the benefit of reclassifying cases already classified using the Trial of ORG 10172 in Acute Stroke Treatment system on existing databases is likely to be small. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

A new hierarchical method for inter-patient heartbeat classification using random projections and RR intervals

PubMed Central

2014-01-01

Background The inter-patient classification schema and the Association for the Advancement of Medical Instrumentation (AAMI) standards are important to the construction and evaluation of automated heartbeat classification systems. The majority of previously proposed methods that take the above two aspects into consideration use the same features and classification method to classify different classes of heartbeats. The performance of the classification system is often unsatisfactory with respect to the ventricular ectopic beat (VEB) and supraventricular ectopic beat (SVEB). Methods Based on the different characteristics of VEB and SVEB, a novel hierarchical heartbeat classification system was constructed. This was done in order to improve the classification performance of these two classes of heartbeats by using different features and classification methods. First, random projection and support vector machine (SVM) ensemble were used to detect VEB. Then, the ratio of the RR interval was compared to a predetermined threshold to detect SVEB. The optimal parameters for the classification models were selected on the training set and used in the independent testing set to assess the final performance of the classification system. Meanwhile, the effect of different lead configurations on the classification results was evaluated. Results Results showed that the performance of this classification system was notably superior to that of other methods. The VEB detection sensitivity was 93.9% with a positive predictive value of 90.9%, and the SVEB detection sensitivity was 91.1% with a positive predictive value of 42.2%. In addition, this classification process was relatively fast. Conclusions A hierarchical heartbeat classification system was proposed based on the inter-patient data division to detect VEB and SVEB. It demonstrated better classification performance than existing methods. It can be regarded as a promising system for detecting VEB and SVEB of unknown patients in clinical practice. PMID:24981916

Extensions to the Speech Disorders Classification System (SDCS)

ERIC Educational Resources Information Center

Shriberg, Lawrence D.; Fourakis, Marios; Hall, Sheryl D.; Karlsson, Heather B.; Lohmeier, Heather L.; McSweeny, Jane L.; Potter, Nancy L.; Scheer-Cohen, Alison R.; Strand, Edythe A.; Tilkens, Christie M.; Wilson, David L.

2010-01-01

This report describes three extensions to a classification system for paediatric speech sound disorders termed the Speech Disorders Classification System (SDCS). Part I describes a classification extension to the SDCS to differentiate motor speech disorders from speech delay and to differentiate among three sub-types of motor speech disorders.…

Comparison of Danish dichotomous and BI-RADS classifications of mammographic density.

PubMed

Hodge, Rebecca; Hellmann, Sophie Sell; von Euler-Chelpin, My; Vejborg, Ilse; Andersen, Zorana Jovanovic

2014-06-01

In the Copenhagen mammography screening program from 1991 to 2001, mammographic density was classified either as fatty or mixed/dense. This dichotomous mammographic density classification system is unique internationally, and has not been validated before. To compare the Danish dichotomous mammographic density classification system from 1991 to 2001 with the density BI-RADS classifications, in an attempt to validate the Danish classification system. The study sample consisted of 120 mammograms taken in Copenhagen in 1991-2001, which tested false positive, and which were in 2012 re-assessed and classified according to the BI-RADS classification system. We calculated inter-rater agreement between the Danish dichotomous mammographic classification as fatty or mixed/dense and the four-level BI-RADS classification by the linear weighted Kappa statistic. Of the 120 women, 32 (26.7%) were classified as having fatty and 88 (73.3%) as mixed/dense mammographic density, according to Danish dichotomous classification. According to BI-RADS density classification, 12 (10.0%) women were classified as having predominantly fatty (BI-RADS code 1), 46 (38.3%) as having scattered fibroglandular (BI-RADS code 2), 57 (47.5%) as having heterogeneously dense (BI-RADS 3), and five (4.2%) as having extremely dense (BI-RADS code 4) mammographic density. The inter-rater variability assessed by weighted kappa statistic showed a substantial agreement (0.75). The dichotomous mammographic density classification system utilized in early years of Copenhagen's mammographic screening program (1991-2001) agreed well with the BI-RADS density classification system.

The history of female genital tract malformation classifications and proposal of an updated system.

PubMed

Acién, Pedro; Acién, Maribel I

2011-01-01

A correct classification of malformations of the female genital tract is essential to prevent unnecessary and inadequate surgical operations and to compare reproductive results. An ideal classification system should be based on aetiopathogenesis and should suggest the appropriate therapeutic strategy. We conducted a systematic review of relevant articles found in PubMed, Scopus, Scirus and ISI webknowledge, and analysis of historical collections of 'female genital malformations' and 'classifications'. Of 124 full-text articles assessed for eligibility, 64 were included because they contained original general, partial or modified classifications. All the existing classifications were analysed and grouped. The unification of terms and concepts was also analysed. Traditionally, malformations of the female genital tract have been catalogued and classified as Müllerian malformations due to agenesis, lack of fusion, the absence of resorption and lack of posterior development of the Müllerian ducts. The American Fertility Society classification of the late 1980s included seven basic groups of malformations also considering the Müllerian development and the relationship of the malformations to fertility. Other classifications are based on different aspects: functional, defects in vertical fusion, embryological or anatomical (Vagina, Cervix, Uterus, Adnex and Associated Malformation: VCUAM classification). However, an embryological-clinical classification system seems to be the most appropriate. Accepting the need for a new classification system of genitourinary malformations that considers the experience gained from the application of the current classification systems, the aetiopathogenesis and that also suggests the appropriate treatment, we proposed an update of our embryological-clinical classification as a new system with six groups of female genitourinary anomalies.

Prototype Expert System for Climate Classification.

ERIC Educational Resources Information Center

Harris, Clay

Many students find climate classification laborious and time-consuming, and through their lack of repetition fail to grasp the details of classification. This paper describes an expert system for climate classification that is being developed at Middle Tennessee State University. Topics include: (1) an introduction to the nature of classification,…

5 CFR 9901.221 - Classification requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Section 9901.221 Administrative Personnel DEPARTMENT OF DEFENSE HUMAN RESOURCES MANAGEMENT AND LABOR RELATIONS SYSTEMS (DEPARTMENT OF DEFENSE-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF DEFENSE NATIONAL SECURITY PERSONNEL SYSTEM (NSPS) Classification Classification Process § 9901.221 Classification...

5 CFR 9701.221 - Classification requirements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Section 9701.221 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Classification Classification Process § 9701.221 Classification...

5 CFR 9701.221 - Classification requirements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Section 9701.221 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Classification Classification Process § 9701.221 Classification...

5 CFR 9701.221 - Classification requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Section 9701.221 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Classification Classification Process § 9701.221 Classification...

5 CFR 9701.221 - Classification requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Section 9701.221 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Classification Classification Process § 9701.221 Classification...

The Bellevue Classification System: nursing's voice upon the library shelves*†

PubMed Central

Mages, Keith C

2011-01-01

This article examines the inspiration, construction, and meaning of the Bellevue Classification System (BCS), created during the 1930s for use in the Bellevue School of Nursing Library. Nursing instructor Ann Doyle, with assistance from librarian Mary Casamajor, designed the BCS after consulting with library leaders and examining leading contemporary classification systems, including the Dewey Decimal Classification and Library of Congress, Ballard, and National Health Library classification systems. A close textual reading of the classes, subclasses, and subdivisions of these classification systems against those of the resulting BCS, reveals Doyle's belief that the BCS was created not only to organize the literature, but also to promote the burgeoning intellectualism and professionalism of early twentieth-century American nursing. PMID:21243054

Feasibility of bioelectrical impedance analysis in persons with severe intellectual and visual disabilities.

PubMed

Havinga-Top, A M; Waninge, A; van der Schans, C P; Jager-Wittenaar, H

2015-12-01

Body composition measurements provide important information about physical fitness and nutritional status. People with severe intellectual and visual disabilities (SIVD) have an increased risk for altered body composition. Bioelectrical impedance analysis (BIA) has been evidenced as a reliable and non-invasive method to asses body composition in healthy persons and various patient populations; however, currently, there is no feasible method available to determine body composition in people with SIVD. In this study, therefore, we aimed to assess the feasibility of BIA measurements in persons with SIVD. In 33 participants with SIVD and Gross Motor Functioning Classification System (GMFCS) Scale I, II, III, or IV, two BIA measurements were sequentially performed employing Resistance and Reactance in Ohm and fat-free mass (FFM) in kg as outcome variables, utilizing the Bodystat(®) QuadScan 4000. Feasibility was considered sufficient if ≥ 80% of the first measurement was performed successfully. Agreement between two repeated measurements was determined by using the paired t-test and Intraclass Correlation Coefficient (ICC; two way random, absolute agreement). Bland-Altman analyses were utilized to determine limits of agreement (LOAs) and systematic error. Agreement was considered acceptable if LOAs were <10% of the mean of the first measurement. The first BIA measurements were completed successfully in 88% of the participants. The paired t-test demonstrated no significant differences in Resistance, Reactance, and FFM between BIA Measurements 1 and 2 (P=0.140, 0.091, and 0.866). ICC was 0.965 (95% CI: 0.922-0.984) for Resistance; 0.858 (95% CI: 0.705-0.934) for Reactance; and 0.992 (95% CI: 0.982-0.996) for FFM. LOAs expressed as a percentage of the mean of Measurement 1 were 6.1% for Resistance, 17.6% for Reactance, and 3.8% for FFM. The results of this study suggest that BIA measurements seem to be feasible in persons with SIVD. Although these results require confirmation in a more extensive sample of persons with SIVD, the findings of this study are an important first step in the assessment of applicability of BIA measurements for non-invasive monitoring of physical fitness and nutritional status of persons with SIVD. Copyright © 2015 Elsevier Ltd. All rights reserved.

Relationship between brain lesion characteristics and communication in preschool children with cerebral palsy.

PubMed

Coleman, Andrea; Fiori, Simona; Weir, Kelly A; Ware, Robert S; Boyd, Roslyn N

2016-11-01

MRI shows promise as a prognostic tool for clinical findings such as gross motor function in children with cerebral palsy(CP), however the relationship with communication skills requires exploration. To examine the relationship between the type and severity of brain lesion on MRI and communication skills in children with CP. 131 children with CP (73 males(56%)), mean corrected age(SD) 28(5) months, Gross Motor Functional Classification System distribution: I=57(44%), II=14(11%), III=19(14%), IV=17(13%), V=24(18%). Children were assessed on the Communication and Symbolic Behavioral Scales Developmental Profile (CSBS-DP) Infant-Toddler Checklist. Structural MRI was analysed with reference to type and semi-quantitative assessment of the severity of brain lesion. Children were classified for motor type, distribution and GMFCS. The relationships between type/severity of brain lesion and communication ability were analysed using multivariable tobit regression. Children with periventricular white matter lesions had better speech than children with cortical/deep grey matter lesions (β=-2.6, 95%CI=-5.0, -0.2, p=0.04). Brain lesion severity on the semi-quantitative scale was related to overall communication skills (β=-0.9, 95%CI=-1.4, -0.5, p<0.001). Motor impairment better accounted for impairment in overall communication skills than brain lesion severity. Structural MRI has potential prognostic value for communication impairment in children with CP. WHAT THIS PAPER ADDS?: This is the first paper to explore important aspects of communication in relation to the type and severity of brain lesion on MRI in a representative cohort of preschool-aged children with CP. We found a relationship between the type of brain lesion and communication skills, children who had cortical and deep grey matter lesions had overall communication skills>1 SD below children with periventricular white matter lesions. Children with more severe brain lesions on MRI had poorer overall communication skills. Children with CP born at term had poorer communication than those born prematurely and were more likely to have cortical and deep grey matter lesions. Gross motor function better accounted for overall communication skills than the type of brain lesion or brain lesion severity. Copyright © 2016. Published by Elsevier Ltd.

Coordination of Local Road Classification with the State Highway System Classification: Impact and Clarification of Related Language in the LVR Manual

DOT National Transportation Integrated Search

1996-02-01

This study reviewed the low volume road (LVR) classifications in Kansas in conjunction with the State A, B, C, D, E road classification system and addressed alignment of these differences. As an extension to the State system, an F, G, H classificatio...

A support vector machine approach for classification of welding defects from ultrasonic signals

NASA Astrophysics Data System (ADS)

Chen, Yuan; Ma, Hong-Wei; Zhang, Guang-Ming

2014-07-01

Defect classification is an important issue in ultrasonic non-destructive evaluation. A layered multi-class support vector machine (LMSVM) classification system, which combines multiple SVM classifiers through a layered architecture, is proposed in this paper. The proposed LMSVM classification system is applied to the classification of welding defects from ultrasonic test signals. The measured ultrasonic defect echo signals are first decomposed into wavelet coefficients by the wavelet packet transform. The energy of the wavelet coefficients at different frequency channels are used to construct the feature vectors. The bees algorithm (BA) is then used for feature selection and SVM parameter optimisation for the LMSVM classification system. The BA-based feature selection optimises the energy feature vectors. The optimised feature vectors are input to the LMSVM classification system for training and testing. Experimental results of classifying welding defects demonstrate that the proposed technique is highly robust, precise and reliable for ultrasonic defect classification.

Classifications of Acute Scaphoid Fractures: A Systematic Literature Review.

PubMed

Ten Berg, Paul W; Drijkoningen, Tessa; Strackee, Simon D; Buijze, Geert A

2016-05-01

Background In the lack of consensus, surgeon-based preference determines how acute scaphoid fractures are classified. There is a great variety of classification systems with considerable controversies. Purposes The purpose of this study was to provide an overview of the different classification systems, clarifying their subgroups and analyzing their popularity by comparing citation indexes. The intention was to improve data comparison between studies using heterogeneous fracture descriptions. Methods We performed a systematic review of the literature based on a search of medical literature from 1950 to 2015, and a manual search using the reference lists in relevant book chapters. Only original descriptions of classifications of acute scaphoid fractures in adults were included. Popularity was based on citation index as reported in the databases of Web of Science (WoS) and Google Scholar. Articles that were cited <10 times in WoS were excluded. Results Our literature search resulted in 308 potentially eligible descriptive reports of which 12 reports met the inclusion criteria. We distinguished 13 different (sub) classification systems based on (1) fracture location, (2) fracture plane orientation, and (3) fracture stability/displacement. Based on citations numbers, the Herbert classification was most popular, followed by the Russe and Mayo classifications. All classification systems were based on plain radiography. Conclusions Most classification systems were based on fracture location, displacement, or stability. Based on the controversy and limited reliability of current classification systems, suggested research areas for an updated classification include three-dimensional fracture pattern etiology and fracture fragment mobility assessed by dynamic imaging.

Classification of close binary systems by Svechnikov

NASA Astrophysics Data System (ADS)

Dryomova, G. N.

The paper presents the historical overview of classification schemes of eclipsing variable stars with the foreground of advantages of the classification scheme by Svechnikov being widely appreciated for Close Binary Systems due to simplicity of classification criteria and brevity.

Recursive heuristic classification

NASA Technical Reports Server (NTRS)

Wilkins, David C.

1994-01-01

The author will describe a new problem-solving approach called recursive heuristic classification, whereby a subproblem of heuristic classification is itself formulated and solved by heuristic classification. This allows the construction of more knowledge-intensive classification programs in a way that yields a clean organization. Further, standard knowledge acquisition and learning techniques for heuristic classification can be used to create, refine, and maintain the knowledge base associated with the recursively called classification expert system. The method of recursive heuristic classification was used in the Minerva blackboard shell for heuristic classification. Minerva recursively calls itself every problem-solving cycle to solve the important blackboard scheduler task, which involves assigning a desirability rating to alternative problem-solving actions. Knowing these ratings is critical to the use of an expert system as a component of a critiquing or apprenticeship tutoring system. One innovation of this research is a method called dynamic heuristic classification, which allows selection among dynamically generated classification categories instead of requiring them to be prenumerated.

Drug-induced sedation endoscopy (DISE) classification systems: a systematic review and meta-analysis.

PubMed

Dijemeni, Esuabom; D'Amone, Gabriele; Gbati, Israel

2017-12-01

Drug-induced sedation endoscopy (DISE) classification systems have been used to assess anatomical findings on upper airway obstruction, and decide and plan surgical treatments and act as a predictor for surgical treatment outcome for obstructive sleep apnoea management. The first objective is to identify if there is a universally accepted DISE grading and classification system for analysing DISE findings. The second objective is to identify if there is one DISE grading and classification treatment planning framework for deciding appropriate surgical treatment for obstructive sleep apnoea (OSA). The third objective is to identify if there is one DISE grading and classification treatment outcome framework for determining the likelihood of success for a given OSA surgical intervention. A systematic review was performed to identify new and significantly modified DISE classification systems: concept, advantages and disadvantages. Fourteen studies proposing a new DISE classification system and three studies proposing a significantly modified DISE classification were identified. None of the studies were based on randomised control trials. DISE is an objective method for visualising upper airway obstruction. The classification and assessment of clinical findings based on DISE is highly subjective due to the increasing number of DISE classification systems. Hence, this creates a growing divergence in surgical treatment planning and treatment outcome. Further research on a universally accepted objective DISE assessment is critically needed.

A New Tool for Climatic Analysis Using the Koppen Climate Classification

ERIC Educational Resources Information Center

Larson, Paul R.; Lohrengel, C. Frederick, II

2011-01-01

The purpose of climate classification is to help make order of the seemingly endless spatial distribution of climates. The Koppen classification system in a modified format is the most widely applied system in use today. This system may not be the best nor most complete climate classification that can be conceived, but it has gained widespread…

Classification of parotidectomy: a proposed modification to the European Salivary Gland Society classification system.

PubMed

Wong, Wai Keat; Shetty, Subhaschandra

2017-08-01

Parotidectomy remains the mainstay of treatment for both benign and malignant lesions of the parotid gland. There exists a wide range of possible surgical options in parotidectomy in terms of extent of parotid tissue removed. There is increasing need for uniformity of terminology resulting from growing interest in modifications of the conventional parotidectomy. It is, therefore, of paramount importance for a standardized classification system in describing extent of parotidectomy. Recently, the European Salivary Gland Society (ESGS) proposed a novel classification system for parotidectomy. The aim of this study is to evaluate this system. A classification system proposed by the ESGS was critically re-evaluated and modified to increase its accuracy and its acceptability. Modifications mainly focused on subdividing Levels I and II into IA, IB, IIA, and IIB. From June 2006 to June 2016, 126 patients underwent 130 parotidectomies at our hospital. The classification system was tested in that cohort of patient. While the ESGS classification system is comprehensive, it does not cover all possibilities. The addition of Sublevels IA, IB, IIA, and IIB may help to address some of the clinical situations seen and is clinically relevant. We aim to test the modified classification system for partial parotidectomy to address some of the challenges mentioned.

The postoperative COFAS end-stage ankle arthritis classification system: interobserver and intraobserver reliability.

PubMed

Krause, Fabian G; Di Silvestro, Matthew; Penner, Murray J; Wing, Kevin J; Glazebrook, Mark A; Daniels, Timothy R; Lau, Johnny T C; Younger, Alastair S E

2012-02-01

End-stage ankle arthritis is operatively treated with numerous designs of total ankle replacement and different techniques for ankle fusion. For superior comparison of these procedures, outcome research requires a classification system to stratify patients appropriately. A postoperative 4-type classification system was designed by 6 fellowship-trained foot and ankle surgeons. Four surgeons reviewed blinded patient profiles and radiographs on 2 occasions to determine the interobserver and intraobserver reliability of the classification. Excellent interobserver reliability (κ = .89) and intraobserver reproducibility (κ = .87) were demonstrated for the postoperative classification system. In conclusion, the postoperative Canadian Orthopaedic Foot and Ankle Society (COFAS) end-stage ankle arthritis classification system appears to be a valid tool to evaluate the outcome of patients operated for end-stage ankle arthritis.

Railroad Classification Yard Technology Manual: Volume II : Yard Computer Systems

DOT National Transportation Integrated Search

1981-08-01

This volume (Volume II) of the Railroad Classification Yard Technology Manual documents the railroad classification yard computer systems methodology. The subjects covered are: functional description of process control and inventory computer systems,...

Cause of and factors associated with stillbirth: a systematic review of classification systems.

PubMed

Aminu, Mamuda; Bar-Zeev, Sarah; van den Broek, Nynke

2017-05-01

An estimated 2.6 million stillbirths occur worldwide each year. A standardized classification system setting out possible cause of death and contributing factors is useful to help obtain comparative data across different settings. We undertook a systematic review of stillbirth classification systems to highlight their strengths and weaknesses for practitioners and policymakers. We conducted a systematic search and review of the literature to identify the classification systems used to aggregate information for stillbirth and perinatal deaths. Narrative synthesis was used to compare the range and depth of information required to apply the systems, and the different categories provided for cause of and factors contributing to stillbirth. A total of 118 documents were screened; 31 classification systems were included, of which six were designed specifically for stillbirth, 14 for perinatal death, three systems included neonatal deaths and two included infant deaths. Most (27/31) were developed in and first tested using data obtained from high-income settings. All systems required information from clinical records. One-third of the classification systems (11/31) included information obtained from histology or autopsy. The percentage where cause of death remained unknown ranged from 0.39% using the Nordic-Baltic classification to 46.4% using the Keeling system. Over time, classification systems have become more complex. The success of application is dependent on the availability of detailed clinical information and laboratory investigations. Systems that adopt a layered approach allow for classification of cause of death to a broad as well as to a more detailed level. © 2017 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).

Searching bioremediation patents through Cooperative Patent Classification (CPC).

PubMed

Prasad, Rajendra

2016-03-01

Patent classification systems have traditionally evolved independently at each patent jurisdiction to classify patents handled by their examiners to be able to search previous patents while dealing with new patent applications. As patent databases maintained by them went online for free access to public as also for global search of prior art by examiners, the need arose for a common platform and uniform structure of patent databases. The diversity of different classification, however, posed problems of integrating and searching relevant patents across patent jurisdictions. To address this problem of comparability of data from different sources and searching patents, WIPO in the recent past developed what is known as International Patent Classification (IPC) system which most countries readily adopted to code their patents with IPC codes along with their own codes. The Cooperative Patent Classification (CPC) is the latest patent classification system based on IPC/European Classification (ECLA) system, developed by the European Patent Office (EPO) and the United States Patent and Trademark Office (USPTO) which is likely to become a global standard. This paper discusses this new classification system with reference to patents on bioremediation.

Adverse events following cervical manipulative therapy: consensus on classification among Dutch medical specialists, manual therapists, and patients.

PubMed

Kranenburg, Hendrikus A; Lakke, Sandra E; Schmitt, Maarten A; Van der Schans, Cees P

2017-12-01

To obtain consensus-based agreement on a classification system of adverse events (AE) following cervical spinal manipulation. The classification system should be comprised of clear definitions, include patients' and clinicians' perspectives, and have an acceptable number of categories. Design : A three-round Delphi study. Participants : Thirty Dutch participants (medical specialists, manual therapists, and patients) participated in an online survey. Procedure : Participants inventoried AE and were asked about their preferences for either a three- or a four-category classification system. The identified AE were classified by two analysts following the International Classification of Functioning, Disability and Health (ICF), and the International Classification of Diseases and Related Health Problems (ICD-10). Participants were asked to classify the severity for all AE in relation to the time duration. Consensus occurred in a three-category classification system. There was strong consensus for 16 AE in all severities (no, minor, and major AE) and all three time durations [hours, days, weeks]. The 16 AE included anxiety, flushing, skin rash, fainting, dizziness, coma, altered sensation, muscle tenderness, pain, increased pain during movement, radiating pain, dislocation, fracture, transient ischemic attack, stroke, and death. Mild to strong consensus was reached for 13 AE. A consensus-based classification system of AE is established which includes patients' and clinicians' perspectives and has three categories. The classification comprises a precise description of potential AE in accordance with internationally accepted classifications. After international validation, clinicians and researchers may use this AE classification system to report AE in clinical practice and research.

Polyp morphology: an interobserver evaluation for the Paris classification among international experts.

PubMed

van Doorn, Sascha C; Hazewinkel, Y; East, James E; van Leerdam, Monique E; Rastogi, Amit; Pellisé, Maria; Sanduleanu-Dascalescu, Silvia; Bastiaansen, Barbara A J; Fockens, Paul; Dekker, Evelien

2015-01-01

The Paris classification is an international classification system for describing polyp morphology. Thus far, the validity and reproducibility of this classification have not been assessed. We aimed to determine the interobserver agreement for the Paris classification among seven Western expert endoscopists. A total of 85 short endoscopic video clips depicting polyps were created and assessed by seven expert endoscopists according to the Paris classification. After a digital training module, the same 85 polyps were assessed again. We calculated the interobserver agreement with a Fleiss kappa and as the proportion of pairwise agreement. The interobserver agreement of the Paris classification among seven experts was moderate with a Fleiss kappa of 0.42 and a mean pairwise agreement of 67%. The proportion of lesions assessed as "flat" by the experts ranged between 13 and 40% (P<0.001). After the digital training, the interobserver agreement did not change (kappa 0.38, pairwise agreement 60%). Our study is the first to validate the Paris classification for polyp morphology. We demonstrated only a moderate interobserver agreement among international Western experts for this classification system. Our data suggest that, in its current version, the use of this classification system in daily practice is questionable and it is unsuitable for comparative endoscopic research. We therefore suggest introduction of a simplification of the classification system.

5 CFR 9701.222 - Reconsideration of classification decisions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Classification Classification Process § 9701.222...

5 CFR 9701.222 - Reconsideration of classification decisions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Classification Classification Process § 9701.222...

5 CFR 9701.222 - Reconsideration of classification decisions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Classification Classification Process § 9701.222...

5 CFR 9701.222 - Reconsideration of classification decisions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Classification Classification Process § 9701.222...

Risk-informed radioactive waste classification and reclassification.

PubMed

Croff, Allen G

2006-11-01

Radioactive waste classification systems have been developed to allow wastes having similar hazards to be grouped for purposes of storage, treatment, packaging, transportation, and/or disposal. As recommended in the National Council on Radiation Protection and Measurements' Report No. 139, Risk-Based Classification of Radioactive and Hazardous Chemical Wastes, a preferred classification system would be based primarily on the health risks to the public that arise from waste disposal and secondarily on other attributes such as the near-term practicalities of managing a waste, i.e., the waste classification system would be risk informed. The current U.S. radioactive waste classification system is not risk informed because key definitions--especially that of high-level waste--are based on the source of the waste instead of its inherent characteristics related to risk. A second important reason for concluding the existing U.S. radioactive waste classification system is not risk informed is there are no general principles or provisions for exempting materials from being classified as radioactive waste which would then allow management without regard to its radioactivity. This paper elaborates the current system for classifying and reclassifying radioactive wastes in the United States, analyzes the extent to which the system is risk informed and the ramifications of its not being so, and provides observations on potential future direction of efforts to address shortcomings in the U.S. radioactive waste classification system as of 2004.

48 CFR 219.303 - Determining North American Industry Classification System (NAICS) codes and size standards.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 3 2011-10-01 2011-10-01 false Determining North American Industry Classification System (NAICS) codes and size standards. 219.303 Section 219.303 Federal... Programs 219.303 Determining North American Industry Classification System (NAICS) codes and size standards...

48 CFR 219.303 - Determining North American Industry Classification System (NAICS) codes and size standards.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 3 2012-10-01 2012-10-01 false Determining North American Industry Classification System (NAICS) codes and size standards. 219.303 Section 219.303 Federal... Programs 219.303 Determining North American Industry Classification System (NAICS) codes and size standards...

48 CFR 219.303 - Determining North American Industry Classification System (NAICS) codes and size standards.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 3 2014-10-01 2014-10-01 false Determining North American Industry Classification System (NAICS) codes and size standards. 219.303 Section 219.303 Federal... Determining North American Industry Classification System (NAICS) codes and size standards. Contracting...

48 CFR 219.303 - Determining North American Industry Classification System (NAICS) codes and size standards.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 3 2013-10-01 2013-10-01 false Determining North American Industry Classification System (NAICS) codes and size standards. 219.303 Section 219.303 Federal... Determining North American Industry Classification System (NAICS) codes and size standards. Contracting...

15 CFR 921.3 - National Estuarine Research Reserve System biogeographic classification scheme and estuarine...

Code of Federal Regulations, 2012 CFR

2012-01-01

... System biogeographic classification scheme and estuarine typologies. 921.3 Section 921.3 Commerce and... biogeographic classification scheme and estuarine typologies. (a) National Estuarine Research Reserves are... classification scheme based on regional variations in the nation's coastal zone has been developed. The...

15 CFR 921.3 - National Estuarine Research Reserve System biogeographic classification scheme and estuarine...

Code of Federal Regulations, 2013 CFR

2013-01-01

... System biogeographic classification scheme and estuarine typologies. 921.3 Section 921.3 Commerce and... biogeographic classification scheme and estuarine typologies. (a) National Estuarine Research Reserves are... classification scheme based on regional variations in the nation's coastal zone has been developed. The...

15 CFR 921.3 - National Estuarine Research Reserve System biogeographic classification scheme and estuarine...

Code of Federal Regulations, 2010 CFR

2010-01-01

... System biogeographic classification scheme and estuarine typologies. 921.3 Section 921.3 Commerce and... biogeographic classification scheme and estuarine typologies. (a) National Estuarine Research Reserves are... classification scheme based on regional variations in the nation's coastal zone has been developed. The...

15 CFR 921.3 - National Estuarine Research Reserve System biogeographic classification scheme and estuarine...

Code of Federal Regulations, 2014 CFR

2014-01-01

... System biogeographic classification scheme and estuarine typologies. 921.3 Section 921.3 Commerce and... biogeographic classification scheme and estuarine typologies. (a) National Estuarine Research Reserves are... classification scheme based on regional variations in the nation's coastal zone has been developed. The...

15 CFR 921.3 - National Estuarine Research Reserve System biogeographic classification scheme and estuarine...

Code of Federal Regulations, 2011 CFR

2011-01-01

... System biogeographic classification scheme and estuarine typologies. 921.3 Section 921.3 Commerce and... biogeographic classification scheme and estuarine typologies. (a) National Estuarine Research Reserves are... classification scheme based on regional variations in the nation's coastal zone has been developed. The...

Use of Deo's classification system on rock : final report.

DOT National Transportation Integrated Search

1983-01-01

A shale from a construction site on Route 23 in Wise County, Virginia, was classified using Deo's classification system, and the usefulness of the classification system was evaluated. In addition, rock that had previously been used in the development...

Intra- and interrater reliability of three different MRI grading and classification systems after acute hamstring injuries.

PubMed

Wangensteen, Arnlaug; Tol, Johannes L; Roemer, Frank W; Bahr, Roald; Dijkstra, H Paul; Crema, Michel D; Farooq, Abdulaziz; Guermazi, Ali

2017-04-01

To assess and compare the intra- and interrater reliability of three different MRI grading and classification systems after acute hamstring injury. Male athletes (n=40) with clinical diagnosis of acute hamstring injury and MRI ≤5days were selected from a prospective cohort. Two radiologists independently evaluated the MRIs using standardised scoring form including the modified Peetrons grading system, the Chan acute muscle strain injury classification and the British Athletics Muscle Injury Classification. Intra-and interrater reliability was assessed with linear weighted kappa (κ) or unweighted Cohen's κ and percentage agreement was calculated. We observed 'substantial' to 'almost perfect' intra- (κ range 0.65-1.00) and interrater reliability (κ range 0.77-1.00) with percentage agreement 83-100% and 88-100%, respectively, for severity gradings, overall anatomical sites and overall classifications for the three MRI systems. We observed substantial variability (κ range -0.05 to 1.00) for subcategories within the Chan classification and the British Athletics Muscle Injury Classification, however, the prevalence of positive scorings was low for some subcategories. The modified Peetrons grading system, overall Chan classification and overall British Athletics Muscle Injury Classification demonstrated 'substantial' to 'almost perfect' intra- and interrater reliability when scored by experienced radiologists. The intra- and interrater reliability for the anatomical subcategories within the classifications remains unclear. Copyright © 2017 Elsevier B.V. All rights reserved.

A domains-based taxonomy of supported accommodation for people with severe and persistent mental illness.

PubMed

Siskind, Dan; Harris, Meredith; Pirkis, Jane; Whiteford, Harvey

2013-06-01

A lack of definitional clarity in supported accommodation and the absence of a widely accepted system for classifying supported accommodation models creates barriers to service planning and evaluation. We undertook a systematic review of existing supported accommodation classification systems. Using a structured system for qualitative data analysis, we reviewed the stratification features in these classification systems, identified the key elements of supported accommodation and arranged them into domains and dimensions to create a new taxonomy. The existing classification systems were mapped onto the new taxonomy to verify the domains and dimensions. Existing classification systems used either a service-level characteristic or programmatic approach. We proposed a taxonomy based around four domains: duration of tenure; patient characteristics; housing characteristics; and service characteristics. All of the domains in the taxonomy were drawn from the existing classification structures; however, none of the existing classification structures covered all of the domains in the taxonomy. Existing classification systems are regionally based, limited in scope and lack flexibility. A domains-based taxonomy can allow more accurate description of supported accommodation services, aid in identifying the service elements likely to improve outcomes for specific patient populations, and assist in service planning.

A Model Assessment and Classification System for Men and Women in Correctional Institutions.

ERIC Educational Resources Information Center

Hellervik, Lowell W.; And Others

The report describes a manpower assessment and classification system for criminal offenders directed towards making practical training and job classification decisions. The model is not concerned with custody classifications except as they affect occupational/training possibilities. The model combines traditional procedures of vocational…

Acute functional deterioration in a child with cerebral palsy

PubMed Central

Smyth, Elizabeth; Kaliaperumal, Chandrasekaran; Leonard, Jane; Caird, John

2012-01-01

We describe a case of acute functional deterioration in a 13-year-old girl with severe spastic diplegia (GMFCS III) and a new diagnosis of diffuse intrinsic pontine glioma (DIPG). She presented with acute deterioration in mobility and motor function over 1 month, which was associated with dysarthria, dysphagia and behavioural change. Her mother had noticed subtle functional deterioration over the 2 months prior to this. Her physiotherapist who was concerned about her acute functional deterioration referred her for emergency review. Neurological imaging revealed a diffuse pontine lesion consistent with DIPG. She was subsequently referred to oncology. She deteriorated further, clinically, over the next few days and following discussion with the team; her family opted for palliative treatment, given the poor prognosis associated with DIPG. PMID:23257647

Comments on new classification, treatment algorithm and prognosis-estimating systems for sigmoid volvulus and ileosigmoid knotting: necessity and utility.

PubMed

Aksungur, N; Korkut, E

2018-05-24

We read Atamanalp classification, treatment algorithm and prognosis-estimating systems for sigmoid volvulus (SV) and ileosigmoid knotting (ISK) in Colorectal Disease [1,2]. Our comments relate to necessity and utility of these new classification systems. Classification or staging systems are generally used in malignant or premalignant pathologies such as colorectal cancers [3] or polyps [4]. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Critical evaluation of the PALM-COEIN classification system among women with abnormal uterine bleeding in low-resource settings.

PubMed

Shubham, Divya; Kawthalkar, Anjali S

2018-05-01

To assess the feasibility of the PALM-COEIN system for the classification of abnormal uterine bleeding (AUB) in low-resource settings and to suggest modifications. A prospective study was conducted among women with AUB who were admitted to the gynecology ward of a tertiary care hospital and research center in central India between November 2014 and October 2016. All patients were managed as per department protocols. The causes of AUB were classified before treatment using the PALM-COEIN system (classification I) and on the basis of the histopathology reports of the hysterectomy specimens (classification II); the results were compared using classification II as the gold standard. The study included 200 women with AUB; hysterectomy was performed in 174 women. Preoperative classification of AUB per the PALM-COEIN system was correct in 130 (65.0%) women. Adenomyosis (evaluated by transvaginal ultrasonography) and endometrial hyperplasia (evaluated by endometrial curettage) were underdiagnosed. The PALM-COEIN classification system helps in deciding the best treatment modality for women with AUB on a case-by-case basis. The incorporation of suggested modifications will further strengthen its utility as a pretreatment classification system in low-resource settings. © 2017 International Federation of Gynecology and Obstetrics.

48 CFR 19.303 - Determining North American Industry Classification System (NAICS) codes and size standards.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Determining North American Industry Classification System (NAICS) codes and size standards. 19.303 Section 19.303 Federal Acquisition... Classification System (NAICS) codes and size standards. (a) The contracting officer shall determine the...

A new tree classification system for southern hardwoods

Treesearch

James S. Meadows; Daniel A. Jr. Skojac

2008-01-01

A new tree classification system for southern hardwoods is described. The new system is based on the Putnam tree classification system, originally developed by Putnam et al., 1960, Management ond inventory of southern hardwoods, Agriculture Handbook 181, US For. Sew., Washington, DC, which consists of four tree classes: (1) preferred growing stock, (2) reserve growing...

Cross-mapping the ICNP with NANDA, HHCC, Omaha System and NIC for unified nursing language system development. International Classification for Nursing Practice. International Council of Nurses. North American Nursing Diagnosis Association. Home Health Care Classification. Nursing Interventions Classification.

PubMed

Hyun, S; Park, H A

2002-06-01

Nursing language plays an important role in describing and defining nursing phenomena and nursing actions. There are numerous vocabularies describing nursing diagnoses, interventions and outcomes in nursing. However, the lack of a standardized unified nursing language is considered a problem for further development of the discipline of nursing. In an effort to unify the nursing languages, the International Council of Nurses (ICN) has proposed the International Classification for Nursing Practice (ICNP) as a unified nursing language system. The purpose of this study was to evaluate the inclusiveness and expressiveness of the ICNP terms by cross-mapping them with the existing nursing terminologies, specifically the North American Nursing Diagnosis Association (NANDA) taxonomy I, the Omaha System, the Home Health Care Classification (HHCC) and the Nursing Interventions Classification (NIC). Nine hundred and seventy-four terms from these four classifications were cross-mapped with the ICNP terms. This was performed in accordance with the Guidelines for Composing a Nursing Diagnosis and Guidelines for Composing a Nursing Intervention, which were suggested by the ICNP development team. An expert group verified the results. The ICNP Phenomena Classification described 87.5% of the NANDA diagnoses, 89.7% of the HHCC diagnoses and 72.7% of the Omaha System problem classification scheme. The ICNP Action Classification described 79.4% of the NIC interventions, 80.6% of the HHCC interventions and 71.4% of the Omaha System intervention scheme. The results of this study suggest that the ICNP has a sound starting structure for a unified nursing language system and can be used to describe most of the existing terminologies. Recommendations for the addition of terms to the ICNP are provided.

A "TNM" classification system for cancer pain: the Edmonton Classification System for Cancer Pain (ECS-CP).

PubMed

Fainsinger, Robin L; Nekolaichuk, Cheryl L

2008-06-01

The purpose of this paper is to provide an overview of the development of a "TNM" cancer pain classification system for advanced cancer patients, the Edmonton Classification System for Cancer Pain (ECS-CP). Until we have a common international language to discuss cancer pain, understanding differences in clinical and research experience in opioid rotation and use remains problematic. The complexity of the cancer pain experience presents unique challenges for the classification of pain. To date, no universally accepted pain classification measure can accurately predict the complexity of pain management, particularly for patients with cancer pain that is difficult to treat. In response to this gap in clinical assessment, the Edmonton Staging System (ESS), a classification system for cancer pain, was developed. Difficulties in definitions and interpretation of some aspects of the ESS restricted acceptance and widespread use. Construct, inter-rater reliability, and predictive validity evidence have contributed to the development of the ECS-CP. The five features of the ECS-CP--Pain Mechanism, Incident Pain, Psychological Distress, Addictive Behavior and Cognitive Function--have demonstrated value in predicting pain management complexity. The development of a standardized classification system that is comprehensive, prognostic and simple to use could provide a common language for clinical management and research of cancer pain. An international study to assess the inter-rater reliability and predictive value of the ECS-CP is currently in progress.

5 CFR 9901.224 - Appeal to OPM for review of classification decisions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... RESOURCES MANAGEMENT AND LABOR RELATIONS SYSTEMS (DEPARTMENT OF DEFENSE-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF DEFENSE NATIONAL SECURITY PERSONNEL SYSTEM (NSPS) Classification Classification Process § 9901...

5 CFR 9901.224 - Appeal to OPM for review of classification decisions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... RESOURCES MANAGEMENT AND LABOR RELATIONS SYSTEMS (DEPARTMENT OF DEFENSE-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF DEFENSE NATIONAL SECURITY PERSONNEL SYSTEM (NSPS) Classification Classification Process § 9901...

Efficacy measures associated to a plantar pressure based classification system in diabetic foot medicine.

PubMed

Deschamps, Kevin; Matricali, Giovanni Arnoldo; Desmet, Dirk; Roosen, Philip; Keijsers, Noel; Nobels, Frank; Bruyninckx, Herman; Staes, Filip

2016-09-01

The concept of 'classification' has, similar to many other diseases, been found to be fundamental in the field of diabetic medicine. In the current study, we aimed at determining efficacy measures of a recently published plantar pressure based classification system. Technical efficacy of the classification system was investigated by applying a high resolution, pixel-level analysis on the normalized plantar pressure pedobarographic fields of the original experimental dataset consisting of 97 patients with diabetes and 33 persons without diabetes. Clinical efficacy was assessed by considering the occurence of foot ulcers at the plantar aspect of the forefoot in this dataset. Classification efficacy was assessed by determining the classification recognition rate as well as its sensitivity and specificity using cross-validation subsets of the experimental dataset together with a novel cohort of 12 patients with diabetes. Pixel-level comparison of the four groups associated to the classification system highlighted distinct regional differences. Retrospective analysis showed the occurence of eleven foot ulcers in the experimental dataset since their gait analysis. Eight out of the eleven ulcers developed in a region of the foot which had the highest forces. Overall classification recognition rate exceeded 90% for all cross-validation subsets. Sensitivity and specificity of the four groups associated to the classification system exceeded respectively the 0.7 and 0.8 level in all cross-validation subsets. The results of the current study support the use of the novel plantar pressure based classification system in diabetic foot medicine. It may particularly serve in communication, diagnosis and clinical decision making. Copyright © 2016 Elsevier B.V. All rights reserved.

Classification System and Information Services in the Library of SAO RAS

NASA Astrophysics Data System (ADS)

Shvedova, G. S.

The classification system used at SAO RAS is described. It includes both special determinants from UDC (Universal Decimal Classification) and newer tables with astronomical terms from the Library-Bibliographical Classification (LBC). The classification tables are continually modified, and new astronomical terms are introduced. At the present time the information services of the scientists is fulfilled with the help of the Abstract Journal Astronomy, Astronomy and Astrophysics Abstracts, catalogues and card indexes of the library. Based on our classification system and The Astronomy Thesaurus completed by R.M. Shobbrook and R.R. Shobbrook the development of a database for the library has been started, which allows prompt service of the observatory's staff members.

Proximal humeral fracture classification systems revisited.

PubMed

Majed, Addie; Macleod, Iain; Bull, Anthony M J; Zyto, Karol; Resch, Herbert; Hertel, Ralph; Reilly, Peter; Emery, Roger J H

2011-10-01

This study evaluated several classification systems and expert surgeons' anatomic understanding of these complex injuries based on a consecutive series of patients. We hypothesized that current proximal humeral fracture classification systems, regardless of imaging methods, are not sufficiently reliable to aid clinical management of these injuries. Complex fractures in 96 consecutive patients were investigated by generation of rapid sequence prototyping models from computed tomography Digital Imaging and Communications in Medicine (DICOM) imaging data. Four independent senior observers were asked to classify each model using 4 classification systems: Neer, AO, Codman-Hertel, and a prototype classification system by Resch. Interobserver and intraobserver κ coefficient values were calculated for the overall classification system and for selected classification items. The κ coefficient values for the interobserver reliability were 0.33 for Neer, 0.11 for AO, 0.44 for Codman-Hertel, and 0.15 for Resch. Interobserver reliability κ coefficient values were 0.32 for the number of fragments and 0.30 for the anatomic segment involved using the Neer system, 0.30 for the AO type (A, B, C), and 0.53, 0.48, and 0.08 for the Resch impaction/distraction, varus/valgus and flexion/extension subgroups, respectively. Three-part fractures showed low reliability for the Neer and AO systems. Currently available evidence suggests fracture classifications in use have poor intra- and inter-observer reliability despite the modality of imaging used thus making treating these injuries difficult as weak as affecting scientific research as well. This study was undertaken to evaluate the reliability of several systems using rapid sequence prototype models. Overall interobserver κ values represented slight to moderate agreement. The most reliable interobserver scores were found with the Codman-Hertel classification, followed by elements of Resch's trial system. The AO system had the lowest values. The higher interobserver reliability values for the Codman-Hertel system showed that is the only comprehensive fracture description studied, whereas the novel classification by Resch showed clear definition in respect to varus/valgus and impaction/distraction angulation. Copyright © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

46 CFR 76.50-5 - Classification.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 3 2011-10-01 2011-10-01 false Classification. 76.50-5 Section 76.50-5 Shipping COAST... Classification. (a) Hand portable fire extinguishers and semiportable fire extinguishing systems shall be... extinguishing systems are set forth in table 76.50-5(c). Table 76.50-5(c) Classification Type Size Soda acid and...

46 CFR 76.50-5 - Classification.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 3 2010-10-01 2010-10-01 false Classification. 76.50-5 Section 76.50-5 Shipping COAST... Classification. (a) Hand portable fire extinguishers and semiportable fire extinguishing systems shall be... extinguishing systems are set forth in table 76.50-5(c). Table 76.50-5(c) Classification Type Size Soda acid and...

46 CFR 76.50-5 - Classification.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 3 2014-10-01 2014-10-01 false Classification. 76.50-5 Section 76.50-5 Shipping COAST... Classification. (a) Hand portable fire extinguishers and semiportable fire extinguishing systems shall be... extinguishing systems are set forth in table 76.50-5(c). Table 76.50-5(c) Classification Type Size Soda acid and...

46 CFR 76.50-5 - Classification.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 3 2013-10-01 2013-10-01 false Classification. 76.50-5 Section 76.50-5 Shipping COAST... Classification. (a) Hand portable fire extinguishers and semiportable fire extinguishing systems shall be... extinguishing systems are set forth in table 76.50-5(c). Table 76.50-5(c) Classification Type Size Soda acid and...

46 CFR 76.50-5 - Classification.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 3 2012-10-01 2012-10-01 false Classification. 76.50-5 Section 76.50-5 Shipping COAST... Classification. (a) Hand portable fire extinguishers and semiportable fire extinguishing systems shall be... extinguishing systems are set forth in table 76.50-5(c). Table 76.50-5(c) Classification Type Size Soda acid and...

43 CFR 2461.1 - Proposed classifications.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Proposed classifications. 2461.1 Section... MANAGEMENT, DEPARTMENT OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) BUREAU INITIATED CLASSIFICATION SYSTEM Multiple-Use Classification Procedures § 2461.1 Proposed classifications. (a) Proposed classifications will...

43 CFR 2461.4 - Changing classifications.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Changing classifications. 2461.4 Section... MANAGEMENT, DEPARTMENT OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) BUREAU INITIATED CLASSIFICATION SYSTEM Multiple-Use Classification Procedures § 2461.4 Changing classifications. Classifications may be changed...

43 CFR 2461.1 - Proposed classifications.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Proposed classifications. 2461.1 Section... MANAGEMENT, DEPARTMENT OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) BUREAU INITIATED CLASSIFICATION SYSTEM Multiple-Use Classification Procedures § 2461.1 Proposed classifications. (a) Proposed classifications will...

43 CFR 2461.4 - Changing classifications.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Changing classifications. 2461.4 Section... MANAGEMENT, DEPARTMENT OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) BUREAU INITIATED CLASSIFICATION SYSTEM Multiple-Use Classification Procedures § 2461.4 Changing classifications. Classifications may be changed...

43 CFR 2461.1 - Proposed classifications.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Proposed classifications. 2461.1 Section... MANAGEMENT, DEPARTMENT OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) BUREAU INITIATED CLASSIFICATION SYSTEM Multiple-Use Classification Procedures § 2461.1 Proposed classifications. (a) Proposed classifications will...

43 CFR 2461.4 - Changing classifications.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Changing classifications. 2461.4 Section... MANAGEMENT, DEPARTMENT OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) BUREAU INITIATED CLASSIFICATION SYSTEM Multiple-Use Classification Procedures § 2461.4 Changing classifications. Classifications may be changed...

43 CFR 2461.1 - Proposed classifications.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Proposed classifications. 2461.1 Section... MANAGEMENT, DEPARTMENT OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) BUREAU INITIATED CLASSIFICATION SYSTEM Multiple-Use Classification Procedures § 2461.1 Proposed classifications. (a) Proposed classifications will...

43 CFR 2461.4 - Changing classifications.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Changing classifications. 2461.4 Section... MANAGEMENT, DEPARTMENT OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) BUREAU INITIATED CLASSIFICATION SYSTEM Multiple-Use Classification Procedures § 2461.4 Changing classifications. Classifications may be changed...

Staging of chronic myeloid leukemia in the imatinib era: an evaluation of the World Health Organization proposal.

PubMed

Cortes, Jorge E; Talpaz, Moshe; O'Brien, Susan; Faderl, Stefan; Garcia-Manero, Guillermo; Ferrajoli, Alessandra; Verstovsek, Srdan; Rios, Mary B; Shan, Jenny; Kantarjian, Hagop M

2006-03-15

Several staging classification systems, all of which were designed in the preimatinib era, are used for chronic myeloid leukemia (CML). The World Health Organization (WHO) recently proposed a new classification system that has not been validated clinically. The authors investigated the significance of the WHO classification system and compared it with the classification systems used to date in imatinib trials ("standard definition") to determine its impact in establishing the outcome of patients after therapy with imatinib. In total, 809 patients who received imatinib for CML were classified into chronic phase (CP), accelerated phase (AP), and blast phase (BP) based on standard definitions and then were reclassified according to the new WHO classification system. Their outcomes with imatinib therapy were compared, and the value of individual components of these classification systems was determined. With the WHO classification, 78 patients (10%) were reclassified: 45 patients (6%) were reclassified from CP to AP, 14 patients (2%) were reclassified from AP to CP, and 19 patients (2%) were reclassified from AP to BP. The rates of complete cytogenetic response for patients in CP, AP, and BP according to the standard definition were 72%, 45%, and 8%, respectively. After these patients were reclassified according to WHO criteria, the response rates were 77% (P = 0.07), 39% (P = 0.28), and 11% (P = 0.61), respectively. The 3-year survival rates were 91%, 65%, and 10%, respectively, according to the standard classification and 95% (P = 0.05), 63% (P = 0.76), and 16% (P = 0.18), respectively, according to the WHO classification. Patients who had a blast percentage of 20-29%, which is considered CML-BP according to the WHO classification, had a significantly better response rate (21% vs. 8%; P = 0.11) and 3-year survival rate (42% vs. 10%; P = 0.0001) compared with patients who had blasts > or = 30%. Different classification systems had an impact on the outcome of patients, and some prognostic features had different prognostic implications in the imatinib era. The authors believe that a new, uniform staging system for CML is warranted, and they propose such a system. (c) 2006 American Cancer Society.

Characteristics of a global classification system for perinatal deaths: a Delphi consensus study.

PubMed

Wojcieszek, Aleena M; Reinebrant, Hanna E; Leisher, Susannah Hopkins; Allanson, Emma; Coory, Michael; Erwich, Jan Jaap; Frøen, J Frederik; Gardosi, Jason; Gordijn, Sanne; Gulmezoglu, Metin; Heazell, Alexander E P; Korteweg, Fleurisca J; McClure, Elizabeth; Pattinson, Robert; Silver, Robert M; Smith, Gordon; Teoh, Zheyi; Tunçalp, Özge; Flenady, Vicki

2016-08-15

Despite the global burden of perinatal deaths, there is currently no single, globally-acceptable classification system for perinatal deaths. Instead, multiple, disparate systems are in use world-wide. This inconsistency hinders accurate estimates of causes of death and impedes effective prevention strategies. The World Health Organisation (WHO) is developing a globally-acceptable classification approach for perinatal deaths. To inform this work, we sought to establish a consensus on the important characteristics of such a system. A group of international experts in the classification of perinatal deaths were identified and invited to join an expert panel to develop a list of important characteristics of a quality global classification system for perinatal death. A Delphi consensus methodology was used to reach agreement. Three rounds of consultation were undertaken using a purpose built on-line survey. Round one sought suggested characteristics for subsequent scoring and selection in rounds two and three. The panel of experts agreed on a total of 17 important characteristics for a globally-acceptable perinatal death classification system. Of these, 10 relate to the structural design of the system and 7 relate to the functional aspects and use of the system. This study serves as formative work towards the development of a globally-acceptable approach for the classification of the causes of perinatal deaths. The list of functional and structural characteristics identified should be taken into consideration when designing and developing such a system.

Interobserver reliability of the young-burgess and tile classification systems for fractures of the pelvic ring.

PubMed

Koo, Henry; Leveridge, Mike; Thompson, Charles; Zdero, Rad; Bhandari, Mohit; Kreder, Hans J; Stephen, David; McKee, Michael D; Schemitsch, Emil H

2008-07-01

The purpose of this study was to measure interobserver reliability of 2 classification systems of pelvic ring fractures and to determine whether computed tomography (CT) improves reliability. The reliability of several radiographic findings was also tested. Thirty patients taken from a database at a Level I trauma facility were reviewed. For each patient, 3 radiographs (AP pelvis, inlet, and outlet) and CT scans were available. Six different reviewers (pelvic and acetabular specialist, orthopaedic traumatologist, or orthopaedic trainee) classified the injury according to Young-Burgess and Tile classification systems after reviewing plain radiographs and then after CT scans. The Kappa coefficient was used to determine interobserver reliability of these classification systems before and after CT scan. For plain radiographs, overall Kappa values for the Young-Burgess and Tile classification systems were 0.72 and 0.30, respectively. For CT scan and plain radiographs, the overall Kappa values for the Young-Burgess and Tile classification systems were 0.63 and 0.33, respectively. The pelvis/acetabular surgeons demonstrated the highest level of agreement using both classification systems. For individual questions, the addition of CT did significantly improve reviewer interpretation of fracture stability. The pre-CT and post-CT Kappa values for fracture stability were 0.59 and 0.93, respectively. The CT scan can improve the reliability of assessment of pelvic stability because of its ability to identify anatomical features of injury. The Young-Burgess system may be optimal for the learning surgeon. The Tile classification system is more beneficial for specialists in pelvic and acetabular surgery.

A Review of Major Nursing Vocabularies and the Extent to Which They Have the Characteristics Required for Implementation in Computer-based Systems

PubMed Central

Henry, Suzanne Bakken; Warren, Judith J.; Lange, Linda; Button, Patricia

1998-01-01

Building on the work of previous authors, the Computer-based Patient Record Institute (CPRI) Work Group on Codes and Structures has described features of a classification scheme for implementation within a computer-based patient record. The authors of the current study reviewed the evaluation literature related to six major nursing vocabularies (the North American Nursing Diagnosis Association Taxonomy 1, the Nursing Interventions Classification, the Nursing Outcomes Classification, the Home Health Care Classification, the Omaha System, and the International Classification for Nursing Practice) to determine the extent to which the vocabularies include the CPRI features. None of the vocabularies met all criteria. The Omaha System, Home Health Care Classification, and International Classification for Nursing Practice each included five features. Criteria not fully met by any systems were clear and non-redundant representation of concepts, administrative cross-references, syntax and grammar, synonyms, uncertainty, context-free identifiers, and language independence. PMID:9670127

Comparison of wheat classification accuracy using different classifiers of the image-100 system

NASA Technical Reports Server (NTRS)

Dejesusparada, N. (Principal Investigator); Chen, S. C.; Moreira, M. A.; Delima, A. M.

1981-01-01

Classification results using single-cell and multi-cell signature acquisition options, a point-by-point Gaussian maximum-likelihood classifier, and K-means clustering of the Image-100 system are presented. Conclusions reached are that: a better indication of correct classification can be provided by using a test area which contains various cover types of the study area; classification accuracy should be evaluated considering both the percentages of correct classification and error of commission; supervised classification approaches are better than K-means clustering; Gaussian distribution maximum likelihood classifier is better than Single-cell and Multi-cell Signature Acquisition Options of the Image-100 system; and in order to obtain a high classification accuracy in a large and heterogeneous crop area, using Gaussian maximum-likelihood classifier, homogeneous spectral subclasses of the study crop should be created to derive training statistics.

Classification in Australia.

ERIC Educational Resources Information Center

McKinlay, John

Despite some inroads by the Library of Congress Classification and short-lived experimentation with Universal Decimal Classification and Bliss Classification, Dewey Decimal Classification, with its ability in recent editions to be hospitable to local needs, remains the most widely used classification system in Australia. Although supplemented at…

Second Language Writing Classification System Based on Word-Alignment Distribution

ERIC Educational Resources Information Center

Kotani, Katsunori; Yoshimi, Takehiko

2010-01-01

The present paper introduces an automatic classification system for assisting second language (L2) writing evaluation. This system, which classifies sentences written by L2 learners as either native speaker-like or learner-like sentences, is constructed by machine learning algorithms using word-alignment distributions as classification features…

Library Classification 2020

ERIC Educational Resources Information Center

Harris, Christopher

2013-01-01

In this article the author explores how a new library classification system might be designed using some aspects of the Dewey Decimal Classification (DDC) and ideas from other systems to create something that works for school libraries in the year 2020. By examining what works well with the Dewey Decimal System, what features should be carried…

48 CFR 19.303 - Determining North American Industry Classification System codes and size standards.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Industry Classification System codes and size standards. 19.303 Section 19.303 Federal Acquisition... of Small Business Status for Small Business Programs 19.303 Determining North American Industry... North American Industry Classification System (NAICS) code and related small business size standard and...

A multilayered approach for the analysis of perinatal mortality using different classification systems.

PubMed

Gordijn, Sanne J; Korteweg, Fleurisca J; Erwich, Jan Jaap H M; Holm, Jozien P; van Diem, Mariet Th; Bergman, Klasien A; Timmer, Albertus

2009-06-01

Many classification systems for perinatal mortality are available, all with their own strengths and weaknesses: none of them has been universally accepted. We present a systematic multilayered approach for the analysis of perinatal mortality based on information related to the moment of death, the conditions associated with death and the underlying cause of death, using a combination of representatives of existing classification systems. We compared the existing classification systems regarding their definition of the perinatal period, level of complexity, inclusion of maternal, foetal and/or placental factors and whether they focus at a clinical or pathological viewpoint. Furthermore, we allocated the classification systems to one of three categories: 'when', 'what' or 'why', dependent on whether the allocation of the individual cases of perinatal mortality is based on the moment of death ('when'), the clinical conditions associated with death ('what'), or the underlying cause of death ('why'). A multilayered approach for the analysis and classification of perinatal mortality is possible by using combinations of existing systems; for example the Wigglesworth or Nordic Baltic ('when'), ReCoDe ('what') and Tulip ('why') classification systems. This approach is useful not only for in depth analysis of perinatal mortality in the developed world but also for analysis of perinatal mortality in the developing countries, where resources to investigate death are often limited.

Comparing the Utility of the 2000 and 2005 Carnegie Classification Systems in Research on Students' College Experiences and Outcomes

ERIC Educational Resources Information Center

McCormick, Alexander C.; Pike, Gary R.; Kuh, George D.; Chen, Pu-Shih Daniel

2009-01-01

This study compares the explanatory power of the 2000 edition of Carnegie Classification, the 2005 revision of the classification, and selected variables underlying Carnegie's expanded 2005 classification system using data from the National Survey of Student Engagement's spring 2004 administration. Results indicate that the 2000 and 2005…

Auto-SEIA: simultaneous optimization of image processing and machine learning algorithms

NASA Astrophysics Data System (ADS)

Negro Maggio, Valentina; Iocchi, Luca

2015-02-01

Object classification from images is an important task for machine vision and it is a crucial ingredient for many computer vision applications, ranging from security and surveillance to marketing. Image based object classification techniques properly integrate image processing and machine learning (i.e., classification) procedures. In this paper we present a system for automatic simultaneous optimization of algorithms and parameters for object classification from images. More specifically, the proposed system is able to process a dataset of labelled images and to return a best configuration of image processing and classification algorithms and of their parameters with respect to the accuracy of classification. Experiments with real public datasets are used to demonstrate the effectiveness of the developed system.

Ground truth management system to support multispectral scanner /MSS/ digital analysis

NASA Technical Reports Server (NTRS)

Coiner, J. C.; Ungar, S. G.

1977-01-01

A computerized geographic information system for management of ground truth has been designed and implemented to relate MSS classification results to in situ observations. The ground truth system transforms, generalizes and rectifies ground observations to conform to the pixel size and shape of high resolution MSS aircraft data. These observations can then be aggregated for comparison to lower resolution sensor data. Construction of a digital ground truth array allows direct pixel by pixel comparison between classification results of MSS data and ground truth. By making comparisons, analysts can identify spatial distribution of error within the MSS data as well as usual figures of merit for the classifications. Use of the ground truth system permits investigators to compare a variety of environmental or anthropogenic data, such as soil color or tillage patterns, with classification results and allows direct inclusion of such data into classification operations. To illustrate the system, examples from classification of simulated Thematic Mapper data for agricultural test sites in North Dakota and Kansas are provided.

Review of Medical Image Classification using the Adaptive Neuro-Fuzzy Inference System

PubMed Central

Hosseini, Monireh Sheikh; Zekri, Maryam

2012-01-01

Image classification is an issue that utilizes image processing, pattern recognition and classification methods. Automatic medical image classification is a progressive area in image classification, and it is expected to be more developed in the future. Because of this fact, automatic diagnosis can assist pathologists by providing second opinions and reducing their workload. This paper reviews the application of the adaptive neuro-fuzzy inference system (ANFIS) as a classifier in medical image classification during the past 16 years. ANFIS is a fuzzy inference system (FIS) implemented in the framework of an adaptive fuzzy neural network. It combines the explicit knowledge representation of an FIS with the learning power of artificial neural networks. The objective of ANFIS is to integrate the best features of fuzzy systems and neural networks. A brief comparison with other classifiers, main advantages and drawbacks of this classifier are investigated. PMID:23493054

5 CFR 9701.221 - Classification requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Classification requirements. 9701.221 Section 9701.221 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT... HUMAN RESOURCES MANAGEMENT SYSTEM Classification Classification Process § 9701.221 Classification...

Nursing Classification Systems

PubMed Central

Henry, Suzanne Bakken; Mead, Charles N.

1997-01-01

Abstract Our premise is that from the perspective of maximum flexibility of data usage by computer-based record (CPR) systems, existing nursing classification systems are necessary, but not sufficient, for representing important aspects of “what nurses do.” In particular, we have focused our attention on those classification systems that represent nurses' clinical activities through the abstraction of activities into categories of nursing interventions. In this theoretical paper, we argue that taxonomic, combinatorial vocabularies capable of coding atomic-level nursing activities are required to effectively capture in a reproducible and reversible manner the clinical decisions and actions of nurses, and that, without such vocabularies and associated grammars, potentially important clinical process data is lost during the encoding process. Existing nursing intervention classification systems do not fulfill these criteria. As background to our argument, we first present an overview of the content, methods, and evaluation criteria used in previous studies whose focus has been to evaluate the effectiveness of existing coding and classification systems. Next, using the Ingenerf typology of taxonomic vocabularies, we categorize the formal type and structure of three existing nursing intervention classification systems—Nursing Interventions Classification, Omaha System, and Home Health Care Classification. Third, we use records from home care patients to show examples of lossy data transformation, the loss of potentially significant atomic data, resulting from encoding using each of the three systems. Last, we provide an example of the application of a formal representation methodology (conceptual graphs) which we believe could be used as a model to build the required combinatorial, taxonomic vocabulary for representing nursing interventions. PMID:9147341

Gender classification in low-resolution surveillance video: in-depth comparison of random forests and SVMs

NASA Astrophysics Data System (ADS)

Geelen, Christopher D.; Wijnhoven, Rob G. J.; Dubbelman, Gijs; de With, Peter H. N.

2015-03-01

This research considers gender classification in surveillance environments, typically involving low-resolution images and a large amount of viewpoint variations and occlusions. Gender classification is inherently difficult due to the large intra-class variation and interclass correlation. We have developed a gender classification system, which is successfully evaluated on two novel datasets, which realistically consider the above conditions, typical for surveillance. The system reaches a mean accuracy of up to 90% and approaches our human baseline of 92.6%, proving a high-quality gender classification system. We also present an in-depth discussion of the fundamental differences between SVM and RF classifiers. We conclude that balancing the degree of randomization in any classifier is required for the highest classification accuracy. For our problem, an RF-SVM hybrid classifier exploiting the combination of HSV and LBP features results in the highest classification accuracy of 89.9 0.2%, while classification computation time is negligible compared to the detection time of pedestrians.

Utilization of patient classification systems in Swedish hospitals and the degree of satisfaction among nursing staff.

PubMed

Perroca, Marcia Galan; Ek, Anna-Christina

2007-07-01

Although patient classification tools have been used in Sweden since the 1980s, few studies have examined how they are utilized and monitored. This paper investigates the patient classification systems implemented in hospitals in the country as well as the level of satisfaction of nurses with the implemented instrument. A postal survey method was used in which a total of 128 questionnaires were sent to nurse managers. Twenty-three hospitals were identified with patient classification systems currently in operation. The Zebra and Beakta systems are the most commonly used instruments. Nurse managers appear to be satisfied with the patient classification systems in use on their wards as a whole except for their inability to measure the quality of care provided, the time spent to use the instruments and the fact that the administration do not estimate nursing staff requirements using the system.

Development of neural network techniques for finger-vein pattern classification

NASA Astrophysics Data System (ADS)

Wu, Jian-Da; Liu, Chiung-Tsiung; Tsai, Yi-Jang; Liu, Jun-Ching; Chang, Ya-Wen

2010-02-01

A personal identification system using finger-vein patterns and neural network techniques is proposed in the present study. In the proposed system, the finger-vein patterns are captured by a device that can transmit near infrared through the finger and record the patterns for signal analysis and classification. The biometric system for verification consists of a combination of feature extraction using principal component analysis and pattern classification using both back-propagation network and adaptive neuro-fuzzy inference systems. Finger-vein features are first extracted by principal component analysis method to reduce the computational burden and removes noise residing in the discarded dimensions. The features are then used in pattern classification and identification. To verify the effect of the proposed adaptive neuro-fuzzy inference system in the pattern classification, the back-propagation network is compared with the proposed system. The experimental results indicated the proposed system using adaptive neuro-fuzzy inference system demonstrated a better performance than the back-propagation network for personal identification using the finger-vein patterns.

A Hybrid Classification System for Heart Disease Diagnosis Based on the RFRS Method.

PubMed

Liu, Xiao; Wang, Xiaoli; Su, Qiang; Zhang, Mo; Zhu, Yanhong; Wang, Qiugen; Wang, Qian

2017-01-01

Heart disease is one of the most common diseases in the world. The objective of this study is to aid the diagnosis of heart disease using a hybrid classification system based on the ReliefF and Rough Set (RFRS) method. The proposed system contains two subsystems: the RFRS feature selection system and a classification system with an ensemble classifier. The first system includes three stages: (i) data discretization, (ii) feature extraction using the ReliefF algorithm, and (iii) feature reduction using the heuristic Rough Set reduction algorithm that we developed. In the second system, an ensemble classifier is proposed based on the C4.5 classifier. The Statlog (Heart) dataset, obtained from the UCI database, was used for experiments. A maximum classification accuracy of 92.59% was achieved according to a jackknife cross-validation scheme. The results demonstrate that the performance of the proposed system is superior to the performances of previously reported classification techniques.

Designing a Classification System for Internet Offenders: Doing Cognitive Distortions

ERIC Educational Resources Information Center

Hundersmarck, Steven F.; Durkin, Keith F.; Delong, Ronald L.

2007-01-01

Televised features such as NBC's "To Catch a Predator" have highlighted the growing problem posed by Internet sexual predators. This paper reports on the authors' attempts in designing a classification system for Internet offenders. The classification system was designed based on existing theory, understanding the nature of Internet offenders and…

78 FR 64925 - Request for Comments on Proposed Elimination of Patents Search Templates

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-30

... is a detailed, collaborative, and dynamic system that will enable patent examiners and the public to... launched in January 2013. CPC is a detailed, dynamic classification system that is based on the IPC and... updating. Further, the USPTO launched a new classification system, the Cooperative Patent Classification...

Perceptual and Acoustic Reliability Estimates for the Speech Disorders Classification System (SDCS)

ERIC Educational Resources Information Center

Shriberg, Lawrence D.; Fourakis, Marios; Hall, Sheryl D.; Karlsson, Heather B.; Lohmeier, Heather L.; McSweeny, Jane L.; Potter, Nancy L.; Scheer-Cohen, Alison R.; Strand, Edythe A.; Tilkens, Christie M.; Wilson, David L.

2010-01-01

A companion paper describes three extensions to a classification system for paediatric speech sound disorders termed the Speech Disorders Classification System (SDCS). The SDCS uses perceptual and acoustic data reduction methods to obtain information on a speaker's speech, prosody, and voice. The present paper provides reliability estimates for…

Towards a consensus on a hearing preservation classification system.

PubMed

Skarzynski, Henryk; van de Heyning, P; Agrawal, S; Arauz, S L; Atlas, M; Baumgartner, W; Caversaccio, M; de Bodt, M; Gavilan, J; Godey, B; Green, K; Gstoettner, W; Hagen, R; Han, D M; Kameswaran, M; Karltorp, E; Kompis, M; Kuzovkov, V; Lassaletta, L; Levevre, F; Li, Y; Manikoth, M; Martin, J; Mlynski, R; Mueller, J; O'Driscoll, M; Parnes, L; Prentiss, S; Pulibalathingal, S; Raine, C H; Rajan, G; Rajeswaran, R; Rivas, J A; Rivas, A; Skarzynski, P H; Sprinzl, G; Staecker, H; Stephan, K; Usami, S; Yanov, Y; Zernotti, M E; Zimmermann, K; Lorens, A; Mertens, G

2013-01-01

The comprehensive Hearing Preservation classification system presented in this paper is suitable for use for all cochlear implant users with measurable pre-operative residual hearing. If adopted as a universal reporting standard, as it was designed to be, it should prove highly beneficial by enabling future studies to quickly and easily compare the results of previous studies and meta-analyze their data. To develop a comprehensive Hearing Preservation classification system suitable for use for all cochlear implant users with measurable pre-operative residual hearing. The HEARRING group discussed and reviewed a number of different propositions of a HP classification systems and reviewed critical appraisals to develop a qualitative system in accordance with the prerequisites. The Hearing Preservation Classification System proposed herein fulfills the following necessary criteria: 1) classification is independent from users' initial hearing, 2) it is appropriate for all cochlear implant users with measurable pre-operative residual hearing, 3) it covers the whole range of pure tone average from 0 to 120 dB; 4) it is easy to use and easy to understand.

Classifying diseases and remedies in ethnomedicine and ethnopharmacology.

PubMed

Staub, Peter O; Geck, Matthias S; Weckerle, Caroline S; Casu, Laura; Leonti, Marco

2015-11-04

Ethnopharmacology focuses on the understanding of local and indigenous use of medicines and therefore an emic approach is inevitable. Often, however, standard biomedical disease classifications are used to describe and analyse local diseases and remedies. Standard classifications might be a valid tool for cross-cultural comparisons and bioprospecting purposes but are not suitable to understand the local perception of disease and use of remedies. Different standard disease classification systems exist but their suitability for cross-cultural comparisons of ethnomedical data has never been assessed. Depending on the research focus, (I) ethnomedical, (II) cross-cultural, and (III) bioprospecting, we provide suggestions for the use of specific classification systems. We analyse three different standard biomedical classification systems (the International Classification of Diseases (ICD); the Economic Botany Data Collection Standard (EBDCS); and the International Classification of Primary Care (ICPC)), and discuss their value for categorizing diseases of ethnomedical systems and their suitability for cross-cultural research in ethnopharmacology. Moreover, based on the biomedical uses of all approved plant derived biomedical drugs, we propose a biomedical therapy-based classification system as a guide for the discovery of drugs from ethnopharmacological sources. Widely used standards, such as the International Classification of Diseases (ICD) by the WHO and the Economic Botany Data Collection Standard (EBDCS) are either technically challenging due to a categorisation system based on clinical examinations, which are usually not possible during field research (ICD) or lack clear biomedical criteria combining disorders and medical effects in an imprecise and confusing way (EBDCS). The International Classification of Primary Care (ICPC), also accepted by the WHO, has more in common with ethnomedical reality than the ICD or the EBDCS, as the categories are designed according to patient's perceptions and are less influenced by clinical medicine. Since diagnostic tools are not required, medical ethnobotanists and ethnopharmacologists can easily classify reported symptoms and complaints with the ICPC in one of the "chapters" based on 17 body systems, psychological and social problems. Also the biomedical uses of plant-derived drugs are classifiable into 17 broad organ- and therapy-based use-categories but can easily be divided into more specific subcategories. Depending on the research focus (I-III) we propose the following classification systems: I. Ethnomedicine: Ethnomedicine is culture-bound and local classifications have to be understood from an emic perspective. Consequently, the application of prefabricated, "one-size fits all" biomedical classification schemes is of limited value. II. Cross-cultural analysis: The ICPC is a suitable standard that can be applied but modified as required. III. Bioprospecting: We suggest a biomedical therapy-driven classification system with currently 17 use-categories based on biomedical uses of all approved plant derived natural product drugs. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Categorization in the wild.

PubMed

Glushko, Robert J; Maglio, Paul P; Matlock, Teenie; Barsalou, Lawrence W

2008-04-01

In studying categorization, cognitive science has focused primarily on cultural categorization, ignoring individual and institutional categorization. Because recent technological developments have made individual and institutional classification systems much more available and powerful, our understanding of the cognitive and social mechanisms that produce these systems is increasingly important. Furthermore, key aspects of categorization that have received little previous attention emerge from considering diverse types of categorization together, such as the social factors that create stability in classification systems, and the interoperability that shared conceptual systems establish between agents. Finally, the profound impact of recent technological developments on classification systems indicates that basic categorization mechanisms are highly adaptive, producing new classification systems as the situations in which they operate change.

Lenke and King classification systems for adolescent idiopathic scoliosis: interobserver agreement and postoperative results.

PubMed

Hosseinpour-Feizi, Hojjat; Soleimanpour, Jafar; Sales, Jafar Ganjpour; Arzroumchilar, Ali

2011-01-01

The aim of this study was to investigate the interobserver agreement of the Lenke and King classifications for adolescent idiopathic scoliosis, and to compare the results of surgery performed based on classification of the scoliosis according to each of these classification systems. The study was conducted in Shohada Hospital in Tabriz, Iran, between 2009 and 2010. First, a reliability assessment was undertaken to assess interobserver agreement of the Lenke and King classifications for adolescent idiopathic scoliosis. Second, postoperative efficacy and safety of surgery performed based on the Lenke and King classifications were compared. Kappa coefficients of agreement were calculated to assess the agreement. Outcomes were compared using bivariate tests and repeated measures analysis of variance. A low to moderate interobserver agreement was observed for the King classification; the Lenke classification yielded mostly high agreement coefficients. The outcome of surgery was not found to be substantially different between the two systems. Based on the results, the Lenke classification method seems advantageous. This takes into consideration the Lenke classification's priority in providing details of curvatures in different anatomical surfaces to explain precise intensity of scoliosis, that it has higher interobserver agreement scores, and also that it leads to noninferior postoperative results compared with the King classification method.

Assessing three fuel classification systems and their maps using Forest Inventory and Analysis (FIA) surface fuel measurements

Treesearch

Robert E. Keane; Jason M. Herynk; Chris Toney; Shawn P. Urbanski; Duncan C. Lutes; Roger D. Ottmar

2015-01-01

Fuel classifications are integral tools in fire management and planning because they are used as inputs to fire behavior and effects simulation models. Fuel Loading Models (FLMs) and Fuel Characteristic Classification System (FCCSs) fuelbeds are the most popular classifications used throughout wildland fire science and management, but they have yet to be thoroughly...

5 CFR 9901.222 - Review of classification decisions.

Code of Federal Regulations, 2011 CFR

2011-01-01

....222 Section 9901.222 Administrative Personnel DEPARTMENT OF DEFENSE HUMAN RESOURCES MANAGEMENT AND LABOR RELATIONS SYSTEMS (DEPARTMENT OF DEFENSE-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF DEFENSE NATIONAL SECURITY PERSONNEL SYSTEM (NSPS) Classification Classification Process § 9901.222 Review of...

5 CFR 9701.222 - Reconsideration of classification decisions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... decisions. 9701.222 Section 9701.222 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Classification Classification Process § 9701.222...

Maxillectomy defects: a suggested classification scheme.

PubMed

Akinmoladun, V I; Dosumu, O O; Olusanya, A A; Ikusika, O F

2013-06-01

The term "maxillectomy" has been used to describe a variety of surgical procedures for a spectrum of diseases involving a diverse anatomical site. Hence, classifications of maxillectomy defects have often made communication difficult. This article highlights this problem, emphasises the need for a uniform system of classification and suggests a classification system which is simple and comprehensive. Articles related to this subject, especially those with specified classifications of maxillary surgical defects were sourced from the internet through Google, Scopus and PubMed using the search terms maxillectomy defects classification. A manual search through available literature was also done. The review of the materials revealed many classifications and modifications of classifications from the descriptive, reconstructive and prosthodontic perspectives. No globally acceptable classification exists among practitioners involved in the management of diseases in the mid-facial region. There were over 14 classifications of maxillary defects found in the English literature. Attempts made to address the inadequacies of previous classifications have tended to result in cumbersome and relatively complex classifications. A single classification that is based on both surgical and prosthetic considerations is most desirable and is hereby proposed.

Interplay of biopharmaceutics, biopharmaceutics drug disposition and salivary excretion classification systems

PubMed Central

Idkaidek, Nasir M.

2013-01-01

The aim of this commentary is to investigate the interplay of Biopharmaceutics Classification System (BCS), Biopharmaceutics Drug Disposition Classification System (BDDCS) and Salivary Excretion Classification System (SECS). BCS first classified drugs based on permeability and solubility for the purpose of predicting oral drug absorption. Then BDDCS linked permeability with hepatic metabolism and classified drugs based on metabolism and solubility for the purpose of predicting oral drug disposition. On the other hand, SECS classified drugs based on permeability and protein binding for the purpose of predicting the salivary excretion of drugs. The role of metabolism, rather than permeability, on salivary excretion is investigated and the results are not in agreement with BDDCS. Conclusion The proposed Salivary Excretion Classification System (SECS) can be used as a guide for drug salivary excretion based on permeability (not metabolism) and protein binding. PMID:24493977

A Classification Methodology and Retrieval Model to Support Software Reuse

DTIC Science & Technology

1988-01-01

Dewey Decimal Classification ( DDC 18), an enumerative scheme, occupies 40 pages [Buchanan 19791. Langridge [19731 states that the facets listed in the...sense of historical importance or wide spread use. The schemes are: Dewey Decimal Classification ( DDC ), Universal Decimal Classification (UDC...Classification Systems ..... ..... 2.3.3 Library Classification__- .52 23.3.1 Dewey Decimal Classification -53 2.33.2 Universal Decimal Classification 55 2333

The impact of OCR accuracy on automated cancer classification of pathology reports.

PubMed

Zuccon, Guido; Nguyen, Anthony N; Bergheim, Anton; Wickman, Sandra; Grayson, Narelle

2012-01-01

To evaluate the effects of Optical Character Recognition (OCR) on the automatic cancer classification of pathology reports. Scanned images of pathology reports were converted to electronic free-text using a commercial OCR system. A state-of-the-art cancer classification system, the Medical Text Extraction (MEDTEX) system, was used to automatically classify the OCR reports. Classifications produced by MEDTEX on the OCR versions of the reports were compared with the classification from a human amended version of the OCR reports. The employed OCR system was found to recognise scanned pathology reports with up to 99.12% character accuracy and up to 98.95% word accuracy. Errors in the OCR processing were found to minimally impact on the automatic classification of scanned pathology reports into notifiable groups. However, the impact of OCR errors is not negligible when considering the extraction of cancer notification items, such as primary site, histological type, etc. The automatic cancer classification system used in this work, MEDTEX, has proven to be robust to errors produced by the acquisition of freetext pathology reports from scanned images through OCR software. However, issues emerge when considering the extraction of cancer notification items.

Autonomous target recognition using remotely sensed surface vibration measurements

NASA Astrophysics Data System (ADS)

Geurts, James; Ruck, Dennis W.; Rogers, Steven K.; Oxley, Mark E.; Barr, Dallas N.

1993-09-01

The remotely measured surface vibration signatures of tactical military ground vehicles are investigated for use in target classification and identification friend or foe (IFF) systems. The use of remote surface vibration sensing by a laser radar reduces the effects of partial occlusion, concealment, and camouflage experienced by automatic target recognition systems using traditional imagery in a tactical battlefield environment. Linear Predictive Coding (LPC) efficiently represents the vibration signatures and nearest neighbor classifiers exploit the LPC feature set using a variety of distortion metrics. Nearest neighbor classifiers achieve an 88 percent classification rate in an eight class problem, representing a classification performance increase of thirty percent from previous efforts. A novel confidence figure of merit is implemented to attain a 100 percent classification rate with less than 60 percent rejection. The high classification rates are achieved on a target set which would pose significant problems to traditional image-based recognition systems. The targets are presented to the sensor in a variety of aspects and engine speeds at a range of 1 kilometer. The classification rates achieved demonstrate the benefits of using remote vibration measurement in a ground IFF system. The signature modeling and classification system can also be used to identify rotary and fixed-wing targets.

Framework for evaluating disease severity measures in older adults with comorbidity.

PubMed

Boyd, Cynthia M; Weiss, Carlos O; Halter, Jeff; Han, K Carol; Ershler, William B; Fried, Linda P

2007-03-01

Accounting for the influence of concurrent conditions on health and functional status for both research and clinical decision-making purposes is especially important in older adults. Although approaches to classifying severity of individual diseases and conditions have been developed, the utility of these classification systems has not been evaluated in the presence of multiple conditions. We present a framework for evaluating severity classification systems for common chronic diseases. The framework evaluates the: (a) goal or purpose of the classification system; (b) physiological and/or functional criteria for severity graduation; and (c) potential reliability and validity of the system balanced against burden and costs associated with classification. Approaches to severity classification of individual diseases were not originally conceived for the study of comorbidity. Therefore, they vary greatly in terms of objectives, physiological systems covered, level of severity characterization, reliability and validity, and costs and burdens. Using different severity classification systems to account for differing levels of disease severity in a patient with multiple diseases, or, assessing global disease burden may be challenging. Most approaches to severity classification are not adequate to address comorbidity. Nevertheless, thoughtful use of some existing approaches and refinement of others may advance the study of comorbidity and diagnostic and therapeutic approaches to patients with multimorbidity.

A consensus view of fold space: Combining SCOP, CATH, and the Dali Domain Dictionary

PubMed Central

Day, Ryan; Beck, David A.C.; Armen, Roger S.; Daggett, Valerie

2003-01-01

We have determined consensus protein-fold classifications on the basis of three classification methods, SCOP, CATH, and Dali. These classifications make use of different methods of defining and categorizing protein folds that lead to different views of protein-fold space. Pairwise comparisons of domains on the basis of their fold classifications show that much of the disagreement between the classification systems is due to differing domain definitions rather than assigning the same domain to different folds. However, there are significant differences in the fold assignments between the three systems. These remaining differences can be explained primarily in terms of the breadth of the fold classifications. Many structures may be defined as having one fold in one system, whereas far fewer are defined as having the analogous fold in another system. By comparing these folds for a nonredundant set of proteins, the consensus method breaks up broad fold classifications and combines restrictive fold classifications into metafolds, creating, in effect, an averaged view of fold space. This averaged view requires that the structural similarities between proteins having the same metafold be recognized by multiple classification systems. Thus, the consensus map is useful for researchers looking for fold similarities that are relatively independent of the method used to compare proteins. The 30 most populated metafolds, representing the folds of about half of a nonredundant subset of the PDB, are presented here. The full list of metafolds is presented on the Web. PMID:14500873

A consensus view of fold space: combining SCOP, CATH, and the Dali Domain Dictionary.

PubMed

Day, Ryan; Beck, David A C; Armen, Roger S; Daggett, Valerie

2003-10-01

We have determined consensus protein-fold classifications on the basis of three classification methods, SCOP, CATH, and Dali. These classifications make use of different methods of defining and categorizing protein folds that lead to different views of protein-fold space. Pairwise comparisons of domains on the basis of their fold classifications show that much of the disagreement between the classification systems is due to differing domain definitions rather than assigning the same domain to different folds. However, there are significant differences in the fold assignments between the three systems. These remaining differences can be explained primarily in terms of the breadth of the fold classifications. Many structures may be defined as having one fold in one system, whereas far fewer are defined as having the analogous fold in another system. By comparing these folds for a nonredundant set of proteins, the consensus method breaks up broad fold classifications and combines restrictive fold classifications into metafolds, creating, in effect, an averaged view of fold space. This averaged view requires that the structural similarities between proteins having the same metafold be recognized by multiple classification systems. Thus, the consensus map is useful for researchers looking for fold similarities that are relatively independent of the method used to compare proteins. The 30 most populated metafolds, representing the folds of about half of a nonredundant subset of the PDB, are presented here. The full list of metafolds is presented on the Web.

Analysis of biliary anatomy according to different classification systems.

PubMed

Deka, Pranjal; Islam, Mahibul; Jindal, Deepti; Kumar, Niteen; Arora, Ankur; Negi, Sanjay Singh

2014-01-01

Variations in biliary anatomy are common, and different classifications have been described. These classification systems have not been compared to each other in a single cohort. We report such variations in biliary anatomy on magnetic resonance cholangiopancreatography (MRCP) using six different classification systems. In 299 patients undergoing MRCP for various indications, biliary anatomy was classified as described by Couinaud (1957), Huang (1996), Karakas (2008), Choi (2003), Champetier (1994), and Ohkubo (2004). Correlation with direct cholangiography and vascular anatomy was done. Bile duct dimensions were measured. Cystic duct junction and pancreaticobiliary ductal junction (PBDJ) were classified. Normal biliary anatomy was noted in 57.8 %. The most common variants were Couinaud type D2, Choi type 3A, Huang type A1, Champetier type a, Ohkubo types D and J, and Karakas type 2a. The Ohkubo classification was the most appropriate; 3.1 % of right ducts and 6.3 % of left ducts with variant anatomy could not be classified using the Ohkubo classification. There was a good agreement between MRCP and direct cholangiography (ĸ = 0.9). Anomalous PBDJ was noted in 8.7 %. Variant biliary anatomy was not associated with gender (p = 0.194) or variant vascular anatomy (p = 0.24). Although each classification system has its merits and demerits, some anatomical variations cannot be classified using any of the previously described classifications. The Ohkubo classification system is the most applicable as it considers most clinically relevant variations pertinent to hepatobiliary surgery.

A Mapping from the Human Factors Analysis and Classification System (DOD-HFACS) to the Domains of Human Systems Integration (HSI)

DTIC Science & Technology

2009-11-01

Equation Chapter 1 Section 1 A MAPPING FROM THE HUMAN FACTORS ANALYSIS AND CLASSIFICATION SYSTEM (DOD...OMB control number. 1. REPORT DATE NOV 2009 2. REPORT TYPE 3. DATES COVERED 4. TITLE AND SUBTITLE A Mapping from the Human Factors Analysis ...7 The Human Factors Analysis and Classification System .................................................. 7 Mapping of DoD

Three-column classification and Schatzker classification: a three- and two-dimensional computed tomography characterisation and analysis of tibial plateau fractures.

PubMed

Patange Subba Rao, Sheethal Prasad; Lewis, James; Haddad, Ziad; Paringe, Vishal; Mohanty, Khitish

2014-10-01

The aim of the study was to evaluate inter-observer reliability and intra-observer reproducibility between the three-column classification and Schatzker classification systems using 2D and 3D CT models. Fifty-two consecutive patients with tibial plateau fractures were evaluated by five orthopaedic surgeons. All patients were classified into Schatzker and three-column classification systems using x-rays and 2D and 3D CT images. The inter-observer reliability was evaluated in the first round and the intra-observer reliability was determined during the second round 2 weeks later. The average intra-observer reproducibility for the three-column classification was from substantial to excellent in all sub classifications, as compared with Schatzker classification. The inter-observer kappa values increased from substantial to excellent in three-column classification and to moderate in Schatzker classification The average values for three-column classification for all the categories are as follows: (I-III) k2D = 0.718, 95% CI 0.554-0.864, p < 0.0001 and average 3D = 0.874, 95% CI 0.754-0.890, p < 0.0001. For Schatzker classification system, the average values for all six categories are as follows: (I-VI) k2D = 0.536, 95% CI 0.365-0.685, p < 0.0001 and average k3D = 0.552 95% CI 0.405-0.700, p < 0.0001. The values are statistically significant. Statistically significant inter-observer values in both rounds were noted with the three-column classification, making it statistically an excellent agreement. The intra-observer reproducibility for the three-column classification improved as compared with the Schatzker classification. The three-column classification seems to be an effective way to characterise and classify fractures of tibial plateau.

A land use and land cover classification system for use with remote sensor data

USGS Publications Warehouse

Anderson, James R.; Hardy, Ernest E.; Roach, John T.; Witmer, Richard E.

1976-01-01

The framework of a national land use and land cover classification system is presented for use with remote sensor data. The classification system has been developed to meet the needs of Federal and State agencies for an up-to-date overview of land use and land cover throughout the country on a basis that is uniform in categorization at the more generalized first and second levels and that will be receptive to data from satellite and aircraft remote sensors. The proposed system uses the features of existing widely used classification systems that are amenable to data derived from remote sensing sources. It is intentionally left open-ended so that Federal, regional, State, and local agencies can have flexibility in developing more detailed land use classifications at the third and fourth levels in order to meet their particular needs and at the same time remain compatible with each other and the national system. Revision of the land use classification system as presented in U.S. Geological Survey Circular 671 was undertaken in order to incorporate the results of extensive testing and review of the categorization and definitions.

Classification of stillbirths is an ongoing dilemma.

PubMed

Nappi, Luigi; Trezza, Federica; Bufo, Pantaleo; Riezzo, Irene; Turillazzi, Emanuela; Borghi, Chiara; Bonaccorsi, Gloria; Scutiero, Gennaro; Fineschi, Vittorio; Greco, Pantaleo

2016-10-01

To compare different classification systems in a cohort of stillbirths undergoing a comprehensive workup; to establish whether a particular classification system is most suitable and useful in determining cause of death, purporting the lowest percentage of unexplained death. Cases of stillbirth at gestational age 22-41 weeks occurring at the Department of Gynecology and Obstetrics of Foggia University during a 4 year period were collected. The World Health Organization (WHO) diagnosis of stillbirth was used. All the data collection was based on the recommendations of an Italian diagnostic workup for stillbirth. Two expert obstetricians reviewed all cases and classified causes according to five classification systems. Relevant Condition at Death (ReCoDe) and Causes Of Death and Associated Conditions (CODAC) classification systems performed best in retaining information. The ReCoDe system provided the lowest rate of unexplained stillbirth (14%) compared to de Galan-Roosen (16%), CODAC (16%), Tulip (18%), Wigglesworth (62%). Classification of stillbirth is influenced by the multiplicity of possible causes and factors related to fetal death. Fetal autopsy, placental histology and cytogenetic analysis are strongly recommended to have a complete diagnostic evaluation. Commonly employed classification systems performed differently in our experience, the most satisfactory being the ReCoDe. Given the rate of "unexplained" cases, none can be considered optimal and further efforts are necessary to work out a clinically useful system.

DORS: DDC Online Retrieval System.

ERIC Educational Resources Information Center

Liu, Songqiao; Svenonius, Elaine

1991-01-01

Describes the Dewey Online Retrieval System (DORS), which was developed at the University of California, Los Angeles (UCLA), to experiment with classification-based search strategies in online catalogs. Classification structures in automated information retrieval are discussed; and specifications for a classification retrieval interface are…

Automated simultaneous multiple feature classification of MTI data

NASA Astrophysics Data System (ADS)

Harvey, Neal R.; Theiler, James P.; Balick, Lee K.; Pope, Paul A.; Szymanski, John J.; Perkins, Simon J.; Porter, Reid B.; Brumby, Steven P.; Bloch, Jeffrey J.; David, Nancy A.; Galassi, Mark C.

2002-08-01

Los Alamos National Laboratory has developed and demonstrated a highly capable system, GENIE, for the two-class problem of detecting a single feature against a background of non-feature. In addition to the two-class case, however, a commonly encountered remote sensing task is the segmentation of multispectral image data into a larger number of distinct feature classes or land cover types. To this end we have extended our existing system to allow the simultaneous classification of multiple features/classes from multispectral data. The technique builds on previous work and its core continues to utilize a hybrid evolutionary-algorithm-based system capable of searching for image processing pipelines optimized for specific image feature extraction tasks. We describe the improvements made to the GENIE software to allow multiple-feature classification and describe the application of this system to the automatic simultaneous classification of multiple features from MTI image data. We show the application of the multiple-feature classification technique to the problem of classifying lava flows on Mauna Loa volcano, Hawaii, using MTI image data and compare the classification results with standard supervised multiple-feature classification techniques.

A statistical approach to root system classification

PubMed Central

Bodner, Gernot; Leitner, Daniel; Nakhforoosh, Alireza; Sobotik, Monika; Moder, Karl; Kaul, Hans-Peter

2013-01-01

Plant root systems have a key role in ecology and agronomy. In spite of fast increase in root studies, still there is no classification that allows distinguishing among distinctive characteristics within the diversity of rooting strategies. Our hypothesis is that a multivariate approach for “plant functional type” identification in ecology can be applied to the classification of root systems. The classification method presented is based on a data-defined statistical procedure without a priori decision on the classifiers. The study demonstrates that principal component based rooting types provide efficient and meaningful multi-trait classifiers. The classification method is exemplified with simulated root architectures and morphological field data. Simulated root architectures showed that morphological attributes with spatial distribution parameters capture most distinctive features within root system diversity. While developmental type (tap vs. shoot-borne systems) is a strong, but coarse classifier, topological traits provide the most detailed differentiation among distinctive groups. Adequacy of commonly available morphologic traits for classification is supported by field data. Rooting types emerging from measured data, mainly distinguished by diameter/weight and density dominated types. Similarity of root systems within distinctive groups was the joint result of phylogenetic relation and environmental as well as human selection pressure. We concluded that the data-define classification is appropriate for integration of knowledge obtained with different root measurement methods and at various scales. Currently root morphology is the most promising basis for classification due to widely used common measurement protocols. To capture details of root diversity efforts in architectural measurement techniques are essential. PMID:23914200

A statistical approach to root system classification.

PubMed

Bodner, Gernot; Leitner, Daniel; Nakhforoosh, Alireza; Sobotik, Monika; Moder, Karl; Kaul, Hans-Peter

2013-01-01

Plant root systems have a key role in ecology and agronomy. In spite of fast increase in root studies, still there is no classification that allows distinguishing among distinctive characteristics within the diversity of rooting strategies. Our hypothesis is that a multivariate approach for "plant functional type" identification in ecology can be applied to the classification of root systems. The classification method presented is based on a data-defined statistical procedure without a priori decision on the classifiers. The study demonstrates that principal component based rooting types provide efficient and meaningful multi-trait classifiers. The classification method is exemplified with simulated root architectures and morphological field data. Simulated root architectures showed that morphological attributes with spatial distribution parameters capture most distinctive features within root system diversity. While developmental type (tap vs. shoot-borne systems) is a strong, but coarse classifier, topological traits provide the most detailed differentiation among distinctive groups. Adequacy of commonly available morphologic traits for classification is supported by field data. Rooting types emerging from measured data, mainly distinguished by diameter/weight and density dominated types. Similarity of root systems within distinctive groups was the joint result of phylogenetic relation and environmental as well as human selection pressure. We concluded that the data-define classification is appropriate for integration of knowledge obtained with different root measurement methods and at various scales. Currently root morphology is the most promising basis for classification due to widely used common measurement protocols. To capture details of root diversity efforts in architectural measurement techniques are essential.

Inter-rater reliability of a modified version of Delitto et al.’s classification-based system for low back pain: a pilot study

PubMed Central

Apeldoorn, Adri T.; van Helvoirt, Hans; Ostelo, Raymond W.; Meihuizen, Hanneke; Kamper, Steven J.; van Tulder, Maurits W.; de Vet, Henrica C. W.

2016-01-01

Study design Observational inter-rater reliability study. Objectives To examine: (1) the inter-rater reliability of a modified version of Delitto et al.’s classification-based algorithm for patients with low back pain; (2) the influence of different levels of familiarity with the system; and (3) the inter-rater reliability of algorithm decisions in patients who clearly fit into a subgroup (clear classifications) and those who do not (unclear classifications). Methods Patients were examined twice on the same day by two of three participating physical therapists with different levels of familiarity with the system. Patients were classified into one of four classification groups. Raters were blind to the others’ classification decision. In order to quantify the inter-rater reliability, percentages of agreement and Cohen’s Kappa were calculated. Results A total of 36 patients were included (clear classification n = 23; unclear classification n = 13). The overall rate of agreement was 53% and the Kappa value was 0·34 [95% confidence interval (CI): 0·11–0·57], which indicated only fair inter-rater reliability. Inter-rater reliability for patients with a clear classification (agreement 52%, Kappa value 0·29) was not higher than for patients with an unclear classification (agreement 54%, Kappa value 0·33). Familiarity with the system (i.e. trained with written instructions and previous research experience with the algorithm) did not improve the inter-rater reliability. Conclusion Our pilot study challenges the inter-rater reliability of the classification procedure in clinical practice. Therefore, more knowledge is needed about factors that affect the inter-rater reliability, in order to improve the clinical applicability of the classification scheme. PMID:27559279

Poisoning by Herbs and Plants: Rapid Toxidromic Classification and Diagnosis.

PubMed

Diaz, James H

2016-03-01

The American Association of Poison Control Centers has continued to report approximately 50,000 telephone calls or 8% of incoming calls annually related to plant exposures, mostly in children. Although the frequency of plant ingestions in children is related to the presence of popular species in households, adolescents may experiment with hallucinogenic plants; and trekkers and foragers may misidentify poisonous plants as edible. Since plant exposures have continued at a constant rate, the objectives of this review were (1) to review the epidemiology of plant poisonings; and (2) to propose a rapid toxidromic classification system for highly toxic plant ingestions for field use by first responders in comparison to current classification systems. Internet search engines were queried to identify and select peer-reviewed articles on plant poisonings using the key words in order to classify plant poisonings into four specific toxidromes: cardiotoxic, neurotoxic, cytotoxic, and gastrointestinal-hepatotoxic. A simple toxidromic classification system of plant poisonings may permit rapid diagnoses of highly toxic versus less toxic and nontoxic plant ingestions both in households and outdoors; direct earlier management of potentially serious poisonings; and reduce costly inpatient evaluations for inconsequential plant ingestions. The current textbook classification schemes for plant poisonings were complex in comparison to the rapid classification system; and were based on chemical nomenclatures and pharmacological effects, and not on clearly presenting toxidromes. Validation of the rapid toxidromic classification system as compared to existing chemical classification systems for plant poisonings will require future adoption and implementation of the toxidromic system by its intended users. Copyright © 2016 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

Forest site classification in the interior uplands

Treesearch

Glendon W. Smalley

1989-01-01

Classification and evaluation of forest sites is an essential step in managing central hardwood forests. In Note 4.01, The Importance of Site Quality, the usefulness of land classification systems was discussed. The present Note describes one of those systems in more detail. It is an easy-to-use system developed for the Cumberland Plateau and Highland Rim-Pennyroyal...

A Challenge to Change: Necessary Changes in the Library Classification System for the Chicago Public Schools.

ERIC Educational Resources Information Center

Williams, Florence M.

This report addresses the feasibility of changing the classification of library materials in the Chicago Public School libraries from the Dewey Decimal classification system (DDC) to the Library of Congress system (LC), thus patterning the city school libraries after the Chicago Public Library and strengthening the existing close relationship…

Prior-to-Secondary School Course Classification System: School Codes for the Exchange of Data (SCED). NFES 2011-801

ERIC Educational Resources Information Center

National Forum on Education Statistics, 2011

2011-01-01

In this handbook, "Prior-to-Secondary School Course Classification System: School Codes for the Exchange of Data" (SCED), the National Center for Education Statistics (NCES) and the National Forum on Education Statistics have extended the existing secondary course classification system with codes and descriptions for courses offered at…

Linking the integrated management of childhood illness (IMCI) and health information system (HIS) classifications: issues and options.

PubMed Central

Rowe, A. K.; Hirnschall, G.; Lambrechts, T.; Bryce, J.

1999-01-01

Differences in the terms used to classify diseases in the Integrated Management of Childhood Illness (IMCI) guidelines and for health information system (HIS) disease surveillance could easily create confusion among health care workers. If the equivalent terms in the two classifications are not clear to health workers who are following the guidelines, they may have problems in performing the dual activities of case management and disease surveillance. These difficulties could adversely affect an individual's performance as well as the overall effectiveness of the IMCI strategy or HIS surveillance, or both. We interviewed key informants to determine the effect of these differences between the IMCI and HIS classifications on the countries that were implementing the IMCI guidelines. Four general approaches for addressing the problem were identified: translating the IMCI classifications into HIS classifications; changing the HIS list to include the IMCI classifications; using both the IMCI and HIS classification systems at the time of consultations; and doing nothing. No single approach can satisfy the needs of all countries. However, if the short-term or medium-term goal of IMCI planners is to find a solution that will reduce the problem for health workers and is also easy to implement, the approach most likely to succeed is translation of IMCI classifications into HIS classifications. Where feasible, a modification of the health information system to include the IMCI classifications may also be considered. PMID:10680246

The ICI classification for calcaneal injuries: a validation study.

PubMed

Frima, Herman; Eshuis, Rienk; Mulder, Paul; Leenen, Luke

2012-06-01

The integral classification of injuries (ICI), by Zwipp et al. has been developed as a classification system for injuries of the bones, joints, cartilage and ligaments of the foot. It follows the principles of the comprehensive classification of fractures by Müller et al. The ICI was developed for 'everyday use' and scientific purposes. Our aim was to perform a validation study for this classification system applied to the calcaneal injuries. A panel of five experienced trauma and orthopaedic surgeons evaluated the ICI score in 20 calcaneal injuries. After 2 months, a second classification was performed in a different order. Inter- and intra-observer variability were evaluated by kappa statistics. Panel members were not able to evaluate capsule and ligamental injuries based on X-ray and computed tomography (CT) films. Two injuries were excluded for logistical reasons. The inter-observer agreement based on 18 injuries of bone and joints was slight; kappa 0.14 (90% confidence interval (CI): 0.05-0.22). The intra-observer agreement was fair; kappa 0.31 (90% CI: 0.22-0.41). Overall, the panel rated the system as very complicated and not practical. The ICI is a complicated classification system with slight to fair inter- and intra-observer variabilities. It might not be a practical classification system for calcaneal injuries in 'everyday use' or scientific purposes. Copyright © 2011 Elsevier Ltd. All rights reserved.

The Communication Function Classification System: cultural adaptation, validity, and reliability of the Farsi version for patients with cerebral palsy.

PubMed

Soleymani, Zahra; Joveini, Ghodsiye; Baghestani, Ahmad Reza

2015-03-01

This study developed a Farsi language Communication Function Classification System and then tested its reliability and validity. Communication Function Classification System is designed to classify the communication functions of individuals with cerebral palsy. Up until now, there has been no instrument for assessment of this communication function in Iran. The English Communication Function Classification System was translated into Farsi and cross-culturally modified by a panel of experts. Professionals and parents then assessed the content validity of the modified version. A backtranslation of the Farsi version was confirmed by the developer of the English Communication Function Classification System. Face validity was assessed by therapists and parents of 10 patients. The Farsi Communication Function Classification System was administered to 152 individuals with cerebral palsy (age, 2 to 18 years; median age, 10 years; mean age, 9.9 years; standard deviation, 4.3 years). Inter-rater reliability was analyzed between parents, occupational therapists, and speech and language pathologists. The test-retest reliability was assessed for 75 patients with a 14 day interval between tests. The inter-rater reliability of the Communication Function Classification System was 0.81 between speech and language pathologists and occupational therapists, 0.74 between parents and occupational therapists, and 0.88 between parents and speech and language pathologists. The test-retest reliability was 0.96 for occupational therapists, 0.98 for speech and language pathologists, and 0.94 for parents. The findings suggest that the Farsi version of Communication Function Classification System is a reliable and valid measure that can be used in clinical settings to assess communication function in patients with cerebral palsy. Copyright © 2015 Elsevier Inc. All rights reserved.

Monitoring nanotechnology using patent classifications: an overview and comparison of nanotechnology classification schemes

NASA Astrophysics Data System (ADS)

Jürgens, Björn; Herrero-Solana, Victor

2017-04-01

Patents are an essential information source used to monitor, track, and analyze nanotechnology. When it comes to search nanotechnology-related patents, a keyword search is often incomplete and struggles to cover such an interdisciplinary discipline. Patent classification schemes can reveal far better results since they are assigned by experts who classify the patent documents according to their technology. In this paper, we present the most important classifications to search nanotechnology patents and analyze how nanotechnology is covered in the main patent classification systems used in search systems nowadays: the International Patent Classification (IPC), the United States Patent Classification (USPC), and the Cooperative Patent Classification (CPC). We conclude that nanotechnology has a significantly better patent coverage in the CPC since considerable more nanotechnology documents were retrieved than by using other classifications, and thus, recommend its use for all professionals involved in nanotechnology patent searches.

37 CFR 2.85 - Classification schedules.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 37 Patents, Trademarks, and Copyrights 1 2013-07-01 2013-07-01 false Classification schedules. 2..., DEPARTMENT OF COMMERCE RULES OF PRACTICE IN TRADEMARK CASES Classification § 2.85 Classification schedules. (a) International classification system. Section 6.1 of this chapter sets forth the international...

37 CFR 2.85 - Classification schedules.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 37 Patents, Trademarks, and Copyrights 1 2012-07-01 2012-07-01 false Classification schedules. 2..., DEPARTMENT OF COMMERCE RULES OF PRACTICE IN TRADEMARK CASES Classification § 2.85 Classification schedules. (a) International classification system. Section 6.1 of this chapter sets forth the international...

37 CFR 2.85 - Classification schedules.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 37 Patents, Trademarks, and Copyrights 1 2014-07-01 2014-07-01 false Classification schedules. 2..., DEPARTMENT OF COMMERCE RULES OF PRACTICE IN TRADEMARK CASES Classification § 2.85 Classification schedules. (a) International classification system. Section 6.1 of this chapter sets forth the international...

37 CFR 2.85 - Classification schedules.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 37 Patents, Trademarks, and Copyrights 1 2011-07-01 2011-07-01 false Classification schedules. 2..., DEPARTMENT OF COMMERCE RULES OF PRACTICE IN TRADEMARK CASES Classification § 2.85 Classification schedules. (a) International classification system. Section 6.1 of this chapter sets forth the international...

37 CFR 2.85 - Classification schedules.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 37 Patents, Trademarks, and Copyrights 1 2010-07-01 2010-07-01 false Classification schedules. 2..., DEPARTMENT OF COMMERCE RULES OF PRACTICE IN TRADEMARK CASES Classification § 2.85 Classification schedules. (a) International classification system. Section 6.1 of this chapter sets forth the international...

76 FR 76896 - International Anti-Fouling System Certificate

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-09

...-fouling System (IAFS) Certificate to the list of certificates a recognized classification society may..., 2001. This final rule will enable recognized classification societies to apply to the Coast Guard for... the Coast Guard to authorize recognized classification societies to issue IAFS Certificates...

Classification systems in nursing: formalizing nursing knowledge and implications for nursing information systems.

PubMed

Goossen, W T; Epping, P J; Abraham, I L

1996-03-01

The development of nursing information systems (NIS) is often hampered by the fact that nursing lacks a unified nursing terminology and classification system. Currently there exist various initiatives in this area. We address the question as to how current initiatives in the development of nursing terminology and classification systems can contribute towards the development of NIS. First, the rationale behind the formalization of nursing knowledge is discussed. Next, using a framework for nursing information processing, the most important developments in the field of nursing on formalization, terminology and classification are critically reviewed. The initiatives discussed include nursing terminology projects in several countries, and the International Classification of Nursing Practice. Suggestions for further developments in the area are discussed. Finally, implications for NIS are presented, as well as the relationships of these components to other sections of an integrated computerized patient record.

A systematic literature review of automated clinical coding and classification systems

PubMed Central

Williams, Margaret; Fenton, Susan H; Jenders, Robert A; Hersh, William R

2010-01-01

Clinical coding and classification processes transform natural language descriptions in clinical text into data that can subsequently be used for clinical care, research, and other purposes. This systematic literature review examined studies that evaluated all types of automated coding and classification systems to determine the performance of such systems. Studies indexed in Medline or other relevant databases prior to March 2009 were considered. The 113 studies included in this review show that automated tools exist for a variety of coding and classification purposes, focus on various healthcare specialties, and handle a wide variety of clinical document types. Automated coding and classification systems themselves are not generalizable, nor are the results of the studies evaluating them. Published research shows these systems hold promise, but these data must be considered in context, with performance relative to the complexity of the task and the desired outcome. PMID:20962126

A systematic literature review of automated clinical coding and classification systems.

PubMed

Stanfill, Mary H; Williams, Margaret; Fenton, Susan H; Jenders, Robert A; Hersh, William R

2010-01-01

Clinical coding and classification processes transform natural language descriptions in clinical text into data that can subsequently be used for clinical care, research, and other purposes. This systematic literature review examined studies that evaluated all types of automated coding and classification systems to determine the performance of such systems. Studies indexed in Medline or other relevant databases prior to March 2009 were considered. The 113 studies included in this review show that automated tools exist for a variety of coding and classification purposes, focus on various healthcare specialties, and handle a wide variety of clinical document types. Automated coding and classification systems themselves are not generalizable, nor are the results of the studies evaluating them. Published research shows these systems hold promise, but these data must be considered in context, with performance relative to the complexity of the task and the desired outcome.

Reflecting on the structure of soil classification systems: insights from a proposal for integrating subsoil data into soil information systems

NASA Astrophysics Data System (ADS)

Dondeyne, Stefaan; Juilleret, Jérôme; Vancampenhout, Karen; Deckers, Jozef; Hissler, Christophe

2017-04-01

Classification of soils in both World Reference Base for soil resources (WRB) and Soil Taxonomy hinges on the identification of diagnostic horizons and characteristics. However as these features often occur within the first 100 cm, these classification systems convey little information on subsoil characteristics. An integrated knowledge of the soil, soil-to-substratum and deeper substratum continuum is required when dealing with environmental issues such as vegetation ecology, water quality or the Critical Zone in general. Therefore, we recently proposed a classification system of the subsolum complementing current soil classification systems. By reflecting on the structure of the subsoil classification system which is inspired by WRB, we aim at fostering a discussion on some potential future developments of WRB. For classifying the subsolum we define Regolite, Saprolite, Saprock and Bedrock as four Subsolum Reference Groups each corresponding to different weathering stages of the subsoil. Principal qualifiers can be used to categorize intergrades of these Subsoil Reference Groups while morphologic and lithologic characteristics can be presented with supplementary qualifiers. We argue that adopting a low hierarchical structure - akin to WRB and in contrast to a strong hierarchical structure as in Soil Taxonomy - offers the advantage of having an open classification system avoiding the need for a priori knowledge of all possible combinations which may be encountered in the field. Just as in WRB we also propose to use principal and supplementary qualifiers as a second level of classification. However, in contrast to WRB we propose to reserve the principal qualifiers for intergrades and to regroup the supplementary qualifiers into thematic categories (morphologic or lithologic). Structuring the qualifiers in this manner should facilitate the integration and handling of both soil and subsoil classification units into soil information systems and calls for paying attention to these structural issues in future developments of WRB.

Osteochondritis dissecans of the humeral capitellum: reliability of four classification systems using radiographs and computed tomography.

PubMed

Claessen, Femke M A P; van den Ende, Kimberly I M; Doornberg, Job N; Guitton, Thierry G; Eygendaal, Denise; van den Bekerom, Michel P J

2015-10-01

The radiographic appearance of osteochondritis dissecans (OCD) of the humeral capitellum varies according to the stage of the lesion. It is important to evaluate the stage of OCD lesion carefully to guide treatment. We compared the interobserver reliability of currently used classification systems for OCD of the humeral capitellum to identify the most reliable classification system. Thirty-two musculoskeletal radiologists and orthopaedic surgeons specialized in elbow surgery from several countries evaluated anteroposterior and lateral radiographs and corresponding computed tomography (CT) scans of 22 patients to classify the stage of OCD of the humeral capitellum according to the classification systems developed by (1) Minami, (2) Berndt and Harty, (3) Ferkel and Sgaglione, and (4) Anderson on a Web-based study platform including a Digital Imaging and Communications in Medicine viewer. Magnetic resonance imaging was not evaluated as part of this study. We measured agreement among observers using the Siegel and Castellan multirater κ. All OCD classification systems, except for Berndt and Harty, which had poor agreement among observers (κ = 0.20), had fair interobserver agreement: κ was 0.27 for the Minami, 0.23 for Anderson, and 0.22 for Ferkel and Sgaglione classifications. The Minami Classification was significantly more reliable than the other classifications (P < .001). The Minami Classification was the most reliable for classifying different stages of OCD of the humeral capitellum. However, it is unclear whether radiographic evidence of OCD of the humeral capitellum, as categorized by the Minami Classification, guides treatment in clinical practice as a result of this fair agreement. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Deep learning application: rubbish classification with aid of an android device

NASA Astrophysics Data System (ADS)

Liu, Sijiang; Jiang, Bo; Zhan, Jie

2017-06-01

Deep learning is a very hot topic currently in pattern recognition and artificial intelligence researches. Aiming at the practical problem that people usually don't know correct classifications some rubbish should belong to, based on the powerful image classification ability of the deep learning method, we have designed a prototype system to help users to classify kinds of rubbish. Firstly the CaffeNet Model was adopted for our classification network training on the ImageNet dataset, and the trained network was deployed on a web server. Secondly an android app was developed for users to capture images of unclassified rubbish, upload images to the web server for analyzing backstage and retrieve the feedback, so that users can obtain the classification guide by an android device conveniently. Tests on our prototype system of rubbish classification show that: an image of one single type of rubbish with origin shape can be better used to judge its classification, while an image containing kinds of rubbish or rubbish with changed shape may fail to help users to decide rubbish's classification. However, the system still shows promising auxiliary function for rubbish classification if the network training strategy can be optimized further.

Classification systems for natural resource management

USGS Publications Warehouse

Kleckner, Richard L.

1981-01-01

Resource managers employ various types of resource classification systems in their management activities such as inventory, mapping, and data analysis. Classification is the ordering or arranging of objects into groups or sets on the basis of their relationships, and as such, provide the resource managers with a structure for organizing their needed information. In addition of conforming to certain logical principles, resource classifications should be flexible, widely applicable to a variety of environmental conditions, and useable with minimal training. The process of classification may be approached from the bottom up (aggregation) or the top down (subdivision) or a combination of both, depending on the purpose of the classification. Most resource classification systems in use today focus on a single resource and are used for a single, limited purpose. However, resource managers now must employ the concept of multiple use in their management activities. What they need is an integrated, ecologically based approach to resource classification which would fulfill multiple-use mandates. In an effort to achieve resource-data compatibility and data sharing among Federal agencies, and interagency agreement has been signed by five Federal agencies to coordinate and cooperate in the area of resource classification and inventory.

On the Implementation of a Land Cover Classification System for SAR Images Using Khoros

NASA Technical Reports Server (NTRS)

Medina Revera, Edwin J.; Espinosa, Ramon Vasquez

1997-01-01

The Synthetic Aperture Radar (SAR) sensor is widely used to record data about the ground under all atmospheric conditions. The SAR acquired images have very good resolution which necessitates the development of a classification system that process the SAR images to extract useful information for different applications. In this work, a complete system for the land cover classification was designed and programmed using the Khoros, a data flow visual language environment, taking full advantages of the polymorphic data services that it provides. Image analysis was applied to SAR images to improve and automate the processes of recognition and classification of the different regions like mountains and lakes. Both unsupervised and supervised classification utilities were used. The unsupervised classification routines included the use of several Classification/Clustering algorithms like the K-means, ISO2, Weighted Minimum Distance, and the Localized Receptive Field (LRF) training/classifier. Different texture analysis approaches such as Invariant Moments, Fractal Dimension and Second Order statistics were implemented for supervised classification of the images. The results and conclusions for SAR image classification using the various unsupervised and supervised procedures are presented based on their accuracy and performance.

48 CFR 245.201-73 - Security classification.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 3 2011-10-01 2011-10-01 false Security classification... Procedures 245.201-73 Security classification. Follow the procedures at PGI 245.201-73 for security classification. ...

48 CFR 245.201-73 - Security classification.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 3 2012-10-01 2012-10-01 false Security classification... Procedures 245.201-73 Security classification. Follow the procedures at PGI 245.201-73 for security classification. ...

Lenke and King classification systems for adolescent idiopathic scoliosis: interobserver agreement and postoperative results

PubMed Central

Hosseinpour-Feizi, Hojjat; Soleimanpour, Jafar; Sales, Jafar Ganjpour; Arzroumchilar, Ali

2011-01-01

Purpose The aim of this study was to investigate the interobserver agreement of the Lenke and King classifications for adolescent idiopathic scoliosis, and to compare the results of surgery performed based on classification of the scoliosis according to each of these classification systems. Methods The study was conducted in Shohada Hospital in Tabriz, Iran, between 2009 and 2010. First, a reliability assessment was undertaken to assess interobserver agreement of the Lenke and King classifications for adolescent idiopathic scoliosis. Second, postoperative efficacy and safety of surgery performed based on the Lenke and King classifications were compared. Kappa coefficients of agreement were calculated to assess the agreement. Outcomes were compared using bivariate tests and repeated measures analysis of variance. Results A low to moderate interobserver agreement was observed for the King classification; the Lenke classification yielded mostly high agreement coefficients. The outcome of surgery was not found to be substantially different between the two systems. Conclusion Based on the results, the Lenke classification method seems advantageous. This takes into consideration the Lenke classification’s priority in providing details of curvatures in different anatomical surfaces to explain precise intensity of scoliosis, that it has higher interobserver agreement scores, and also that it leads to noninferior postoperative results compared with the King classification method. PMID:22267934

Clinical Application of Six Current Classification Systems for Iatrogenic Bile Duct Injuries after Cholecystectomy.

PubMed

Velidedeoglu, Mehmet; Arikan, Akif Enes; Uludag, Sezgin Server; Olgun, Deniz Cebi; Kilic, Fahrettin; Kapan, Metin

2015-05-01

Due to being a severe complication, iatrogenic bile duct injury is still a challenging issue for surgeons in gallbladder surgery. However, a commonly accepted classification describing the type of injury has not been available yet. This study aims to evaluate ability of six current classification systems to discriminate bile duct injury patterns. Twelve patients, who were referred to our clinic because of iatrogenic bile duct injury after laparoscopic cholecystectomy were reviewed retrospectively. We described type of injury for each patient according to current six different classifications. 9 patients underwent definitive biliary reconstruction. Bismuth, Strasberg-Bismuth, Stewart-Way and Neuhaus classifications do not consider vascular involvement, Siewert system does, but only for the tangential lesions without structural loss of duct and lesion with a structural defect of hepatic or common bile duct. Siewert, Neuhaus and Stewart-Way systems do not discriminate between lesions at or above bifurcation of the hepatic duct. The Hannover classification may resolve the missing aspects of other systems by describing additional vascular involvement and location of the lesion at or above bifurcation.

a Gsa-Svm Hybrid System for Classification of Binary Problems

NASA Astrophysics Data System (ADS)

Sarafrazi, Soroor; Nezamabadi-pour, Hossein; Barahman, Mojgan

2011-06-01

This paperhybridizesgravitational search algorithm (GSA) with support vector machine (SVM) and made a novel GSA-SVM hybrid system to improve the classification accuracy in binary problems. GSA is an optimization heuristic toolused to optimize the value of SVM kernel parameter (in this paper, radial basis function (RBF) is chosen as the kernel function). The experimental results show that this newapproach can achieve high classification accuracy and is comparable to or better than the particle swarm optimization (PSO)-SVM and genetic algorithm (GA)-SVM, which are two hybrid systems for classification.

43 CFR 2461.2 - Classifications.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Classifications. 2461.2 Section 2461.2..., DEPARTMENT OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) BUREAU INITIATED CLASSIFICATION SYSTEM Multiple-Use Classification Procedures § 2461.2 Classifications. Not less than 60 days after publication of the...

43 CFR 2461.2 - Classifications.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Classifications. 2461.2 Section 2461.2..., DEPARTMENT OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) BUREAU INITIATED CLASSIFICATION SYSTEM Multiple-Use Classification Procedures § 2461.2 Classifications. Not less than 60 days after publication of the...

28 CFR 524.73 - Classification procedures.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Classification procedures. 524.73 Section..., CLASSIFICATION, AND TRANSFER CLASSIFICATION OF INMATES Central Inmate Monitoring (CIM) System § 524.73 Classification procedures. (a) Initial assignment. Except as provided for in paragraphs (a) (1) through (4) of...

43 CFR 2461.2 - Classifications.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Classifications. 2461.2 Section 2461.2..., DEPARTMENT OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) BUREAU INITIATED CLASSIFICATION SYSTEM Multiple-Use Classification Procedures § 2461.2 Classifications. Not less than 60 days after publication of the...

43 CFR 2461.2 - Classifications.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Classifications. 2461.2 Section 2461.2..., DEPARTMENT OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) BUREAU INITIATED CLASSIFICATION SYSTEM Multiple-Use Classification Procedures § 2461.2 Classifications. Not less than 60 days after publication of the...

28 CFR 524.73 - Classification procedures.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Classification procedures. 524.73 Section..., CLASSIFICATION, AND TRANSFER CLASSIFICATION OF INMATES Central Inmate Monitoring (CIM) System § 524.73 Classification procedures. (a) Initial assignment. Except as provided for in paragraphs (a) (1) through (4) of...

28 CFR 524.73 - Classification procedures.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Classification procedures. 524.73 Section..., CLASSIFICATION, AND TRANSFER CLASSIFICATION OF INMATES Central Inmate Monitoring (CIM) System § 524.73 Classification procedures. (a) Initial assignment. Except as provided for in paragraphs (a) (1) through (4) of...

28 CFR 524.73 - Classification procedures.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Classification procedures. 524.73 Section..., CLASSIFICATION, AND TRANSFER CLASSIFICATION OF INMATES Central Inmate Monitoring (CIM) System § 524.73 Classification procedures. (a) Initial assignment. Except as provided for in paragraphs (a) (1) through (4) of...

5 CFR 9901.223 - Appeal to DoD for review of classification decisions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... RESOURCES MANAGEMENT AND LABOR RELATIONS SYSTEMS (DEPARTMENT OF DEFENSE-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF DEFENSE NATIONAL SECURITY PERSONNEL SYSTEM (NSPS) Classification Classification Process § 9901... an appeal. A management official may disallow an employee's representative when— (1) An individual's...

Global Similarity Predicts Dissociation of Classification and Recognition: Evidence Questioning the Implicit-Explicit Learning Distinction in Amnesia

ERIC Educational Resources Information Center

Jamieson, Randall K.; Holmes, Signy; Mewhort, D. J. K.

2010-01-01

Dissociation of classification and recognition in amnesia is widely taken to imply 2 functional systems: an implicit procedural-learning system that is spared in amnesia and an explicit episodic-learning system that is compromised. We argue that both tasks reflect the global similarity of probes to memory. In classification, subjects sort…

Assessment of fatty degeneration of the gluteal muscles in patients with THA using MRI: reliability and accuracy of the Goutallier and quartile classification systems.

PubMed

Engelken, Florian; Wassilew, Georgi I; Köhlitz, Torsten; Brockhaus, Sebastian; Hamm, Bernd; Perka, Carsten; Diederichs, und Gerd

2014-01-01

The purpose of this study was to quantify the performance of the Goutallier classification for assessing fatty degeneration of the gluteus muscles from magnetic resonance (MR) images and to compare its performance to a newly proposed system. Eighty-four hips with clinical signs of gluteal insufficiency and 50 hips from asymptomatic controls were analyzed using a standard classification system (Goutallier) and a new scoring system (Quartile). Interobserver reliability and intraobserver repeatability were determined, and accuracy was assessed by comparing readers' scores with quantitative estimates of the proportion of intramuscular fat based on MR signal intensities (gold standard). The existing Goutallier classification system and the new Quartile system performed equally well in assessing fatty degeneration of the gluteus muscles, both showing excellent levels of interrater and intrarater agreement. While the Goutallier classification system has the advantage of being widely known, the benefit of the Quartile system is that it is based on more clearly defined grades of fatty degeneration. Copyright © 2014 Elsevier Inc. All rights reserved.

From Classification to Epilepsy Ontology and Informatics

PubMed Central

Zhang, Guo-Qiang; Sahoo, Satya S; Lhatoo, Samden D

2012-01-01

Summary The 2010 International League Against Epilepsy (ILAE) classification and terminology commission report proposed a much needed departure from previous classifications to incorporate advances in molecular biology, neuroimaging, and genetics. It proposed an interim classification and defined two key requirements that need to be satisfied. The first is the ability to classify epilepsy in dimensions according to a variety of purposes including clinical research, patient care, and drug discovery. The second is the ability of the classification system to evolve with new discoveries. Multi-dimensionality and flexibility are crucial to the success of any future classification. In addition, a successful classification system must play a central role in the rapidly growing field of epilepsy informatics. An epilepsy ontology, based on classification, will allow information systems to facilitate data-intensive studies and provide a proven route to meeting the two foregoing key requirements. Epilepsy ontology will be a structured terminology system that accommodates proposed and evolving ILAE classifications, the NIH/NINDS Common Data Elements, the ICD systems and explicitly specifies all known relationships between epilepsy concepts in a proper framework. This will aid evidence based epilepsy diagnosis, investigation, treatment and research for a diverse community of clinicians and researchers. Benefits range from systematization of electronic patient records to multi-modal data repositories for research and training manuals for those involved in epilepsy care. Given the complexity, heterogeneity and pace of research advances in the epilepsy domain, such an ontology must be collaboratively developed by key stakeholders in the epilepsy community and experts in knowledge engineering and computer science. PMID:22765502

MRI classification system (MRICS) for children with cerebral palsy: development, reliability, and recommendations.

PubMed

Himmelmann, Kate; Horber, Veronka; De La Cruz, Javier; Horridge, Karen; Mejaski-Bosnjak, Vlatka; Hollody, Katalin; Krägeloh-Mann, Ingeborg

2017-01-01

To develop and evaluate a classification system for magnetic resonance imaging (MRI) findings of children with cerebral palsy (CP) that can be used in CP registers. The classification system was based on pathogenic patterns occurring in different periods of brain development. The MRI classification system (MRICS) consists of five main groups: maldevelopments, predominant white matter injury, predominant grey matter injury, miscellaneous, and normal findings. A detailed manual for the descriptions of these patterns was developed, including test cases (www.scpenetwork.eu/en/my-scpe/rtm/neuroimaging/cp-neuroimaging/). A literature review was performed and MRICS was compared with other classification systems. An exercise was carried out to check applicability and interrater reliability. Professionals working with children with CP or in CP registers were invited to participate in the exercise and chose to classify either 18 MRIs or MRI reports of children with CP. Classification systems in the literature were compatible with MRICS and harmonization possible. Interrater reliability was found to be good overall (k=0.69; 0.54-0.82) among the 41 participants and very good (k=0.81; 0.74-0.92) using the classification based on imaging reports. Surveillance of Cerebral Palsy in Europe (SCPE) proposes the MRICS as a reliable tool. Together with its manual it is simple to apply for CP registers. © 2016 Mac Keith Press.

43 CFR 2450.4 - Protests: Initial classification decision.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Protests: Initial classification decision... CLASSIFICATION SYSTEM Petition-Application Procedures § 2450.4 Protests: Initial classification decision. (a) For a period of 30 days after the proposed classification decision has been served upon the parties...

49 CFR 173.53 - Provisions for using old classifications of explosives.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 2 2010-10-01 2010-10-01 false Provisions for using old classifications of... SHIPPERS-GENERAL REQUIREMENTS FOR SHIPMENTS AND PACKAGINGS Definitions, Classification and Packaging for Class 1 § 173.53 Provisions for using old classifications of explosives. Where the classification system...

Speech Enhancement based on the Dominant Classification Between Speech and Noise Using Feature Data in Spectrogram of Observation Signal

NASA Astrophysics Data System (ADS)

Nomura, Yukihiro; Lu, Jianming; Sekiya, Hiroo; Yahagi, Takashi

This paper presents a speech enhancement using the classification between the dominants of speech and noise. In our system, a new classification scheme between the dominants of speech and noise is proposed. The proposed classifications use the standard deviation of the spectrum of observation signal in each band. We introduce two oversubtraction factors for the dominants of speech and noise, respectively. And spectral subtraction is carried out after the classification. The proposed method is tested on several noise types from the Noisex-92 database. From the investigation of segmental SNR, Itakura-Saito distance measure, inspection of spectrograms and listening tests, the proposed system is shown to be effective to reduce background noise. Moreover, the enhanced speech using our system generates less musical noise and distortion than that of conventional systems.

A Functional Classification of Occupations.

ERIC Educational Resources Information Center

McKinlay, Donald Bruce

The need for more and better manpower information is hampered by the lack of adequate occupational data classification systems. The diversity of interests in occupations probably accounts for the absence of consensus regarding either the general outlines or the specific details of a standardized occupational classification system which would…

Dewey Decimal Classification: A Quagmire.

ERIC Educational Resources Information Center

Gamaluddin, Ahmad Fouad

1980-01-01

A survey of 660 Pennsylvania school librarians indicates that, though there is limited professional interest in the Library of Congress Classification system, Dewey Decimal Classification (DDC) appears to be firmly entrenched. This article also discusses the relative merits of DDC, the need for a uniform system, librarianship preparation, and…

5 CFR 9901.223 - Appeal to DoD for review of classification decisions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... RESOURCES MANAGEMENT AND LABOR RELATIONS SYSTEMS (DEPARTMENT OF DEFENSE-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF DEFENSE NATIONAL SECURITY PERSONNEL SYSTEM (NSPS) Classification Classification Process § 9901... process. (1) Employee appeals to DoD must be submitted through the employee's servicing Human Resources...

Evaluation of Urinary Tract Dilation Classification System for Grading Postnatal Hydronephrosis.

PubMed

Hodhod, Amr; Capolicchio, John-Paul; Jednak, Roman; El-Sherif, Eid; El-Doray, Abd El-Alim; El-Sherbiny, Mohamed

2016-03-01

We assessed the reliability and validity of the Urinary Tract Dilation classification system as a new grading system for postnatal hydronephrosis. We retrospectively reviewed charts of patients who presented with hydronephrosis from 2008 to 2013. We included patients diagnosed prenatally and those with hydronephrosis discovered incidentally during the first year of life. We excluded cases involving urinary tract infection, neurogenic bladder and chromosomal anomalies, those associated with extraurinary congenital malformations and those with followup of less than 24 months without resolution. Hydronephrosis was graded postnatally using the Society for Fetal Urology system, and then the management protocol was chosen. All units were regraded using the Urinary Tract Dilation classification system and compared to the Society for Fetal Urology system to assess reliability. Univariate and multivariate analyses were performed to assess the validity of the Urinary Tract Dilation classification system in predicting hydronephrosis resolution and surgical intervention. A total of 490 patients (730 renal units) were eligible to participate. The Urinary Tract Dilation classification system was reliable in the assessment of hydronephrosis (parallel forms 0.92). Hydronephrosis resolved in 357 units (49%), and 86 units (12%) were managed by surgical intervention. The remainder of renal units demonstrated stable or improved hydronephrosis. Multivariate analysis revealed that the likelihood of surgical intervention was predicted independently by Urinary Tract Dilation classification system risk group, while Society for Fetal Urology grades were predictive of likelihood of resolution. The Urinary Tract Dilation classification system is reliable for evaluation of postnatal hydronephrosis and is valid in predicting surgical intervention. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Topographic, bioclimatic, and vegetation characteristics of three ecoregion classification systems in North America: Comparisons along continent-wide transects

USGS Publications Warehouse

Thompson, R.S.; Shafer, S.L.; Anderson, K.H.; Strickland, L.E.; Pelltier, R.T.; Bartlein, P.J.; Kerwin, M.W.

2005-01-01

Ecoregion classification systems are increasingly used for policy and management decisions, particularly among conservation and natural resource managers. A number of ecoregion classification systems are currently available, with each system defining ecoregions using different classification methods and different types of data. As a result, each classification system describes a unique set of ecoregions. To help potential users choose the most appropriate ecoregion system for their particular application, we used three latitudinal transects across North America to compare the boundaries and environmental characteristics of three ecoregion classification systems [Ku??chler, World Wildlife Fund (WWF), and Bailey]. A variety of variables were used to evaluate the three systems, including woody plant species richness, normalized difference in vegetation index (NDVI), and bioclimatic variables (e.g., mean temperature of the coldest month) along each transect. Our results are dominated by geographic patterns in temperature, which are generally aligned north-south, and in moisture, which are generally aligned east-west. In the west, the dramatic changes in physiography, climate, and vegetation impose stronger controls on ecoregion boundaries than in the east. The Ku??chler system has the greatest number of ecoregions on all three transects, but does not necessarily have the highest degree of internal consistency within its ecoregions with regard to the bioclimatic and species richness data. In general, the WWF system appears to track climatic and floristic variables the best of the three systems, but not in all regions on all transects. ?? 2005 Springer Science+Business Media, Inc.

Accurate crop classification using hierarchical genetic fuzzy rule-based systems

NASA Astrophysics Data System (ADS)

Topaloglou, Charalampos A.; Mylonas, Stelios K.; Stavrakoudis, Dimitris G.; Mastorocostas, Paris A.; Theocharis, John B.

2014-10-01

This paper investigates the effectiveness of an advanced classification system for accurate crop classification using very high resolution (VHR) satellite imagery. Specifically, a recently proposed genetic fuzzy rule-based classification system (GFRBCS) is employed, namely, the Hierarchical Rule-based Linguistic Classifier (HiRLiC). HiRLiC's model comprises a small set of simple IF-THEN fuzzy rules, easily interpretable by humans. One of its most important attributes is that its learning algorithm requires minimum user interaction, since the most important learning parameters affecting the classification accuracy are determined by the learning algorithm automatically. HiRLiC is applied in a challenging crop classification task, using a SPOT5 satellite image over an intensively cultivated area in a lake-wetland ecosystem in northern Greece. A rich set of higher-order spectral and textural features is derived from the initial bands of the (pan-sharpened) image, resulting in an input space comprising 119 features. The experimental analysis proves that HiRLiC compares favorably to other interpretable classifiers of the literature, both in terms of structural complexity and classification accuracy. Its testing accuracy was very close to that obtained by complex state-of-the-art classification systems, such as the support vector machines (SVM) and random forest (RF) classifiers. Nevertheless, visual inspection of the derived classification maps shows that HiRLiC is characterized by higher generalization properties, providing more homogeneous classifications that the competitors. Moreover, the runtime requirements for producing the thematic map was orders of magnitude lower than the respective for the competitors.

43 CFR 2462.1 - Publication of notice of, and public hearings on, proposed classification.

Code of Federal Regulations, 2011 CFR

2011-10-01

... hearings on, proposed classification. 2462.1 Section 2462.1 Public Lands: Interior Regulations Relating to... (2000) BUREAU INITIATED CLASSIFICATION SYSTEM Disposal Classification Procedure: Over 2,560 Acres § 2462.1 Publication of notice of, and public hearings on, proposed classification. The authorized officer...

43 CFR 2462.2 - Publication of notice of classification.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Publication of notice of classification... CLASSIFICATION SYSTEM Disposal Classification Procedure: Over 2,560 Acres § 2462.2 Publication of notice of classification. After having considered the comments received as the result of publication, the authorized...

28 CFR 524.76 - Appeals of CIM classification.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Appeals of CIM classification. 524.76..., CLASSIFICATION, AND TRANSFER CLASSIFICATION OF INMATES Central Inmate Monitoring (CIM) System § 524.76 Appeals of CIM classification. An inmate may at any time appeal (through the Administrative Remedy Program) the...

77 FR 37879 - Cooperative Patent Classification External User Day

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-25

... Classification External User Day AGENCY: United States Patent and Trademark Office, Commerce. ACTION: Notice... Classification (CPC) External User Day event at its Alexandria Campus. CPC is a partnership between the USPTO and... classification system that will incorporate the best classification practices of the two Offices. This CPC event...

32 CFR 1648.6 - Registrants transferred for classification.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 6 2014-07-01 2014-07-01 false Registrants transferred for classification. 1648... SYSTEM CLASSIFICATION BY LOCAL BOARD § 1648.6 Registrants transferred for classification. (a) Before a..., be transferred for classification to a local board nearer to his current address than is the local...

32 CFR 1648.6 - Registrants transferred for classification.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 6 2013-07-01 2013-07-01 false Registrants transferred for classification. 1648... SYSTEM CLASSIFICATION BY LOCAL BOARD § 1648.6 Registrants transferred for classification. (a) Before a..., be transferred for classification to a local board nearer to his current address than is the local...

32 CFR 1648.6 - Registrants transferred for classification.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 6 2010-07-01 2010-07-01 false Registrants transferred for classification. 1648... SYSTEM CLASSIFICATION BY LOCAL BOARD § 1648.6 Registrants transferred for classification. (a) Before a..., be transferred for classification to a local board nearer to his current address than is the local...

32 CFR 1648.6 - Registrants transferred for classification.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 6 2011-07-01 2011-07-01 false Registrants transferred for classification. 1648... SYSTEM CLASSIFICATION BY LOCAL BOARD § 1648.6 Registrants transferred for classification. (a) Before a..., be transferred for classification to a local board nearer to his current address than is the local...

32 CFR 1648.6 - Registrants transferred for classification.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 6 2012-07-01 2012-07-01 false Registrants transferred for classification. 1648... SYSTEM CLASSIFICATION BY LOCAL BOARD § 1648.6 Registrants transferred for classification. (a) Before a..., be transferred for classification to a local board nearer to his current address than is the local...

Ototoxicity (cochleotoxicity) classifications: A review.

PubMed

Crundwell, Gemma; Gomersall, Phil; Baguley, David M

2016-01-01

Drug-mediated ototoxicity, specifically cochleotoxicity, is a concern for patients receiving medications for the treatment of serious illness. A number of classification schemes exist, most of which are based on pure-tone audiometry, in order to assist non-audiological/non-otological specialists in the identification and monitoring of iatrogenic hearing loss. This review identifies the primary classification systems used in cochleototoxicity monitoring. By bringing together classifications published in discipline-specific literature, the paper aims to increase awareness of their relative strengths and limitations in the assessment and monitoring of ototoxic hearing loss and to indicate how future classification systems may improve upon the status-quo. Literature review. PubMed identified 4878 articles containing the search term ototox*. A systematic search identified 13 key classification systems. Cochleotoxicity classification systems can be divided into those which focus on hearing change from a baseline audiogram and those that focus on the functional impact of the hearing loss. Common weaknesses of these grading scales included a lack of sensitivity to small adverse changes in hearing thresholds, a lack of high-frequency audiometry (>8 kHz), and lack of indication of which changes are likely to be clinically significant for communication and quality of life.

Global similarity predicts dissociation of classification and recognition: evidence questioning the implicit-explicit learning distinction in amnesia.

PubMed

Jamieson, Randall K; Holmes, Signy; Mewhort, D J K

2010-11-01

Dissociation of classification and recognition in amnesia is widely taken to imply 2 functional systems: an implicit procedural-learning system that is spared in amnesia and an explicit episodic-learning system that is compromised. We argue that both tasks reflect the global similarity of probes to memory. In classification, subjects sort unstudied grammatical exemplars from lures, whereas in recognition, they sort studied grammatical exemplars from lures. Hence, global similarity is necessarily greater in recognition than in classification. Moreover, a grammatical exemplar's similarity to studied exemplars is a nonlinear function of the integrity of the data in memory. Assuming that data integrity is better for control subjects than for subjects with amnesia, the nonlinear relation combined with the advantage for recognition over classification predicts the dissociation of recognition and classification. To illustrate the dissociation of recognition and classification in healthy undergraduates, we manipulated study time to vary the integrity of the data in memory and brought the dissociation under experimental control. We argue that the dissociation reflects a general cost in memory rather than a selective impairment of separate procedural and episodic systems. (c) 2010 APA, all rights reserved

Classification of natural ponds and lakes in the glaciated prairie region

USGS Publications Warehouse

Stewart, Robert E.; Kantrud, Harold A.

1971-01-01

The wetland classification system for the United States adopted by the Bureau of Sport Fisheries and Wildlife in 1953 is described by Martin et al (1953) and by Shaw and Fredine (1956).  That classification has been followed by many biologists in recent years and is especially useful in categorizing in a general manner the wetlands throughout the country over a span of years.  It has become apparent, however, that for research and intensive management a dynamic classification system that more precisely reflects seasonal, regional, and local variations in the environment is needed.  To establish a detailed wetland classification system for all of  North America will require intensive ecological investigation of wetlands in each of the major biogeographical regions.

Practice patterns when treating patients with low back pain: a survey of physical therapists.

PubMed

Davies, Claire; Nitz, Arthur J; Mattacola, Carl G; Kitzman, Patrick; Howell, Dana; Viele, Kert; Baxter, David; Brockopp, Dorothy

2014-08-01

Low back pain (LBP), is a common musculoskeletal problem, affecting 75-85% of adults in their lifetime. Direct costs of LBP in the USA were estimated over 85 billion dollars in 2005 resulting in a significant economic burden for the healthcare system. LBP classification systems and outcome measures are available to guide physical therapy assessments and intervention. However, little is known about which, if any, physical therapists use in clinical practice. The purpose of this study was to identify the use of and barriers to LBP classification systems and outcome measures among physical therapists in one state. A mixed methods study using a cross-sectional cohort design with descriptive qualitative methods was performed. A survey collected both quantitative and qualitative data relevant to classification systems and outcome measures used by physical therapists working with patients with LBP. Physical therapists responded using classification systems designed to direct treatment predominantly. The McKenzie method was the most frequent approach to classify LBP. Barriers to use of classification systems and outcome measures were lack of knowledge, too limiting and time. Classification systems are being used for decision-making in physical therapy practice for patients with LBP. Lack of knowledge and training seems to be the main barrier to the use of classification systems in practice. The Oswestry Disability Index and Numerical Pain Scale were the most commonly used outcome measures. The main barrier to their use was lack of time. Continuing education and reading the literature were identified as important tools to teach evidence-based practice to physical therapists in practice.

The software application and classification algorithms for welds radiograms analysis

NASA Astrophysics Data System (ADS)

Sikora, R.; Chady, T.; Baniukiewicz, P.; Grzywacz, B.; Lopato, P.; Misztal, L.; Napierała, L.; Piekarczyk, B.; Pietrusewicz, T.; Psuj, G.

2013-01-01

The paper presents a software implementation of an Intelligent System for Radiogram Analysis (ISAR). The system has to support radiologists in welds quality inspection. The image processing part of software with a graphical user interface and a welds classification part are described with selected classification results. Classification was based on a few algorithms: an artificial neural network, a k-means clustering, a simplified k-means and a rough sets theory.

Comparing drug classification systems.

PubMed

Mahoney, Anne; Evans, Jonathan

2008-11-06

An essential quality of drug classification systems is the ability to assign medications to a structured hierarchy for categories such as mechanism of action, physiological effects, and therapeutic indications. No single classification system can meet all of these needs; however, there should be consistency among those that group by the same underlying principals. We discovered discrepancies in how drugs with multiple therapeutic indications are classified among four widely used schemas.

A classification of large amplitude oscillations of a spring-pendulum system

NASA Technical Reports Server (NTRS)

Broucke, R.

1977-01-01

We present a detailed classification of large amplitude oscillations of a non-integrable autonomous system with two degrees of freedom: the spring pendulum system. The classification is made with the method of invariant curves. The results show the importance of three types of motion: periodic, quasi-periodic and semi-ergodic. The numerical results are given for nine different values of the energy constant.

48 CFR 204.7107 - Contract accounting classification reference number (ACRN) and agency accounting identifier (AAI).

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 3 2011-10-01 2011-10-01 false Contract accounting classification reference number (ACRN) and agency accounting identifier (AAI). 204.7107 Section 204.7107 Federal... ADMINISTRATIVE MATTERS Uniform Contract Line Item Numbering System 204.7107 Contract accounting classification...

Spectral Classification in the MK System of 167 Northern HD Stars

NASA Astrophysics Data System (ADS)

Jensen, K. S.

1981-09-01

Spectral classifications in the MK system of 167 northern HD stars are presented. The spectra (102 A/mm at Hγ, width 0.60 mm) are from objective prism plates obtained with the Schmidt telescope of the CUO, Brorfelde. Most of the stars have no previous MK classification.

Towards a Collaborative Intelligent Tutoring System Classification Scheme

ERIC Educational Resources Information Center

Harsley, Rachel

2014-01-01

This paper presents a novel classification scheme for Collaborative Intelligent Tutoring Systems (CITS), an emergent research field. The three emergent classifications of CITS are unstructured, semi-structured, and fully structured. While all three types of CITS offer opportunities to improve student learning gains, the full extent to which these…

The Alaska vegetation classification.

Treesearch

L.A. Viereck; C.T. Dyrness; A.R. Batten; K.J. Wenzlick

1992-01-01

The Alaska vegetation classification presented here is a comprehensive, statewide system that has been under development since 1976. The classification is based, as much as possible, on the characteristics of the vegetation itself and is designed to categorize existing vegetation, not potential vegetation. A hierarchical system with five levels of resolution is used...

48 CFR 204.7107 - Contract accounting classification reference number (ACRN) and agency accounting identifier (AAI).

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Contract accounting classification reference number (ACRN) and agency accounting identifier (AAI). 204.7107 Section 204.7107 Federal... ADMINISTRATIVE MATTERS Uniform Contract Line Item Numbering System 204.7107 Contract accounting classification...

The Interrater and Intrarater Agreement of a Modified Neer Classification System and Associated Treatment Choice for Lateral Clavicle Fractures.

PubMed

Cho, Chul-Hyun; Oh, Joo Han; Jung, Gu-Hee; Moon, Gi-Hyuk; Rhyou, In Hyeok; Yoon, Jong Pil; Lee, Ho Min

2015-10-01

As there is substantial variation in the classification and diagnosis of lateral clavicle fractures, proper management can be challenging. Although the Neer classification system modified by Craig has been widely used, no study has assessed its validity through inter- and intrarater agreement. To determine the inter- and intrarater agreement of the modified Neer classification system and associated treatment choice for lateral clavicle fractures and to assess whether 3-dimensional computed tomography (3D CT) improves the level of agreement. Cohort study (diagnosis); Level of evidence, 3. Nine experienced shoulder specialists and 9 orthopaedic fellows evaluated 52 patients with lateral clavicle fractures, completing fracture typing according to the modified Neer classification system and selecting a treatment choice for each case. Web-based assessment was performed using plain radiographs only, followed by the addition of 3D CT images 2 weeks later. This procedure was repeated 4 weeks later. Fleiss κ values were calculated to estimate the inter- and intrarater agreement. Based on plain radiographs only, the inter- and intrarater agreement of the modified Neer classification system was regarded as fair (κ = 0.344) and moderate (κ = 0.496), respectively; the inter- and intrarater agreement of treatment choice was both regarded as moderate (κ = 0.465 and 0.555, respectively). Based on the plain radiographs and 3D CT images, the inter- and intrarater agreement of the classification system was regarded as fair (κ = 0.317) and moderate (κ = 0.508), respectively; the inter- and intrarater agreement of treatment choice was regarded as moderate (κ = 0.463) and substantial (κ = 0.623), respectively. There were no significant differences in the level of agreement between the plain radiographs only and plain radiographs plus 3D CT images for any κ values (all P > .05). The level of interrater agreement of the modified Neer classification system for lateral clavicle fractures was fair. Additional 3D CT did not improve the overall level of interrater or intrarater agreement of the modified Neer classification system or associated treatment choice. To eliminate a common source of disagreement among surgeons, a new classification system to focus on unclassifiable fracture types is needed. © 2015 The Author(s).

Improved wavelet packet classification algorithm for vibrational intrusions in distributed fiber-optic monitoring systems

NASA Astrophysics Data System (ADS)

Wang, Bingjie; Pi, Shaohua; Sun, Qi; Jia, Bo

2015-05-01

An improved classification algorithm that considers multiscale wavelet packet Shannon entropy is proposed. Decomposition coefficients at all levels are obtained to build the initial Shannon entropy feature vector. After subtracting the Shannon entropy map of the background signal, components of the strongest discriminating power in the initial feature vector are picked out to rebuild the Shannon entropy feature vector, which is transferred to radial basis function (RBF) neural network for classification. Four types of man-made vibrational intrusion signals are recorded based on a modified Sagnac interferometer. The performance of the improved classification algorithm has been evaluated by the classification experiments via RBF neural network under different diffusion coefficients. An 85% classification accuracy rate is achieved, which is higher than the other common algorithms. The classification results show that this improved classification algorithm can be used to classify vibrational intrusion signals in an automatic real-time monitoring system.

[Landscape classification: research progress and development trend].

PubMed

Liang, Fa-Chao; Liu, Li-Ming

2011-06-01

Landscape classification is the basis of the researches on landscape structure, process, and function, and also, the prerequisite for landscape evaluation, planning, protection, and management, directly affecting the precision and practicability of landscape research. This paper reviewed the research progress on the landscape classification system, theory, and methodology, and summarized the key problems and deficiencies of current researches. Some major landscape classification systems, e. g. , LANMAP and MUFIC, were introduced and discussed. It was suggested that a qualitative and quantitative comprehensive classification based on the ideology of functional structure shape and on the integral consideration of landscape classification utility, landscape function, landscape structure, physiogeographical factors, and human disturbance intensity should be the major research directions in the future. The integration of mapping, 3S technology, quantitative mathematics modeling, computer artificial intelligence, and professional knowledge to enhance the precision of landscape classification would be the key issues and the development trend in the researches of landscape classification.

Assessment of the Hong Kong Liver Cancer Staging System in Europe.

PubMed

Kolly, Philippe; Reeves, Helen; Sangro, Bruno; Knöpfli, Marina; Candinas, Daniel; Dufour, Jean-François

2016-06-01

European and American guidelines have endorsed the Barcelona Clinic Liver Cancer (BCLC) staging system. The aim of this study was to assess the performance of the recently developed Hong Kong Liver Cancer (HKLC) classification as a staging system for hepatocellular carcinoma (HCC) in Europe. We used a pooled set of 1693 HCC patients combining three prospective European cohorts. Discrimination ability between the nine substages and five stages of the HKLC classification system was assessed. To evaluate the predictive power of the HKLC and BCLC staging systems on overall survival, Nagelkerke pseudo R2, Bayesian Information Criterion and Harrell's concordance index were calculated. The number of patients who would benefit from a curative therapy was assessed for both staging systems. The HKLC classification in nine substages shows suboptimal discrimination between the staging groups. The classification in five stages shows better discrimination between groups. However, the BCLC classification performs better than the HKLC classification in the ability to predict overall survival (OS). The HKLC treatment algorithm tags significantly more patients to curative therapy than the BCLC. The BCLC staging system performs better for European patients than the HKLC staging system in predicting OS. Twice more patients are eligible for a curative therapy with the HKLC algorithm; whether this translates in survival benefit remains to be investigated. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A novel approach to malignant-benign classification of pulmonary nodules by using ensemble learning classifiers.

PubMed

Tartar, A; Akan, A; Kilic, N

2014-01-01

Computer-aided detection systems can help radiologists to detect pulmonary nodules at an early stage. In this paper, a novel Computer-Aided Diagnosis system (CAD) is proposed for the classification of pulmonary nodules as malignant and benign. The proposed CAD system using ensemble learning classifiers, provides an important support to radiologists at the diagnosis process of the disease, achieves high classification performance. The proposed approach with bagging classifier results in 94.7 %, 90.0 % and 77.8 % classification sensitivities for benign, malignant and undetermined classes (89.5 % accuracy), respectively.

R-parametrization and its role in classification of linear multivariable feedback systems

NASA Technical Reports Server (NTRS)

Chen, Robert T. N.

1988-01-01

A classification of all the compensators that stabilize a given general plant in a linear, time-invariant multi-input, multi-output feedback system is developed. This classification, along with the associated necessary and sufficient conditions for stability of the feedback system, is achieved through the introduction of a new parameterization, referred to as R-Parameterization, which is a dual of the familiar Q-Parameterization. The classification is made to the stability conditions of the compensators and the plant by themselves; and necessary and sufficient conditions are based on the stability of Q and R themselves.

Effects of pressure ulcer classification system education programme on knowledge and visual differential diagnostic ability of pressure ulcer classification and incontinence-associated dermatitis for clinical nurses in Korea.

PubMed

Lee, Yun Jin; Kim, Jung Yoon

2016-03-01

The objective of this study was to evaluate the effect of pressure ulcer classification system education on clinical nurses' knowledge and visual differential diagnostic ability of pressure ulcer (PU) classification and incontinence-associated dermatitis (IAD). One group pre and post-test was used. A convenience sample of 407 nurses, participating in PU classification education programme of continuing education, were enrolled. The education programme was composed of a 50-minute lecture on PU classification and case-studies. The PU Classification system and IAD knowledge test (PUCS-KT) and visual differential diagnostic ability tool (VDDAT), consisting of 21 photographs including clinical information were used. Paired t-test was performed using SPSS/WIN 20.0. The overall mean difference of PUCS-KT (t = -11·437, P<0·001) and VDDAT (t = -21·113, P<0·001) was significantly increased after PU classification education. Overall understanding of six PU classification and IAD after education programme was increased, but lacked visual differential diagnostic ability regarding Stage III PU, suspected deep tissue injury (SDTI), and Unstageable. Continuous differentiated education based on clinical practice is needed to improve knowledge and visual differential diagnostic ability for PU classification, and comparison experiment study is required to examine effects of education programmes. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

5 CFR 9701.231 - Conversion of positions and employees to the DHS classification system.

Code of Federal Regulations, 2010 CFR

2010-01-01

... HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Classification Transitional...

Comparative study of classification algorithms for damage classification in smart composite laminates

NASA Astrophysics Data System (ADS)

Khan, Asif; Ryoo, Chang-Kyung; Kim, Heung Soo

2017-04-01

This paper presents a comparative study of different classification algorithms for the classification of various types of inter-ply delaminations in smart composite laminates. Improved layerwise theory is used to model delamination at different interfaces along the thickness and longitudinal directions of the smart composite laminate. The input-output data obtained through surface bonded piezoelectric sensor and actuator is analyzed by the system identification algorithm to get the system parameters. The identified parameters for the healthy and delaminated structure are supplied as input data to the classification algorithms. The classification algorithms considered in this study are ZeroR, Classification via regression, Naïve Bayes, Multilayer Perceptron, Sequential Minimal Optimization, Multiclass-Classifier, and Decision tree (J48). The open source software of Waikato Environment for Knowledge Analysis (WEKA) is used to evaluate the classification performance of the classifiers mentioned above via 75-25 holdout and leave-one-sample-out cross-validation regarding classification accuracy, precision, recall, kappa statistic and ROC Area.

On-board multispectral classification study

NASA Technical Reports Server (NTRS)

Ewalt, D.

1979-01-01

The factors relating to onboard multispectral classification were investigated. The functions implemented in ground-based processing systems for current Earth observation sensors were reviewed. The Multispectral Scanner, Thematic Mapper, Return Beam Vidicon, and Heat Capacity Mapper were studied. The concept of classification was reviewed and extended from the ground-based image processing functions to an onboard system capable of multispectral classification. Eight different onboard configurations, each with varying amounts of ground-spacecraft interaction, were evaluated. Each configuration was evaluated in terms of turnaround time, onboard processing and storage requirements, geometric and classification accuracy, onboard complexity, and ancillary data required from the ground.

[New International Classification of Chronic Pancreatitis (M-ANNHEIM multifactor classification system, 2007): principles, merits, and demerits].

PubMed

Tsimmerman, Ia S

2008-01-01

The new International Classification of Chronic Pancreatitis (designated as M-ANNHEIM) proposed by a group of German specialists in late 2007 is reviewed. All its sections are subjected to analysis (risk group categories, clinical stages and phases, variants of clinical course, diagnostic criteria for "established" and "suspected" pancreatitis, instrumental methods and functional tests used in the diagnosis, evaluation of the severity of the disease using a scoring system, stages of elimination of pain syndrome). The new classification is compared with the earlier classification proposed by the author. Its merits and demerits are discussed.

Virtual Sensor of Surface Electromyography in a New Extensive Fault-Tolerant Classification System.

PubMed

de Moura, Karina de O A; Balbinot, Alexandre

2018-05-01

A few prosthetic control systems in the scientific literature obtain pattern recognition algorithms adapted to changes that occur in the myoelectric signal over time and, frequently, such systems are not natural and intuitive. These are some of the several challenges for myoelectric prostheses for everyday use. The concept of the virtual sensor, which has as its fundamental objective to estimate unavailable measures based on other available measures, is being used in other fields of research. The virtual sensor technique applied to surface electromyography can help to minimize these problems, typically related to the degradation of the myoelectric signal that usually leads to a decrease in the classification accuracy of the movements characterized by computational intelligent systems. This paper presents a virtual sensor in a new extensive fault-tolerant classification system to maintain the classification accuracy after the occurrence of the following contaminants: ECG interference, electrode displacement, movement artifacts, power line interference, and saturation. The Time-Varying Autoregressive Moving Average (TVARMA) and Time-Varying Kalman filter (TVK) models are compared to define the most robust model for the virtual sensor. Results of movement classification were presented comparing the usual classification techniques with the method of the degraded signal replacement and classifier retraining. The experimental results were evaluated for these five noise types in 16 surface electromyography (sEMG) channel degradation case studies. The proposed system without using classifier retraining techniques recovered of mean classification accuracy was of 4% to 38% for electrode displacement, movement artifacts, and saturation noise. The best mean classification considering all signal contaminants and channel combinations evaluated was the classification using the retraining method, replacing the degraded channel by the virtual sensor TVARMA model. This method recovered the classification accuracy after the degradations, reaching an average of 5.7% below the classification of the clean signal, that is the signal without the contaminants or the original signal. Moreover, the proposed intelligent technique minimizes the impact of the motion classification caused by signal contamination related to degrading events over time. There are improvements in the virtual sensor model and in the algorithm optimization that need further development to provide an increase the clinical application of myoelectric prostheses but already presents robust results to enable research with virtual sensors on biological signs with stochastic behavior.

Virtual Sensor of Surface Electromyography in a New Extensive Fault-Tolerant Classification System

PubMed Central

Balbinot, Alexandre

2018-01-01

A few prosthetic control systems in the scientific literature obtain pattern recognition algorithms adapted to changes that occur in the myoelectric signal over time and, frequently, such systems are not natural and intuitive. These are some of the several challenges for myoelectric prostheses for everyday use. The concept of the virtual sensor, which has as its fundamental objective to estimate unavailable measures based on other available measures, is being used in other fields of research. The virtual sensor technique applied to surface electromyography can help to minimize these problems, typically related to the degradation of the myoelectric signal that usually leads to a decrease in the classification accuracy of the movements characterized by computational intelligent systems. This paper presents a virtual sensor in a new extensive fault-tolerant classification system to maintain the classification accuracy after the occurrence of the following contaminants: ECG interference, electrode displacement, movement artifacts, power line interference, and saturation. The Time-Varying Autoregressive Moving Average (TVARMA) and Time-Varying Kalman filter (TVK) models are compared to define the most robust model for the virtual sensor. Results of movement classification were presented comparing the usual classification techniques with the method of the degraded signal replacement and classifier retraining. The experimental results were evaluated for these five noise types in 16 surface electromyography (sEMG) channel degradation case studies. The proposed system without using classifier retraining techniques recovered of mean classification accuracy was of 4% to 38% for electrode displacement, movement artifacts, and saturation noise. The best mean classification considering all signal contaminants and channel combinations evaluated was the classification using the retraining method, replacing the degraded channel by the virtual sensor TVARMA model. This method recovered the classification accuracy after the degradations, reaching an average of 5.7% below the classification of the clean signal, that is the signal without the contaminants or the original signal. Moreover, the proposed intelligent technique minimizes the impact of the motion classification caused by signal contamination related to degrading events over time. There are improvements in the virtual sensor model and in the algorithm optimization that need further development to provide an increase the clinical application of myoelectric prostheses but already presents robust results to enable research with virtual sensors on biological signs with stochastic behavior. PMID:29723994

Multi-material classification of dry recyclables from municipal solid waste based on thermal imaging.

PubMed

Gundupalli, Sathish Paulraj; Hait, Subrata; Thakur, Atul

2017-12-01

There has been a significant rise in municipal solid waste (MSW) generation in the last few decades due to rapid urbanization and industrialization. Due to the lack of source segregation practice, a need for automated segregation of recyclables from MSW exists in the developing countries. This paper reports a thermal imaging based system for classifying useful recyclables from simulated MSW sample. Experimental results have demonstrated the possibility to use thermal imaging technique for classification and a robotic system for sorting of recyclables in a single process step. The reported classification system yields an accuracy in the range of 85-96% and is comparable with the existing single-material recyclable classification techniques. We believe that the reported thermal imaging based system can emerge as a viable and inexpensive large-scale classification-cum-sorting technology in recycling plants for processing MSW in developing countries. Copyright © 2017 Elsevier Ltd. All rights reserved.

Innovative vehicle classification strategies : using LIDAR to do more for less.

DOT National Transportation Integrated Search

2012-06-23

This study examines LIDAR (light detection and ranging) based vehicle classification and classification : performance monitoring. First, we develop a portable LIDAR based vehicle classification system that can : be rapidly deployed, and then we use t...

An evaluation of classification systems for stillbirth

PubMed Central

Flenady, Vicki; Frøen, J Frederik; Pinar, Halit; Torabi, Rozbeh; Saastad, Eli; Guyon, Grace; Russell, Laurie; Charles, Adrian; Harrison, Catherine; Chauke, Lawrence; Pattinson, Robert; Koshy, Rachel; Bahrin, Safiah; Gardener, Glenn; Day, Katie; Petersson, Karin; Gordon, Adrienne; Gilshenan, Kristen

2009-01-01

Background Audit and classification of stillbirths is an essential part of clinical practice and a crucial step towards stillbirth prevention. Due to the limitations of the ICD system and lack of an international approach to an acceptable solution, numerous disparate classification systems have emerged. We assessed the performance of six contemporary systems to inform the development of an internationally accepted approach. Methods We evaluated the following systems: Amended Aberdeen, Extended Wigglesworth; PSANZ-PDC, ReCoDe, Tulip and CODAC. Nine teams from 7 countries applied the classification systems to cohorts of stillbirths from their regions using 857 stillbirth cases. The main outcome measures were: the ability to retain the important information about the death using the InfoKeep rating; the ease of use according to the Ease rating (both measures used a five-point scale with a score <2 considered unsatisfactory); inter-observer agreement and the proportion of unexplained stillbirths. A randomly selected subset of 100 stillbirths was used to assess inter-observer agreement. Results InfoKeep scores were significantly different across the classifications (p ≤ 0.01) due to low scores for Wigglesworth and Aberdeen. CODAC received the highest mean (SD) score of 3.40 (0.73) followed by PSANZ-PDC, ReCoDe and Tulip [2.77 (1.00), 2.36 (1.21), 1.92 (1.24) respectively]. Wigglesworth and Aberdeen resulted in a high proportion of unexplained stillbirths and CODAC and Tulip the lowest. While Ease scores were different (p ≤ 0.01), all systems received satisfactory scores; CODAC received the highest score. Aberdeen and Wigglesworth showed poor agreement with kappas of 0.35 and 0.25 respectively. Tulip performed best with a kappa of 0.74. The remainder had good to fair agreement. Conclusion The Extended Wigglesworth and Amended Aberdeen systems cannot be recommended for classification of stillbirths. Overall, CODAC performed best with PSANZ-PDC and ReCoDe performing well. Tulip was shown to have the best agreement and a low proportion of unexplained stillbirths. The virtues of these systems need to be considered in the development of an international solution to classification of stillbirths. Further studies are required on the performance of classification systems in the context of developing countries. Suboptimal agreement highlights the importance of instituting measures to ensure consistency for any classification system. PMID:19538759

An evaluation of classification systems for stillbirth.

PubMed

Flenady, Vicki; Frøen, J Frederik; Pinar, Halit; Torabi, Rozbeh; Saastad, Eli; Guyon, Grace; Russell, Laurie; Charles, Adrian; Harrison, Catherine; Chauke, Lawrence; Pattinson, Robert; Koshy, Rachel; Bahrin, Safiah; Gardener, Glenn; Day, Katie; Petersson, Karin; Gordon, Adrienne; Gilshenan, Kristen

2009-06-19

Audit and classification of stillbirths is an essential part of clinical practice and a crucial step towards stillbirth prevention. Due to the limitations of the ICD system and lack of an international approach to an acceptable solution, numerous disparate classification systems have emerged. We assessed the performance of six contemporary systems to inform the development of an internationally accepted approach. We evaluated the following systems: Amended Aberdeen, Extended Wigglesworth; PSANZ-PDC, ReCoDe, Tulip and CODAC. Nine teams from 7 countries applied the classification systems to cohorts of stillbirths from their regions using 857 stillbirth cases. The main outcome measures were: the ability to retain the important information about the death using the InfoKeep rating; the ease of use according to the Ease rating (both measures used a five-point scale with a score <2 considered unsatisfactory); inter-observer agreement and the proportion of unexplained stillbirths. A randomly selected subset of 100 stillbirths was used to assess inter-observer agreement. InfoKeep scores were significantly different across the classifications (p < or = 0.01) due to low scores for Wigglesworth and Aberdeen. CODAC received the highest mean (SD) score of 3.40 (0.73) followed by PSANZ-PDC, ReCoDe and Tulip [2.77 (1.00), 2.36 (1.21), 1.92 (1.24) respectively]. Wigglesworth and Aberdeen resulted in a high proportion of unexplained stillbirths and CODAC and Tulip the lowest. While Ease scores were different (p < or = 0.01), all systems received satisfactory scores; CODAC received the highest score. Aberdeen and Wigglesworth showed poor agreement with kappas of 0.35 and 0.25 respectively. Tulip performed best with a kappa of 0.74. The remainder had good to fair agreement. The Extended Wigglesworth and Amended Aberdeen systems cannot be recommended for classification of stillbirths. Overall, CODAC performed best with PSANZ-PDC and ReCoDe performing well. Tulip was shown to have the best agreement and a low proportion of unexplained stillbirths. The virtues of these systems need to be considered in the development of an international solution to classification of stillbirths. Further studies are required on the performance of classification systems in the context of developing countries. Suboptimal agreement highlights the importance of instituting measures to ensure consistency for any classification system.

Attachment-based classifications of children's family drawings: psychometric properties and relations with children's adjustment in kindergarten.

PubMed

Pianta, R C; Longmaid, K; Ferguson, J E

1999-06-01

Investigated an attachment-based theoretical framework and classification system, introduced by Kaplan and Main (1986), for interpreting children's family drawings. This study concentrated on the psychometric properties of the system and the relation between drawings classified using this system and teacher ratings of classroom social-emotional and behavioral functioning, controlling for child age, ethnic status, intelligence, and fine motor skills. This nonclinical sample consisted of 200 kindergarten children of diverse racial and socioeconomic status (SES). Limited support for reliability of this classification system was obtained. Kappas for overall classifications of drawings (e.g., secure) exceeded .80 and mean kappa for discrete drawing features (e.g., figures with smiles) was .82. Coders' endorsement of the presence of certain discrete drawing features predicted their overall classification at 82.5% accuracy. Drawing classification was related to teacher ratings of classroom functioning independent of child age, sex, race, SES, intelligence, and fine motor skills (with p values for the multivariate effects ranging from .043-.001). Results are discussed in terms of the psychometric properties of this system for classifying children's representations of family and the limitations of family drawing techniques for young children.

A Confidence Paradigm for Classification Systems

DTIC Science & Technology

2008-09-01

methodology to determine how much confi- dence one should have in a classifier output. This research proposes a framework to determine the level of...theoretical framework that attempts to unite the viewpoints of the classification system developer (or engineer) and the classification system user (or...operating point. An algorithm is developed that minimizes a “confidence” measure called Binned Error in the Posterior ( BEP ). Then, we prove that training a

Automated analysis of food-borne pathogens using a novel microbial cell culture, sensing and classification system.

PubMed

Xiang, Kun; Li, Yinglei; Ford, William; Land, Walker; Schaffer, J David; Congdon, Robert; Zhang, Jing; Sadik, Omowunmi

2016-02-21

We hereby report the design and implementation of an Autonomous Microbial Cell Culture and Classification (AMC(3)) system for rapid detection of food pathogens. Traditional food testing methods require multistep procedures and long incubation period, and are thus prone to human error. AMC(3) introduces a "one click approach" to the detection and classification of pathogenic bacteria. Once the cultured materials are prepared, all operations are automatic. AMC(3) is an integrated sensor array platform in a microbial fuel cell system composed of a multi-potentiostat, an automated data collection system (Python program, Yocto Maxi-coupler electromechanical relay module) and a powerful classification program. The classification scheme consists of Probabilistic Neural Network (PNN), Support Vector Machines (SVM) and General Regression Neural Network (GRNN) oracle-based system. Differential Pulse Voltammetry (DPV) is performed on standard samples or unknown samples. Then, using preset feature extractions and quality control, accepted data are analyzed by the intelligent classification system. In a typical use, thirty-two extracted features were analyzed to correctly classify the following pathogens: Escherichia coli ATCC#25922, Escherichia coli ATCC#11775, and Staphylococcus epidermidis ATCC#12228. 85.4% accuracy range was recorded for unknown samples, and within a shorter time period than the industry standard of 24 hours.

Analysis on Target Detection and Classification in LTE Based Passive Forward Scattering Radar.

PubMed

Raja Abdullah, Raja Syamsul Azmir; Abdul Aziz, Noor Hafizah; Abdul Rashid, Nur Emileen; Ahmad Salah, Asem; Hashim, Fazirulhisyam

2016-09-29

The passive bistatic radar (PBR) system can utilize the illuminator of opportunity to enhance radar capability. By utilizing the forward scattering technique and procedure into the specific mode of PBR can provide an improvement in target detection and classification. The system is known as passive Forward Scattering Radar (FSR). The passive FSR system can exploit the peculiar advantage of the enhancement in forward scatter radar cross section (FSRCS) for target detection. Thus, the aim of this paper is to show the feasibility of passive FSR for moving target detection and classification by experimental analysis and results. The signal source is coming from the latest technology of 4G Long-Term Evolution (LTE) base station. A detailed explanation on the passive FSR receiver circuit, the detection scheme and the classification algorithm are given. In addition, the proposed passive FSR circuit employs the self-mixing technique at the receiver; hence the synchronization signal from the transmitter is not required. The experimental results confirm the passive FSR system's capability for ground target detection and classification. Furthermore, this paper illustrates the first classification result in the passive FSR system. The great potential in the passive FSR system provides a new research area in passive radar that can be used for diverse remote monitoring applications.

78 FR 30393 - Preparations for the 43rd Session of the United Nations Sub-Committee of Experts on the Transport...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-22

... System of Classification and Labelling of Chemicals (UNSCEGHS) AGENCY: Pipeline and Hazardous Materials... the Globally Harmonized System of Classification and Labelling of Chemicals (UNSCEGHS) to be held July... UNSCOE TDG meeting include: Explosives and related matters Listing, classification and packing Electric...

An ecological classification system for the central hardwoods region: The Hoosier National Forest

Treesearch

James E. Van Kley; George R. Parker

1993-01-01

This study, a multifactor ecological classification system, using vegetation, soil characteristics, and physiography, was developed for the landscape of the Hoosier National Forest in Southern Indiana. Measurements of ground flora, saplings, and canopy trees from selected stands older than 80 years were subjected to TWINSPAN classification and DECORANA ordination....

Annehurst Curriculum Classification System Variables as Dimensions of Aptitude Treatment Interactions.

ERIC Educational Resources Information Center

Clark, Ginny; Grady, M. Tim

The objective of this study was to determine if the Annehurst Curriculum Classification System (ACCS) learner characteristics and curriculum materials classifications among elementary mathematics students, can be used as the dimensions of an aptitude-treatment interaction analysis. The subjects were 34 fourth and fifth graders in three open-space…

48 CFR 19.303 - Determining North American Industry Classification System (NAICS) codes and size standards.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Industry Classification System (NAICS) codes and size standards. 19.303 Section 19.303 Federal Acquisition... of Small Business Status for Small Business Programs 19.303 Determining North American Industry... user, the added text is set forth as follows: 19.303 Determining North American Industry Classification...

Quantitative classification of a historic northern Wisconsin (U.S.A.) landscape: mapping forests at regional scales

Treesearch

Lisa A. Schulte; David J. Mladenoff; Erik V. Nordheim

2002-01-01

We developed a quantitative and replicable classification system to improve understanding of historical composition and structure within northern Wisconsin's forests. The classification system was based on statistical cluster analysis and two forest metrics, relative dominance (% basal area) and relative importance (mean of relative dominance and relative density...

Challenges of interoperability using HL7 v3 in Czech healthcare.

PubMed

Nagy, Miroslav; Preckova, Petra; Seidl, Libor; Zvarova, Jana

2010-01-01

The paper describes several classification systems that could improve patient safety through semantic interoperability among contemporary electronic health record systems (EHR-Ss) with support of the HL7 v3 standard. We describe a proposal and a pilot implementation of a semantic interoperability platform (SIP) interconnecting current EHR-Ss by using HL7 v3 messages and concepts mappings on most widely used classification systems. The increasing number of classification systems and nomenclatures requires designing of various conversion tools for transfer between main classification systems. We present the so-called LIM filler module and the HL7 broker, which are parts of the SIP, playing the role of such conversion tools. The analysis of suitability and usability of individual terminological thesauri has been started by mapping of clinical contents of the Minimal Data Model for Cardiology (MDMC) to various terminological classification systems. A national-wide implementation of the SIP would include adopting and translating international coding systems and nomenclatures, and developing implementation guidelines facilitating the migration from national standards to international ones. Our research showed that creation of such a platform is feasible; however, it will require a huge effort to adapt fully the Czech healthcare system to the European environment.

Starmind: A Fuzzy Logic Knowledge-Based System for the Automated Classification of Stars in the MK System

NASA Astrophysics Data System (ADS)

Manteiga, M.; Carricajo, I.; Rodríguez, A.; Dafonte, C.; Arcay, B.

2009-02-01

Astrophysics is evolving toward a more rational use of costly observational data by intelligently exploiting the large terrestrial and spatial astronomical databases. In this paper, we present a study showing the suitability of an expert system to perform the classification of stellar spectra in the Morgan and Keenan (MK) system. Using the formalism of artificial intelligence for the development of such a system, we propose a rules' base that contains classification criteria and confidence grades, all integrated in an inference engine that emulates human reasoning by means of a hierarchical decision rules tree that also considers the uncertainty factors associated with rules. Our main objective is to illustrate the formulation and development of such a system for an astrophysical classification problem. An extensive spectral database of MK standard spectra has been collected and used as a reference to determine the spectral indexes that are suitable for classification in the MK system. It is shown that by considering 30 spectral indexes and associating them with uncertainty factors, we can find an accurate diagnose in MK types of a particular spectrum. The system was evaluated against the NOAO-INDO-US spectral catalog.

New Classification of Focal Cortical Dysplasia: Application to Practical Diagnosis

PubMed Central

Bae, Yoon-Sung; Kang, Hoon-Chul; Kim, Heung Dong; Kim, Se Hoon

2012-01-01

Background and Purpose: Malformation of cortical development (MCD) is a well-known cause of drug-resistant epilepsy and focal cortical dysplasia (FCD) is the most common neuropathological finding in surgical specimens from drug-resistant epilepsy patients. Palmini’s classification proposed in 2004 is now widely used to categorize FCD. Recently, however, Blumcke et al. recommended a new system for classifying FCD in 2011. Methods: We applied the new classification system in practical diagnosis of a sample of 117 patients who underwent neurosurgical operations due to drug-resistant epilepsy at Severance Hospital in Seoul, Korea. Results: Among 117 cases, a total of 16 cases were shifted to other FCD subtypes under the new classification system. Five cases were reclassified to type IIIa and five cases were categorized as dual pathology. The other six cases were changed within the type I category. Conclusions: The most remarkable changes in the new classification system are the advent of dual pathology and FCD type III. Thus, it will be very important for pathologists and clinicians to discriminate between these new categories. More large-scale research needs to be conducted to elucidate the clinical influence of the alterations within the classification of type I disease. Although the new FCD classification system has several advantages compared to the former, the correlation with clinical characteristics is not yet clear. PMID:24649461

The First AO Classification System for Fractures of the Craniomaxillofacial Skeleton: Rationale, Methodological Background, Developmental Process, and Objectives

PubMed Central

Audigé, Laurent; Cornelius, Carl-Peter; Ieva, Antonio Di; Prein, Joachim

2014-01-01

Validated trauma classification systems are the sole means to provide the basis for reliable documentation and evaluation of patient care, which will open the gateway to evidence-based procedures and healthcare in the coming years. With the support of AO Investigation and Documentation, a classification group was established to develop and evaluate a comprehensive classification system for craniomaxillofacial (CMF) fractures. Blueprints for fracture classification in the major constituents of the human skull were drafted and then evaluated by a multispecialty group of experienced CMF surgeons and a radiologist in a structured process during iterative agreement sessions. At each session, surgeons independently classified the radiological imaging of up to 150 consecutive cases with CMF fractures. During subsequent review meetings, all discrepancies in the classification outcome were critically appraised for clarification and improvement until consensus was reached. The resulting CMF classification system is structured in a hierarchical fashion with three levels of increasing complexity. The most elementary level 1 simply distinguishes four fracture locations within the skull: mandible (code 91), midface (code 92), skull base (code 93), and cranial vault (code 94). Levels 2 and 3 focus on further defining the fracture locations and for fracture morphology, achieving an almost individual mapping of the fracture pattern. This introductory article describes the rationale for the comprehensive AO CMF classification system, discusses the methodological framework, and provides insight into the experiences and interactions during the evaluation process within the core groups. The details of this system in terms of anatomy and levels are presented in a series of focused tutorials illustrated with case examples in this special issue of the Journal. PMID:25489387

The First AO Classification System for Fractures of the Craniomaxillofacial Skeleton: Rationale, Methodological Background, Developmental Process, and Objectives.

PubMed

Audigé, Laurent; Cornelius, Carl-Peter; Di Ieva, Antonio; Prein, Joachim

2014-12-01

Validated trauma classification systems are the sole means to provide the basis for reliable documentation and evaluation of patient care, which will open the gateway to evidence-based procedures and healthcare in the coming years. With the support of AO Investigation and Documentation, a classification group was established to develop and evaluate a comprehensive classification system for craniomaxillofacial (CMF) fractures. Blueprints for fracture classification in the major constituents of the human skull were drafted and then evaluated by a multispecialty group of experienced CMF surgeons and a radiologist in a structured process during iterative agreement sessions. At each session, surgeons independently classified the radiological imaging of up to 150 consecutive cases with CMF fractures. During subsequent review meetings, all discrepancies in the classification outcome were critically appraised for clarification and improvement until consensus was reached. The resulting CMF classification system is structured in a hierarchical fashion with three levels of increasing complexity. The most elementary level 1 simply distinguishes four fracture locations within the skull: mandible (code 91), midface (code 92), skull base (code 93), and cranial vault (code 94). Levels 2 and 3 focus on further defining the fracture locations and for fracture morphology, achieving an almost individual mapping of the fracture pattern. This introductory article describes the rationale for the comprehensive AO CMF classification system, discusses the methodological framework, and provides insight into the experiences and interactions during the evaluation process within the core groups. The details of this system in terms of anatomy and levels are presented in a series of focused tutorials illustrated with case examples in this special issue of the Journal.

Automatic plankton image classification combining multiple view features via multiple kernel learning.

PubMed

Zheng, Haiyong; Wang, Ruchen; Yu, Zhibin; Wang, Nan; Gu, Zhaorui; Zheng, Bing

2017-12-28

Plankton, including phytoplankton and zooplankton, are the main source of food for organisms in the ocean and form the base of marine food chain. As the fundamental components of marine ecosystems, plankton is very sensitive to environment changes, and the study of plankton abundance and distribution is crucial, in order to understand environment changes and protect marine ecosystems. This study was carried out to develop an extensive applicable plankton classification system with high accuracy for the increasing number of various imaging devices. Literature shows that most plankton image classification systems were limited to only one specific imaging device and a relatively narrow taxonomic scope. The real practical system for automatic plankton classification is even non-existent and this study is partly to fill this gap. Inspired by the analysis of literature and development of technology, we focused on the requirements of practical application and proposed an automatic system for plankton image classification combining multiple view features via multiple kernel learning (MKL). For one thing, in order to describe the biomorphic characteristics of plankton more completely and comprehensively, we combined general features with robust features, especially by adding features like Inner-Distance Shape Context for morphological representation. For another, we divided all the features into different types from multiple views and feed them to multiple classifiers instead of only one by combining different kernel matrices computed from different types of features optimally via multiple kernel learning. Moreover, we also applied feature selection method to choose the optimal feature subsets from redundant features for satisfying different datasets from different imaging devices. We implemented our proposed classification system on three different datasets across more than 20 categories from phytoplankton to zooplankton. The experimental results validated that our system outperforms state-of-the-art plankton image classification systems in terms of accuracy and robustness. This study demonstrated automatic plankton image classification system combining multiple view features using multiple kernel learning. The results indicated that multiple view features combined by NLMKL using three kernel functions (linear, polynomial and Gaussian kernel functions) can describe and use information of features better so that achieve a higher classification accuracy.

Gender classification under extended operating conditions

NASA Astrophysics Data System (ADS)

Rude, Howard N.; Rizki, Mateen

2014-06-01

Gender classification is a critical component of a robust image security system. Many techniques exist to perform gender classification using facial features. In contrast, this paper explores gender classification using body features extracted from clothed subjects. Several of the most effective types of features for gender classification identified in literature were implemented and applied to the newly developed Seasonal Weather And Gender (SWAG) dataset. SWAG contains video clips of approximately 2000 samples of human subjects captured over a period of several months. The subjects are wearing casual business attire and outer garments appropriate for the specific weather conditions observed in the Midwest. The results from a series of experiments are presented that compare the classification accuracy of systems that incorporate various types and combinations of features applied to multiple looks at subjects at different image resolutions to determine a baseline performance for gender classification.

Classification of subsurface objects using singular values derived from signal frames

DOEpatents

Chambers, David H; Paglieroni, David W

2014-05-06

The classification system represents a detected object with a feature vector derived from the return signals acquired by an array of N transceivers operating in multistatic mode. The classification system generates the feature vector by transforming the real-valued return signals into complex-valued spectra, using, for example, a Fast Fourier Transform. The classification system then generates a feature vector of singular values for each user-designated spectral sub-band by applying a singular value decomposition (SVD) to the N.times.N square complex-valued matrix formed from sub-band samples associated with all possible transmitter-receiver pairs. The resulting feature vector of singular values may be transformed into a feature vector of singular value likelihoods and then subjected to a multi-category linear or neural network classifier for object classification.

48 CFR 952.204-70 - Classification/Declassification.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false Classification... Classification/Declassification. As prescribed in 904.404(d)(2), the following clause shall be included in all contracts which involve classified information: Classification/Declassification (SEP 1997) In the...

48 CFR 952.204-70 - Classification/Declassification.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 5 2013-10-01 2013-10-01 false Classification... Classification/Declassification. As prescribed in 904.404(d)(2), the following clause shall be included in all contracts which involve classified information: Classification/Declassification (SEP 1997) In the...

48 CFR 952.204-70 - Classification/Declassification.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 5 2012-10-01 2012-10-01 false Classification... Classification/Declassification. As prescribed in 904.404(d)(2), the following clause shall be included in all contracts which involve classified information: Classification/Declassification (SEP 1997) In the...

48 CFR 952.204-70 - Classification/Declassification.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false Classification... Classification/Declassification. As prescribed in 904.404(d)(2), the following clause shall be included in all contracts which involve classified information: Classification/Declassification (SEP 1997) In the...

48 CFR 952.204-70 - Classification/Declassification.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Classification... Classification/Declassification. As prescribed in 904.404(d)(2), the following clause shall be included in all contracts which involve classified information: Classification/Declassification (SEP 1997) In the...

Blastocyst classification systems used in Latin America: is a consensus possible?

PubMed Central

Puga-Torres, Tatiana; Blum-Rojas, Xavier; Blum-Narváez, Medardo

2017-01-01

Objective To identify different blastocyst classification systems used by embryologists in Latin American countries and evaluate the possibility of establishing a consensus among these countries. Methods An E-mail survey was carried out through the Latin American Network of Assisted Reproduction (REDLARA) aimed at embryologists from assisted reproduction centers in Latin countries. Results Sixty surveys were collected from 12 Latin American countries, of which 66.7% had >10years of professional practice as embryologists. Seven different blastocyst classification systems were reported, of which 5 have previously been described in the literature. Conclusion Although the group of embryologists surveyed use different blastocyst classification systems, most in this group consider that the embryo score system should be unified in their countries as well as in the region. PMID:28837032

Arrhythmia Classification Based on Multi-Domain Feature Extraction for an ECG Recognition System.

PubMed

Li, Hongqiang; Yuan, Danyang; Wang, Youxi; Cui, Dianyin; Cao, Lu

2016-10-20

Automatic recognition of arrhythmias is particularly important in the diagnosis of heart diseases. This study presents an electrocardiogram (ECG) recognition system based on multi-domain feature extraction to classify ECG beats. An improved wavelet threshold method for ECG signal pre-processing is applied to remove noise interference. A novel multi-domain feature extraction method is proposed; this method employs kernel-independent component analysis in nonlinear feature extraction and uses discrete wavelet transform to extract frequency domain features. The proposed system utilises a support vector machine classifier optimized with a genetic algorithm to recognize different types of heartbeats. An ECG acquisition experimental platform, in which ECG beats are collected as ECG data for classification, is constructed to demonstrate the effectiveness of the system in ECG beat classification. The presented system, when applied to the MIT-BIH arrhythmia database, achieves a high classification accuracy of 98.8%. Experimental results based on the ECG acquisition experimental platform show that the system obtains a satisfactory classification accuracy of 97.3% and is able to classify ECG beats efficiently for the automatic identification of cardiac arrhythmias.

Arrhythmia Classification Based on Multi-Domain Feature Extraction for an ECG Recognition System

PubMed Central

Li, Hongqiang; Yuan, Danyang; Wang, Youxi; Cui, Dianyin; Cao, Lu

2016-01-01

Automatic recognition of arrhythmias is particularly important in the diagnosis of heart diseases. This study presents an electrocardiogram (ECG) recognition system based on multi-domain feature extraction to classify ECG beats. An improved wavelet threshold method for ECG signal pre-processing is applied to remove noise interference. A novel multi-domain feature extraction method is proposed; this method employs kernel-independent component analysis in nonlinear feature extraction and uses discrete wavelet transform to extract frequency domain features. The proposed system utilises a support vector machine classifier optimized with a genetic algorithm to recognize different types of heartbeats. An ECG acquisition experimental platform, in which ECG beats are collected as ECG data for classification, is constructed to demonstrate the effectiveness of the system in ECG beat classification. The presented system, when applied to the MIT-BIH arrhythmia database, achieves a high classification accuracy of 98.8%. Experimental results based on the ECG acquisition experimental platform show that the system obtains a satisfactory classification accuracy of 97.3% and is able to classify ECG beats efficiently for the automatic identification of cardiac arrhythmias. PMID:27775596

Automated radial basis function neural network based image classification system for diabetic retinopathy detection in retinal images

NASA Astrophysics Data System (ADS)

Anitha, J.; Vijila, C. Kezi Selva; Hemanth, D. Jude

2010-02-01

Diabetic retinopathy (DR) is a chronic eye disease for which early detection is highly essential to avoid any fatal results. Image processing of retinal images emerge as a feasible tool for this early diagnosis. Digital image processing techniques involve image classification which is a significant technique to detect the abnormality in the eye. Various automated classification systems have been developed in the recent years but most of them lack high classification accuracy. Artificial neural networks are the widely preferred artificial intelligence technique since it yields superior results in terms of classification accuracy. In this work, Radial Basis function (RBF) neural network based bi-level classification system is proposed to differentiate abnormal DR Images and normal retinal images. The results are analyzed in terms of classification accuracy, sensitivity and specificity. A comparative analysis is performed with the results of the probabilistic classifier namely Bayesian classifier to show the superior nature of neural classifier. Experimental results show promising results for the neural classifier in terms of the performance measures.

Systems Operation Studies for Automated Guideway Transit Systems - Classification and Definition of AGT Systems

DOT National Transportation Integrated Search

1980-02-01

The report describes the development of an AGT classification structure. Five classes are defined based on three system characteristics: service type, minimum travelling unit capacity, and maximum operating velocity. The five classes defined are: Per...

Development and initial validation of the Classification of Early-Onset Scoliosis (C-EOS).

PubMed

Williams, Brendan A; Matsumoto, Hiroko; McCalla, Daren J; Akbarnia, Behrooz A; Blakemore, Laurel C; Betz, Randal R; Flynn, John M; Johnston, Charles E; McCarthy, Richard E; Roye, David P; Skaggs, David L; Smith, John T; Snyder, Brian D; Sponseller, Paul D; Sturm, Peter F; Thompson, George H; Yazici, Muharrem; Vitale, Michael G

2014-08-20

Early-onset scoliosis is a heterogeneous condition, with highly variable manifestations and natural history. No standardized classification system exists to describe and group patients, to guide optimal care, or to prognosticate outcomes within this population. A classification system for early-onset scoliosis is thus a necessary prerequisite to the timely evolution of care of these patients. Fifteen experienced surgeons participated in a nominal group technique designed to achieve a consensus-based classification system for early-onset scoliosis. A comprehensive list of factors important in managing early-onset scoliosis was generated using a standardized literature review, semi-structured interviews, and open forum discussion. Three group meetings and two rounds of surveying guided the selection of classification components, subgroupings, and cut-points. Initial validation of the system was conducted using an interobserver reliability assessment based on the classification of a series of thirty cases. Nominal group technique was used to identify three core variables (major curve angle, etiology, and kyphosis) with high group content validity scores. Age and curve progression ranked slightly lower. Participants evaluated the cases of thirty patients with early-onset scoliosis for reliability testing. The mean kappa value for etiology (0.64) was substantial, while the mean kappa values for major curve angle (0.95) and kyphosis (0.93) indicated almost perfect agreement. The final classification consisted of a continuous age prefix, etiology (congenital or structural, neuromuscular, syndromic, and idiopathic), major curve angle (1, 2, 3, or 4), and kyphosis (-, N, or +) variables, and an optional progression modifier (P0, P1, or P2). Utilizing formal consensus-building methods in a large group of surgeons experienced in treating early-onset scoliosis, a novel classification system for early-onset scoliosis was developed with all core components demonstrating substantial to excellent interobserver reliability. This classification system will serve as a foundation to guide ongoing research efforts and standardize communication in the clinical setting. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

A Classification Scheme for Smart Manufacturing Systems’ Performance Metrics

PubMed Central

Lee, Y. Tina; Kumaraguru, Senthilkumaran; Jain, Sanjay; Robinson, Stefanie; Helu, Moneer; Hatim, Qais Y.; Rachuri, Sudarsan; Dornfeld, David; Saldana, Christopher J.; Kumara, Soundar

2017-01-01

This paper proposes a classification scheme for performance metrics for smart manufacturing systems. The discussion focuses on three such metrics: agility, asset utilization, and sustainability. For each of these metrics, we discuss classification themes, which we then use to develop a generalized classification scheme. In addition to the themes, we discuss a conceptual model that may form the basis for the information necessary for performance evaluations. Finally, we present future challenges in developing robust, performance-measurement systems for real-time, data-intensive enterprises. PMID:28785744

Use of an automatic procedure for determination of classes of land use in the Teste Araras area of the peripheral Paulist depression

NASA Technical Reports Server (NTRS)

Dejesusparada, N. (Principal Investigator); Lombardo, M. A.; Valeriano, D. D.

1981-01-01

An evaluation of the multispectral image analyzer (system Image 1-100), using automatic classification, is presented. The region studied is situated. The automatic was carried out using the maximum likelihood (MAXVER) classification system. The following classes were established: urban area, bare soil, sugar cane, citrus culture (oranges), pastures, and reforestation. The classification matrix of the test sites indicate that the percentage of correct classification varied between 63% and 100%.

Family Traits of Galaxies: From the Tuning Fork to a Physical Classification in a Multi-Wavelength Context

NASA Astrophysics Data System (ADS)

Rampazzo, Roberto; D'Onofrio, Mauro; Zaggia, Simone; Elmegreen, Debra M.; Laurikainen, Eija; Duc, Pierre-Alain; Gallart, Carme; Fraix-Burnet, Didier

At the time of the Great Debate nebulæ where recognized to have different morphologies and first classifications, sometimes only descriptive, have been attempted. A review of these early classification systems are well documented by the Allan Sandage's review in 2005 (Sandage 2005). This review emphasized the debt, in term of continuity of forms of spiral galaxies, due by the Hubble's classification scheme to the Reynold's systems proposed in 1920 (Reynolds, 1920).

46 CFR 56.04-2 - Piping classification according to service.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 2 2010-10-01 2010-10-01 false Piping classification according to service. 56.04-2... PIPING SYSTEMS AND APPURTENANCES Piping Classification § 56.04-2 Piping classification according to... Piping Classification Service Class 1 Pressure (p.s.i.g.) Temp. (°F) Class B and C poisons 2 I any and 0...

46 CFR 56.04-2 - Piping classification according to service.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 2 2011-10-01 2011-10-01 false Piping classification according to service. 56.04-2... PIPING SYSTEMS AND APPURTENANCES Piping Classification § 56.04-2 Piping classification according to... Piping Classification Service Class 1 Pressure (p.s.i.g.) Temp. (°F) Class B and C poisons 2 I any and 0...

48 CFR 1852.204-75 - Security classification requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false Security classification... and Clauses 1852.204-75 Security classification requirements. As prescribed in 1804.404-70, insert the following clause: Security Classification Requirements (SEP 1989) Performance under this contract will...

43 CFR 2450.3 - Proposed classification decision.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Proposed classification decision. 2450.3... MANAGEMENT, DEPARTMENT OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) PETITION-APPLICATION CLASSIFICATION SYSTEM Petition-Application Procedures § 2450.3 Proposed classification decision. (a) The State Director...

48 CFR 1852.204-75 - Security classification requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Security classification... and Clauses 1852.204-75 Security classification requirements. As prescribed in 1804.404-70, insert the following clause: Security Classification Requirements (SEP 1989) Performance under this contract will...

32 CFR 1602.13 - Judgmental Classification.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 6 2012-07-01 2012-07-01 false Judgmental Classification. 1602.13 Section 1602.13 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM DEFINITIONS § 1602.13 Judgmental Classification. A classification action relating to a registrant's claim for...

48 CFR 52.247-53 - Freight Classification Description.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 2 2012-10-01 2012-10-01 false Freight Classification....247-53 Freight Classification Description. As prescribed in 47.305-9(b)(1), insert the following... modifications of previously shipped items, and different freight classifications may apply: Freight...

32 CFR 1602.13 - Judgmental Classification.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 6 2013-07-01 2013-07-01 false Judgmental Classification. 1602.13 Section 1602.13 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM DEFINITIONS § 1602.13 Judgmental Classification. A classification action relating to a registrant's claim for...

32 CFR 1602.13 - Judgmental Classification.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 6 2014-07-01 2014-07-01 false Judgmental Classification. 1602.13 Section 1602.13 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM DEFINITIONS § 1602.13 Judgmental Classification. A classification action relating to a registrant's claim for...

48 CFR 52.247-53 - Freight Classification Description.

Code of Federal Regulations, 2014 CFR

2014-10-01

... modifications of previously shipped items, and different freight classifications may apply: Freight... 48 Federal Acquisition Regulations System 2 2014-10-01 2014-10-01 false Freight Classification....247-53 Freight Classification Description. As prescribed in 47.305-9(b)(1), insert the following...

48 CFR 52.247-53 - Freight Classification Description.

Code of Federal Regulations, 2013 CFR

2013-10-01

... modifications of previously shipped items, and different freight classifications may apply: Freight... 48 Federal Acquisition Regulations System 2 2013-10-01 2013-10-01 false Freight Classification....247-53 Freight Classification Description. As prescribed in 47.305-9(b)(1), insert the following...

32 CFR 1602.13 - Judgmental Classification.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 6 2010-07-01 2010-07-01 false Judgmental Classification. 1602.13 Section 1602.13 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM DEFINITIONS § 1602.13 Judgmental Classification. A classification action relating to a registrant's claim for...

48 CFR 52.247-53 - Freight Classification Description.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 2 2011-10-01 2011-10-01 false Freight Classification....247-53 Freight Classification Description. As prescribed in 47.305-9(b)(1), insert the following... modifications of previously shipped items, and different freight classifications may apply: Freight...

32 CFR 1602.13 - Judgmental Classification.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 6 2011-07-01 2011-07-01 false Judgmental Classification. 1602.13 Section 1602.13 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM DEFINITIONS § 1602.13 Judgmental Classification. A classification action relating to a registrant's claim for...

48 CFR 52.247-53 - Freight Classification Description.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Freight Classification....247-53 Freight Classification Description. As prescribed in 47.305-9(b)(1), insert the following... modifications of previously shipped items, and different freight classifications may apply: Freight...

10 CFR 1045.8 - Procedural exemptions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Classification. (b) A request for an exemption shall be made in writing to the Director of Classification and... DEPARTMENT OF ENERGY (GENERAL PROVISIONS) NUCLEAR CLASSIFICATION AND DECLASSIFICATION Program Management of the Restricted Data and Formerly Restricted Data Classification System § 1045.8 Procedural exemptions...

10 CFR 1045.8 - Procedural exemptions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Classification. (b) A request for an exemption shall be made in writing to the Director of Classification and... DEPARTMENT OF ENERGY (GENERAL PROVISIONS) NUCLEAR CLASSIFICATION AND DECLASSIFICATION Program Management of the Restricted Data and Formerly Restricted Data Classification System § 1045.8 Procedural exemptions...

77 FR 32111 - Privacy Act System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-31

... or fraud, or harm to the security or integrity of this system or other systems or programs (whether... to comment. FCC/MB-2 System Name: Broadcast Station Public Inspection Files. Security Classification: The FCC's Security Operations Center (SOC) has not assigned a security classification to this system...

A novel method to guide classification of para swimmers with limb deficiency.

PubMed

Hogarth, Luke; Payton, Carl; Van de Vliet, Peter; Connick, Mark; Burkett, Brendan

2018-05-30

The International Paralympic Committee has directed International Federations that govern Para sports to develop evidence-based classification systems. This study defined the impact of limb deficiency impairment on 100 m freestyle performance to guide an evidence-based classification system in Para Swimming, which will be implemented following the 2020 Tokyo Paralympic games. Impairment data and competitive race performances of 90 international swimmers with limb deficiency were collected. Ensemble partial least squares regression established the relationship between relative limb length measures and competitive 100 m freestyle performance. The model explained 80% of the variance in 100 m freestyle performance, and found hand length and forearm length to be the most important predictors of performance. Based on the results of this model, Para swimmers were clustered into four-, five-, six- and seven-class structures using nonparametric kernel density estimations. The validity of these classification structures, and effectiveness against the current classification system, were examined by establishing within-class variations in 100 m freestyle performance and differences between adjacent classes. The derived classification structures were found to be more effective than current classification based on these criteria. This study provides a novel method that can be used to improve the objectivity and transparency of decision-making in Para sport classification. Expert consensus from experienced coaches, Para swimmers, classifiers and sport science and medicine personnel will benefit the translation of these findings into a revised classification system that is accepted by the Para swimming community. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Overview of classification systems in peripheral artery disease.

PubMed

Hardman, Rulon L; Jazaeri, Omid; Yi, J; Smith, M; Gupta, Rajan

2014-12-01

Peripheral artery disease (PAD), secondary to atherosclerotic disease, is currently the leading cause of morbidity and mortality in the western world. While PAD is common, it is estimated that the majority of patients with PAD are undiagnosed and undertreated. The challenge to the treatment of PAD is to accurately diagnose the symptoms and determine treatment for each patient. The varied presentations of peripheral vascular disease have led to numerous classification schemes throughout the literature. Consistent grading of patients leads to both objective criteria for treating patients and a baseline for clinical follow-up. Reproducible classification systems are also important in clinical trials and when comparing medical, surgical, and endovascular treatment paradigms. This article reviews the various classification systems for PAD and advantages to each system.

Classification of maxillectomy defects: a systematic review and criteria necessary for a universal description.

PubMed

Bidra, Avinash S; Jacob, Rhonda F; Taylor, Thomas D

2012-04-01

Maxillectomy defects are complex and involve a number of anatomic structures. Several maxillectomy defect classifications have been proposed with no universal acceptance among surgeons and prosthodontists. Established criteria for describing the maxillectomy defect are lacking. This systematic review aimed to evaluate classification systems in the available literature, to provide a critical appraisal, and to identify the criteria necessary for a universal description of maxillectomy and midfacial defects. An electronic search of the English language literature between the periods of 1974 and June 2011 was performed by using PubMed, Scopus, and Cochrane databases with predetermined inclusion criteria. Key terms included in the search were maxillectomy classification, maxillary resection classification, maxillary removal classification, maxillary reconstruction classification, midfacial defect classification, and midfacial reconstruction classification. This was supplemented by a manual search of selected journals. After application of predetermined exclusion criteria, the final list of articles was reviewed in-depth to provide a critical appraisal and identify criteria for a universal description of a maxillectomy defect. The electronic database search yielded 261 titles. Systematic application of inclusion and exclusion criteria resulted in identification of 14 maxillectomy and midfacial defect classification systems. From these articles, 6 different criteria were identified as necessary for a universal description of a maxillectomy defect. Multiple deficiencies were noted in each classification system. Though most articles described the superior-inferior extent of the defect, only a small number of articles described the anterior-posterior and medial-lateral extent of the defect. Few articles listed dental status and soft palate involvement when describing maxillectomy defects. No classification system has accurately described the maxillectomy defect, based on criteria that satisfy both surgical and prosthodontic needs. The 6 criteria identified in this systematic review for a universal description of a maxillectomy defect are: 1) dental status; 2) oroantral/nasal communication status; 3) soft palate and other contiguous structure involvement; 4) superior-inferior extent; 5) anterior-posterior extent; and 6) medial-lateral extent of the defect. A criteria-based description appears more objective and amenable for universal use than a classification-based description. Copyright © 2012 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.

Discriminant forest classification method and system

DOEpatents

Chen, Barry Y.; Hanley, William G.; Lemmond, Tracy D.; Hiller, Lawrence J.; Knapp, David A.; Mugge, Marshall J.

2012-11-06

A hybrid machine learning methodology and system for classification that combines classical random forest (RF) methodology with discriminant analysis (DA) techniques to provide enhanced classification capability. A DA technique which uses feature measurements of an object to predict its class membership, such as linear discriminant analysis (LDA) or Andersen-Bahadur linear discriminant technique (AB), is used to split the data at each node in each of its classification trees to train and grow the trees and the forest. When training is finished, a set of n DA-based decision trees of a discriminant forest is produced for use in predicting the classification of new samples of unknown class.

Natural fracture systems on planetary surfaces: Genetic classification and pattern randomness

NASA Technical Reports Server (NTRS)

Rossbacher, Lisa A.

1987-01-01

One method for classifying natural fracture systems is by fracture genesis. This approach involves the physics of the formation process, and it has been used most frequently in attempts to predict subsurface fractures and petroleum reservoir productivity. This classification system can also be applied to larger fracture systems on any planetary surface. One problem in applying this classification system to planetary surfaces is that it was developed for ralatively small-scale fractures that would influence porosity, particularly as observed in a core sample. Planetary studies also require consideration of large-scale fractures. Nevertheless, this system offers some valuable perspectives on fracture systems of any size.

On the use of administrative databases to support planning activities: the case of the evaluation of neonatal case-mix in the Emilia-Romagna region using DRG and APR-DRG classification systems.

PubMed

Fantini, M P; Cisbani, L; Manzoli, L; Vertrees, J; Lorenzoni, L

2003-06-01

There are several versions of the Diagnosis Related Group (DRG) classification systems that are used for case-mix analysis, utilization review, prospective payment, and planning applications. The objective of this study was to assess the adequacy of two of these DRG systems--Medicare DRG and All Patient Refined DRG--to classify neonatal patients. The first part of the paper contains a descriptive analysis that outlines the major differences between the two systems in terms of classification logic and variables used in the assignment process. The second part examines the statistical performance of each system on the basis of the administrative data collected in all public hospitals of the Emilia-Romagna region relating to neonates discharged in 1997 and 1998. The Medicare DRG are less developed in terms of classification structure and yield a poorer statistical performance in terms of reduction in variance for length of stay. This is important because, for specific areas, a more refined system can prove useful at regional level to remove systematic biases in the measurement of case-mix due to the structural characteristics of the Medicare DRGs classification system.

The Self-Directed Violence Classification System and the Columbia Classification Algorithm for Suicide Assessment: A Crosswalk

ERIC Educational Resources Information Center

Matarazzo, Bridget B.; Clemans, Tracy A.; Silverman, Morton M.; Brenner, Lisa A.

2013-01-01

The lack of a standardized nomenclature for suicide-related thoughts and behaviors prompted the Centers for Disease Control and Prevention, with the Veterans Integrated Service Network 19 Mental Illness Research Education and Clinical Center, to create the Self-Directed Violence Classification System (SDVCS). SDVCS has been adopted by the…

Development of an ecological classification system for the Wayne National Forest

Treesearch

David M. Hix; Andrea M. Chech

1993-01-01

In 1991, a collaborative research project was initiated to create an ecological classification system for the Wayne National Forest of southeastern Ohio. The work focuses on the ecological land type (ELT) level of ecosystem classification. The most common ELTs are being identified and described using information from intensive field sampling and multivariate data...

The 2010 Standard Occupational Classification (SOC): A Classification System Gets an Update

ERIC Educational Resources Information Center

Emmel, Alissa; Cosca, Theresa

2010-01-01

Making sense of occupational data isn't always easy. But the task is less daunting when the data are well organized. For Federal occupational statistics, the Standard Occupational Classification (SOC) system establishes that organization. And a recent revision to the SOC means that the data will be current, in addition to being well organized. The…

Classification systems for causes of stillbirth and neonatal death, 2009-2014: an assessment of alignment with characteristics for an effective global system.

PubMed

Leisher, Susannah Hopkins; Teoh, Zheyi; Reinebrant, Hanna; Allanson, Emma; Blencowe, Hannah; Erwich, Jan Jaap; Frøen, J Frederik; Gardosi, Jason; Gordijn, Sanne; Gülmezoglu, A Metin; Heazell, Alexander E P; Korteweg, Fleurisca; Lawn, Joy; McClure, Elizabeth M; Pattinson, Robert; Smith, Gordon C S; Tunçalp, Ӧzge; Wojcieszek, Aleena M; Flenady, Vicki

2016-09-15

To reduce the burden of 5.3 million stillbirths and neonatal deaths annually, an understanding of causes of deaths is critical. A systematic review identified 81 systems for classification of causes of stillbirth (SB) and neonatal death (NND) between 2009 and 2014. The large number of systems hampers efforts to understand and prevent these deaths. This study aimed to assess the alignment of current classification systems with expert-identified characteristics for a globally effective classification system. Eighty-one classification systems were assessed for alignment with 17 characteristics previously identified through expert consensus as necessary for an effective global system. Data were extracted independently by two authors. Systems were assessed against each characteristic and weighted and unweighted scores assigned to each. Subgroup analyses were undertaken by system use, setting, type of death included and type of characteristic. None of the 81 systems were aligned with more than 9 of the 17 characteristics; most (82 %) were aligned with four or fewer. On average, systems were aligned with 19 % of characteristics. The most aligned system (Frøen 2009-Codac) still had an unweighted score of only 9/17. Alignment with individual characteristics ranged from 0 to 49 %. Alignment was somewhat higher for widely used as compared to less used systems (22 % v 17 %), systems used only in high income countries as compared to only in low and middle income countries (20 % vs 16 %), and systems including both SB and NND (23 %) as compared to NND-only (15 %) and SB-only systems (13 %). Alignment was higher with characteristics assessing structure (23 %) than function (15 %). There is an unmet need for a system exhibiting all the characteristics of a globally effective system as defined by experts in the use of systems, as none of the 81 contemporary classification systems assessed was highly aligned with these characteristics. A particular concern in terms of global effectiveness is the lack of alignment with "ease of use" among all systems, including even the most-aligned. A system which meets the needs of users would have the potential to become the first truly globally effective classification system.

Global Stress Classification System for Materials Used in Solar Energy Applications

NASA Astrophysics Data System (ADS)

Slamova, Karolina; Schill, Christian; Herrmann, Jan; Datta, Pawan; Chih Wang, Chien

2016-08-01

Depending on the geographical location, the individual or combined impact of environmental stress factors and corresponding performance losses for solar applications varies significantly. Therefore, as a strategy to reduce investment risks and operating and maintenance costs, it is necessary to adapt the materials and components of solar energy systems specifically to regional environmental conditions. The project «GloBe Solar» supports this strategy by focusing on the development of a global stress classification system for materials in solar energy applications. The aim of this classification system is to assist in the identification of the individual stress conditions for every location on the earth's surface. The stress classification system could serve as a decision support tool for the industry (manufacturers, investors, lenders and project developers) and help to improve knowledge and services that can provide higher confidence to solar power systems.