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New definitions of 6 clinical signs of perceptual disorder in children with cerebral palsy: an observational study through reliability measures
No full textBACKGROUND: Recently authors have begun to emphasize the non-motor aspects of Cerebral Palsy and their influence on motor control and recovery prognosis. Much has been written about single clinical signs (i.e., startle reaction) but so far no definitions of the six perceptual signs presented in this study have appeared in literature.
AIM: This study defines 6 signs (startle reaction, upper limbs in startle position, frequent eye blinking, posture freezing, averted eye gaze, grimacing) suggestive of perceptual disorders in children with cerebral palsy and measures agreement on sign recognition among independent observers and consistency of opinions over time.
DESIGN: Observational study with both cross-sectional and prospective components.
SETTING: Fifty-six videos presented to observers in random order. Videos were taken from 19 children with a bilateral form of cerebral palsy referred to the Children Rehabilitation Unit in Reggio Emilia.
PARTICIPANTS: Thirty-five rehabilitation professionals from all over Italy: 9 doctors and 26 physiotherapists.
METHODS: Measure of agreement among 35 independent observers was compiled from a sample of 56 videos. Interobserver reliability was determined using the K index of Fleiss and reliability intra-observer was calculated by the Spearman correlation index between ranks (rho - ρ). Percentage of agreement between observers and Gold Standard was used as criterion validity.
RESULTS: Interobserver reliability was moderate for startle reaction, upper limb in startle position, adverted eye gaze and eye-blinking and fair for posture freezing and grimacing. Intraobserver reliability remained consistent over time. Criterion validity revealed very high agreement between independent observer evaluation and gold standard.
CONCLUSIONS: Semiotics of perceptual disorders can be used as a specific and sensitive instrument in order to identify a new class of patients within existing heterogeneous clinical types of bilateral cerebral palsy forms and could help clinicians in identifying functional prognosis.
CLINICAL REHABILITATION IMPACT: To provide clinicians with a definition of 6 clinical signs found in children with cerebral palsy in routine rehabilitation settings. Future research should explore the link between these signs and motor prognosis (i.e., time to independent walking)
Spalla in...Stabile L’importanza dell’articolazione scapolo-toracica nella riabilitazione delle sindromi conflittuali di spalla degli sportivi
No full text
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Perception disorder: how to identify it in children with spastic diplegia.
No full textINTRODUCTION
It is well known that “movement and perception are the two sides of the same coin in Cerebral Palsy (CP)”. In PC, the alteration of perceptive system represents a crucial element for “palsy development”. Central Nervous System (CNS) isn’t able to collect, elaborate, and integrate sensitive and sensorial information to obtain representations that are coherent among them and corresponding to reality[1]. In particular the altered process of collimation between visual and proprioceptive information may produce visual-kinestesic conflict. In children with CP this is mainly expressed through intolerance to movement, emptiness and depth. It is has been surveyed that in diplegic population, the biggest group in CP, perception disorder influences in a determining way functional abilities, in particular motor autonomy and walking quality[2]. The recognition of this perception disorder represents a basic preliminary assumption for a correct diagnostic framing and for the statement of the most appropriate rehabilitation goals and choices. This study intends to research one or more pathognomonic signs of this pathologic pattern in order to identify the perception disorder in a simple, not invasive setting, easy to be applied in territorial services. From data collected in past observations, the startle resulted as one of the most recurring signs. Therefore we want to investigate its presence in a population of diplegic children walking without support and to verify if it is a pathognomonic sign of perception disorder for the group of selected patients.
METHODS
This is a retrospective blind-randomized study.
We evaluated 41 videos, realised with standard modalities, showing children with spastic diplegia while they are walking. Video are randomly selected among those of patients followed at Child Rehabilitation in RE. The inclusion criteria were: spastic diplegia supported by MRI, age between 5 and 15 years old, no surgical intervention since at least one year and no botulinum injection since at least 6 months, walking without support.
Then the studied population was divided into two groups through video observation of walking. Group A is composed of subjects presenting clinic sign of startle during the march, while Group B by subjects not showing that sign. According to the information regarding the perception disorder found in clinical documentation (realised by gold standard) the sample studied has been divided again into two groups: children with (Group C) or without (Group D) perception disorder.
To identify the importance of the startle clinic sign during walk, we evaluated whether Group A corresponded to Group C and Group B to Group D. We defined motor autonomy level of 41 patients according to the Palisano et al. classification [GMFCS] to assess the possible correlation between this one and the perception disorder.
RESULTS
Among the 14 patients, whose documentation reported the presence of perception disorder (Group C), the 100% shows startle reaction during walk without support. Among the 27 patients without disorder (Group D), only one subject has startle (3,7%). Among subjects of Group C, 6 patients out of 14 (42,86%) belong to level II of GMFCS and the remaining 8 (57,14%) to level III. In Group D, 17 children belong to level I of GMFCS (62,96%) and the remaining 10 to level II (37,04%).
DISCUSSION
Thanks to the results obtained, it is possible to assert that startle represents a pathognomonic sign of perception disorder for population able to walk without support.
It is interesting to underline how clinical documentation of the only subject from group D presenting startle during walk, highlights previous signs of perception disorder which were not relevant in the last years.
The importance of recognizing perception disorder is once again confirmed by the results regarding GMFCS. The presence of the disorder influences in a negative way motor autonomy and its identification is therefore necessary for..
Construct Validity of the Activities Scale for Kids Performance in Children with Cerebral Palsy: Brief Report
Full text linkAims: This study collects evidence of construct convergent validity of the Activity Scale for Kids performance (ASKp), comparing its results with the 66-item Gross Motor Function Measure (GMFM-66) and with the Gross Motor Function Classification System (GMFCS) and testing the ASKp’s ability to discriminate between individuals with different functional capabilities. Methods: This cross-sectional study involved 60 children with spastic cerebral palsy (CP) assessed with the GMFM-66 who self-administered the Italian version of the ASKp. Results: Children were 10.9 (±3) years old with GMFCS Level I–III. Moderate correlations were found between GMFM and ASKp scores (r = 0.577; p < .001), and between GMFCS levels and ASKp score (rs = −0.541, p < .001). The ASKp discriminated between children with different functional capabilities, determined by the GMFCS (F = 18.2, p < .001). Conclusions: ASKp is valid to assess physical functioning, a crucial domain in rehabilitation of children with spastic CP. Trial registration: ClinicalTrials.gov Identifier: NCT03325842
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
The term diplegia should be enhanced. Part I: a new rehabilitation oriented classification of cerebral palsy
No full textThe classification systems for cerebral palsy (CP) need to be continuously
updated, according to specific aims and to significant changes observed over the
years in the panorama of CP. A simplification of CP categories, abandoning the
use of the term diplegia, has been recently suggested. Conversely, in this paper
a new proposal for classification of CP is briefly presented, where special
attention is given to diplegia which is suggested to be divided into four main
clinical forms, according to the patterns of walking observable in these
subjects. The proposed classification was applied to a large population of 213
subjects with diplegia, among 467 cases of CP admitted to two reference centres
for this disorder. The relative incidence of the four forms is reported. The
adopted classification criteria, based on a primary ability of professionals
working in rehabilitation, i.e. observation capacity, makes this approach simple
and easy to use at all levels of the rehabilitation services for CP
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Perception disorder: how to identify it in children with spastic diplegia
No full textINTRODUCTION
It is well known that “movement and perception are the two sides of the same coin in Cerebral Palsy (CP)”. In PC, the alteration of perceptive system represents a crucial element for “palsy development”. Central Nervous System (CNS) isn’t able to collect, elaborate, and integrate sensitive and sensorial information to obtain representations that are coherent among them and corresponding to reality[1]. In particular the altered process of collimation between visual and proprioceptive information may produce visual-kinestesic conflict. In children with CP this is mainly expressed through intolerance to movement, emptiness and depth. It is has been surveyed that in diplegic population, the biggest group in CP, perception disorder influences in a determining way functional abilities, in particular motor autonomy and walking quality[2]. The recognition of this perception disorder represents a basic preliminary assumption for a correct diagnostic framing and for the statement of the most appropriate rehabilitation goals and choices. This study intends to research one or more pathognomonic signs of this pathologic pattern in order to identify the perception disorder in a simple, not invasive setting, easy to be applied in territorial services. From data collected in past observations, the startle resulted as one of the most recurring signs. Therefore we want to investigate its presence in a population of diplegic children walking without support and to verify if it is a pathognomonic sign of perception disorder for the group of selected patients.
METHODS
This is a retrospective blind-randomized study.
We evaluated 41 videos, realised with standard modalities, showing children with spastic diplegia while they are walking. Video are randomly selected among those of patients followed at Child Rehabilitation in RE. The inclusion criteria were: spastic diplegia supported by MRI, age between 5 and 15 years old, no surgical intervention since at least one year and no botulinum injection since at least 6 months, walking without support.
Then the studied population was divided into two groups through video observation of walking. Group A is composed of subjects presenting clinic sign of startle during the march, while Group B by subjects not showing that sign. According to the information regarding the perception disorder found in clinical documentation (realised by gold standard) the sample studied has been divided again into two groups: children with (Group C) or without (Group D) perception disorder.
To identify the importance of the startle clinic sign during walk, we evaluated whether Group A corresponded to Group C and Group B to Group D. We defined motor autonomy level of 41 patients according to the Palisano et al. classification [GMFCS] to assess the possible correlation between this one and the perception disorder.
RESULTS
Among the 14 patients, whose documentation reported the presence of perception disorder (Group C), the 100% shows startle reaction during walk without support. Among the 27 patients without disorder (Group D), only one subject has startle (3,7%). Among subjects of Group C, 6 patients out of 14 (42,86%) belong to level II of GMFCS and the remaining 8 (57,14%) to level III. In Group D, 17 children belong to level I of GMFCS (62,96%) and the remaining 10 to level II (37,04%).
DISCUSSION
Thanks to the results obtained, it is possible to assert that startle represents a pathognomonic sign of perception disorder for population able to walk without support.
It is interesting to underline how clinical documentation of the only subject from group D presenting startle during walk, highlights previous signs of perception disorder which were not relevant in the last years.
The importance of recognizing perception disorder is once again confirmed by the results regarding GMFCS. The presence of the disorder influences in a negative way motor autonomy and its identification is therefore necessary for..
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