Journal of Developmental and Behavioral Pediatrics, Oct 1, 2008
The &... more The "Prone to Play" campaign was proposed and has been ongoing since 2001, but the causal and dosage effects of wakeful prone positioning on motor development are still unclear. The purpose of this longitudinal cohort study was to investigate the effects of prone wakeful positioning at 3 to 6 months of age on motor development during the 6 to 24 months age bracket. Two hundred eighty-eight full-term newborns were recruited at birth and followed up at 4, 6, 12, and 24 months of age respectively. Data on experience, duration, and preference of prone wakeful positioning were collected at 4 and 6 months of age. The acquisition ages of prone specific and nonprone milestones were collected and analyzed to evaluate the impact of wakeful prone positioning on motor development during early life. Gross motor developmental quotients (GMDQ) and fine motor developmental quotients (FMDQ) of the Comprehensive Developmental Inventory for Infants and Toddlers were assessed at ages 6 and 24 months. The prone duration significantly affected the acquisition ages of 3 prone specific milestones (rolling, crawling-on-abdomen, crawling-on-all-fours) and sitting; without affecting the other 2 nonprone specific milestones (walking and transferring objects), GMDQs and FMDQs. The infants of prone preference achieved prone specific milestones earlier than those of nonprone preference. The prone experience affected the crawling-on-abdomen acquisition age, but not the other motor outcomes. Wakeful prone positioning promotes prone-specific motor milestones in early infancy. "Prone to play for a certain amount of time in an interactive and supervised environment" might be advocated.
Purpose: Muscle strength plays an important role in the motor function of children with cerebral ... more Purpose: Muscle strength plays an important role in the motor function of children with cerebral palsy (CP). The information about the prerequisites for muscle strength measurement methods, validity and reliability, however, are lacking in children with CP. The purpose of this study, therefore, was to examine the reliability of muscle strength measurement with a Nicholas Manual Muscle Tester (NMMT) in children with CP and non-disabled (ND) children. Subjects: Twenty children with spastic CP and 30 ND children ages 6 to 12 years participated. Methods: The intrasession, intersession, and interrater reliability were analyzed with intraclass correlation coefficient (ICC (2,1)) for 12 muscle groups. Results: The intrasession reliability was good (ICC=0.83-0.98) in both groups. The intersession reliability was good in ND children (ICC=075-0.98), and moderate to good in children with CP (ICC=0.60-0.94), except for the elbow extensors and hip adductors. The interrater reliability was moderate to good in both groups (ICC=0.62-0.97), except for the shoulder abductors and extensors, elbow extensors and hip extensors in children with CP. Conclusion: The NMMT is reliable in testing muscle strength of non-disabled children and children with CP.
”Participation” in life experiences for school children is important for the development of psych... more ”Participation” in life experiences for school children is important for the development of psychological, emotional and physical skills. Children at school age may face a transition from preschool to school settings, or from home to community contexts that generate change in life experiences. Especially for school children with disabilities, full participation in home, school, and community is the ultimate outcome for developing rehabilitation and education plans. The International Classification of Functioning, Disabilities and Health (ICF) and its child and youth version (ICF-CY) define participation as ”involvement in a life situation”. However, participation of children has been defined with varied terms and multiple perspectives across measurement tools. Therefore, this review synthesized participation measures by 3 constructs (”Capability”, Performance”, and ”Subjective experience”) with the aim to operationally define ”Participation” for children at school age. The reviewed measures for participation were linked to the three constructs and corresponding measurable dimensions. Dependent on aim for assessment professionals can use the measures for specific dimensions to support children's participation by identifying participation related environmental problems, and for setting goals in collaboration with teachers and families.
背景與目的:「國際健康功能與身心障礙分類系統」(International Classification of Functioning, Disability and Health,簡稱ICF)... more 背景與目的:「國際健康功能與身心障礙分類系統」(International Classification of Functioning, Disability and Health,簡稱ICF)強調活動與參與是健康情形和情境因素互動的結果,本先導研究之目的為:以ICF架構提出動作發展遲緩幼兒的粗大動作功能狀況之相關因子並驗證其關聯性。方法:橫斷式研究,以方便取樣徵召130個有6~24個月臨界或確診動作發展遲緩幼兒的家庭,將兒童的身體功能與粗大動作活動與參與(靜態姿勢維持能力、基本移動能力及功能性移動能力)作為依變項,以健康情形為自變項,環境因素與身體功能作為中介變項,分別建構3個中介模型,再採用多重中介模型驗證各個ICF成分間的中介路徑。結果:模式指出健康情形(動作遲緩程度)可直接或間接經由身體功能(精熟動機、肌肉力量、肌肉張力、動作反應)中介因子預測粗大動作活動與參與,而家長知覺的需求滿足程度是健康情形與身體功能間唯一顯著的中介環境變項。結論:幼兒期的部分身體功能及環境因素是粗大動作功能狀況的中介變項,此模式可作為早期介入之決策參考,然因果關係有待進一步研究。
Social participation involves forming and maintaining social relationships through interactions w... more Social participation involves forming and maintaining social relationships through interactions with others during daily activities and is supported by accessible environments. Youth with physical disabilities experience increased challenges in social participation given their difficulties in mobility, communication and socialization. Restrictions in social participation may increase their difficulties associated with successful transition to adult life. Knowledge of factors that are facilitators or barriers to social participation is limited in youth with physical disabilities. This review appraised research evidence on multiple determinants that affect social participation based on the framework of the International Classification of Functioning, Disability and Health (ICF) and its children/youth version (ICF-CY). Knowledge of determinants of social participation should help therapists better understand factors pertain to body functions and structures and activity, as well as personal and environmental factors associated with higher social participation. An important role of physical therapists is to provide support and services, or to remove barriers, that will facilitate youth's engagement in community social life and contribution to society. The findings will have implications for providing youth- and family-centered services that support youths in achieving their goals for social participation and community integration.
Background Caregiver engagement and collaborative team early childhood intervention (ECI) service... more Background Caregiver engagement and collaborative team early childhood intervention (ECI) services are international trends; however, relevant evidence of collaborative home-visiting ECI in rural areas is as yet undetermined. Objective The study aimed to investigate the effectiveness of a collaborative ECI program in a rural area of Taiwan. Design The study was a pilot randomized control led trial. Methods Children aged 6 to 33 months experiencing motor delays and their caregivers were enrolled in Taitung, Taiwan. Using stratified randomization, 24 participants were allocated to either experimental or control groups, and both received 5 home visits within 3 months. The experimental group received ECI services based on the International Classification of Functioning, Disability and Health framework and family-centered approaches. The control group received regular home visits by local social workers. Child outcomes included Pediatric Evaluation of Disability Inventory Chinese Version...
Developmental Medicine & Child Neurology, Mar 22, 2022
AimThis study evaluated the performance of children with learning problems in Taiwan by using the... more AimThis study evaluated the performance of children with learning problems in Taiwan by using the Taiwan Data Bank of Persons with Disability.MethodWe included 3854 children (2343 males, 1511 females; mean [SD] age 9y 11mo [2y 4mo]) with specific learning disorder (SLD), attention‐deficit/hyperactivity disorder (ADHD), autism, epilepsy, or intellectual disabilities for analysis. We used the Functioning Scale of the Disability Evaluation System‐Child version to investigate performance at follow‐up for at least 3 years.ResultsThese participants demonstrated improvement across all the domains of the International Classification of Functioning, Health, and Disability including for mobility, learning, social participation, and daily living. The children with SLD (p=0.3) and epilepsy (p=0.442) did not demonstrate significant improvement in learning, whereas those with ADHD (p<0.001), autism (p<0.001), and intellectual disabilities (p<0.001) did. The children with epilepsy displayed the most impairment and least improvement.InterpretationThis cross‐diagnostic study of learning problems indicated the children with autism or ADHD received more structural education. However, education strategies for those with SLD or epilepsy required improvement. Finally, SLD is possibly underdiagnosed in children, and children with epilepsy are affected in multiple aspects.What this paper adds Specific learning disorder (SLD), ADHD, autism, epilepsy, and intellectual disability can cause learning problems in children. Children with ADHD and autism showed more improvement in academic performance. SLD has been neglected and underdiagnosed, resulting in poor improvement. Children with epilepsy have multiple impairments and exhibited minimal improvement.
The Child and Adolescent Factors Inventory (CAFI) is a parent-report measure that assesses type a... more The Child and Adolescent Factors Inventory (CAFI) is a parent-report measure that assesses type and severity of impairments experienced by children and youth with a range of disabling conditions. The CAFI was translated from English into Traditional Chinese (CAFI-C) and has been used in the Disability Evaluation System (DES) in Taiwan. The aim of this study was to validate the use of the CAFI-C in the DES. Participants included 18,119 children and youth with disabilities between the ages of 6.0-17.9 (Mean=11.6; SD=3.46). The factor structure, internal consistency, convergent validity, and discriminant (known groups) validity were examined. The results indicated that the CAFI-C had a two-factor structure (Mental/speech and Physical/sensory impairment) that explained 54.3% of the variance, and had adequate internal consistency (α=0.80-0.90). Children and youth with higher CAFI-C scores had significantly more participation restrictions and environment barriers. CAFI-C scores were signi...
Journal of Developmental and Behavioral Pediatrics, Oct 1, 2008
The &... more The "Prone to Play" campaign was proposed and has been ongoing since 2001, but the causal and dosage effects of wakeful prone positioning on motor development are still unclear. The purpose of this longitudinal cohort study was to investigate the effects of prone wakeful positioning at 3 to 6 months of age on motor development during the 6 to 24 months age bracket. Two hundred eighty-eight full-term newborns were recruited at birth and followed up at 4, 6, 12, and 24 months of age respectively. Data on experience, duration, and preference of prone wakeful positioning were collected at 4 and 6 months of age. The acquisition ages of prone specific and nonprone milestones were collected and analyzed to evaluate the impact of wakeful prone positioning on motor development during early life. Gross motor developmental quotients (GMDQ) and fine motor developmental quotients (FMDQ) of the Comprehensive Developmental Inventory for Infants and Toddlers were assessed at ages 6 and 24 months. The prone duration significantly affected the acquisition ages of 3 prone specific milestones (rolling, crawling-on-abdomen, crawling-on-all-fours) and sitting; without affecting the other 2 nonprone specific milestones (walking and transferring objects), GMDQs and FMDQs. The infants of prone preference achieved prone specific milestones earlier than those of nonprone preference. The prone experience affected the crawling-on-abdomen acquisition age, but not the other motor outcomes. Wakeful prone positioning promotes prone-specific motor milestones in early infancy. "Prone to play for a certain amount of time in an interactive and supervised environment" might be advocated.
Purpose: Muscle strength plays an important role in the motor function of children with cerebral ... more Purpose: Muscle strength plays an important role in the motor function of children with cerebral palsy (CP). The information about the prerequisites for muscle strength measurement methods, validity and reliability, however, are lacking in children with CP. The purpose of this study, therefore, was to examine the reliability of muscle strength measurement with a Nicholas Manual Muscle Tester (NMMT) in children with CP and non-disabled (ND) children. Subjects: Twenty children with spastic CP and 30 ND children ages 6 to 12 years participated. Methods: The intrasession, intersession, and interrater reliability were analyzed with intraclass correlation coefficient (ICC (2,1)) for 12 muscle groups. Results: The intrasession reliability was good (ICC=0.83-0.98) in both groups. The intersession reliability was good in ND children (ICC=075-0.98), and moderate to good in children with CP (ICC=0.60-0.94), except for the elbow extensors and hip adductors. The interrater reliability was moderate to good in both groups (ICC=0.62-0.97), except for the shoulder abductors and extensors, elbow extensors and hip extensors in children with CP. Conclusion: The NMMT is reliable in testing muscle strength of non-disabled children and children with CP.
”Participation” in life experiences for school children is important for the development of psych... more ”Participation” in life experiences for school children is important for the development of psychological, emotional and physical skills. Children at school age may face a transition from preschool to school settings, or from home to community contexts that generate change in life experiences. Especially for school children with disabilities, full participation in home, school, and community is the ultimate outcome for developing rehabilitation and education plans. The International Classification of Functioning, Disabilities and Health (ICF) and its child and youth version (ICF-CY) define participation as ”involvement in a life situation”. However, participation of children has been defined with varied terms and multiple perspectives across measurement tools. Therefore, this review synthesized participation measures by 3 constructs (”Capability”, Performance”, and ”Subjective experience”) with the aim to operationally define ”Participation” for children at school age. The reviewed measures for participation were linked to the three constructs and corresponding measurable dimensions. Dependent on aim for assessment professionals can use the measures for specific dimensions to support children's participation by identifying participation related environmental problems, and for setting goals in collaboration with teachers and families.
背景與目的:「國際健康功能與身心障礙分類系統」(International Classification of Functioning, Disability and Health,簡稱ICF)... more 背景與目的:「國際健康功能與身心障礙分類系統」(International Classification of Functioning, Disability and Health,簡稱ICF)強調活動與參與是健康情形和情境因素互動的結果,本先導研究之目的為:以ICF架構提出動作發展遲緩幼兒的粗大動作功能狀況之相關因子並驗證其關聯性。方法:橫斷式研究,以方便取樣徵召130個有6~24個月臨界或確診動作發展遲緩幼兒的家庭,將兒童的身體功能與粗大動作活動與參與(靜態姿勢維持能力、基本移動能力及功能性移動能力)作為依變項,以健康情形為自變項,環境因素與身體功能作為中介變項,分別建構3個中介模型,再採用多重中介模型驗證各個ICF成分間的中介路徑。結果:模式指出健康情形(動作遲緩程度)可直接或間接經由身體功能(精熟動機、肌肉力量、肌肉張力、動作反應)中介因子預測粗大動作活動與參與,而家長知覺的需求滿足程度是健康情形與身體功能間唯一顯著的中介環境變項。結論:幼兒期的部分身體功能及環境因素是粗大動作功能狀況的中介變項,此模式可作為早期介入之決策參考,然因果關係有待進一步研究。
Social participation involves forming and maintaining social relationships through interactions w... more Social participation involves forming and maintaining social relationships through interactions with others during daily activities and is supported by accessible environments. Youth with physical disabilities experience increased challenges in social participation given their difficulties in mobility, communication and socialization. Restrictions in social participation may increase their difficulties associated with successful transition to adult life. Knowledge of factors that are facilitators or barriers to social participation is limited in youth with physical disabilities. This review appraised research evidence on multiple determinants that affect social participation based on the framework of the International Classification of Functioning, Disability and Health (ICF) and its children/youth version (ICF-CY). Knowledge of determinants of social participation should help therapists better understand factors pertain to body functions and structures and activity, as well as personal and environmental factors associated with higher social participation. An important role of physical therapists is to provide support and services, or to remove barriers, that will facilitate youth's engagement in community social life and contribution to society. The findings will have implications for providing youth- and family-centered services that support youths in achieving their goals for social participation and community integration.
Background Caregiver engagement and collaborative team early childhood intervention (ECI) service... more Background Caregiver engagement and collaborative team early childhood intervention (ECI) services are international trends; however, relevant evidence of collaborative home-visiting ECI in rural areas is as yet undetermined. Objective The study aimed to investigate the effectiveness of a collaborative ECI program in a rural area of Taiwan. Design The study was a pilot randomized control led trial. Methods Children aged 6 to 33 months experiencing motor delays and their caregivers were enrolled in Taitung, Taiwan. Using stratified randomization, 24 participants were allocated to either experimental or control groups, and both received 5 home visits within 3 months. The experimental group received ECI services based on the International Classification of Functioning, Disability and Health framework and family-centered approaches. The control group received regular home visits by local social workers. Child outcomes included Pediatric Evaluation of Disability Inventory Chinese Version...
Developmental Medicine & Child Neurology, Mar 22, 2022
AimThis study evaluated the performance of children with learning problems in Taiwan by using the... more AimThis study evaluated the performance of children with learning problems in Taiwan by using the Taiwan Data Bank of Persons with Disability.MethodWe included 3854 children (2343 males, 1511 females; mean [SD] age 9y 11mo [2y 4mo]) with specific learning disorder (SLD), attention‐deficit/hyperactivity disorder (ADHD), autism, epilepsy, or intellectual disabilities for analysis. We used the Functioning Scale of the Disability Evaluation System‐Child version to investigate performance at follow‐up for at least 3 years.ResultsThese participants demonstrated improvement across all the domains of the International Classification of Functioning, Health, and Disability including for mobility, learning, social participation, and daily living. The children with SLD (p=0.3) and epilepsy (p=0.442) did not demonstrate significant improvement in learning, whereas those with ADHD (p<0.001), autism (p<0.001), and intellectual disabilities (p<0.001) did. The children with epilepsy displayed the most impairment and least improvement.InterpretationThis cross‐diagnostic study of learning problems indicated the children with autism or ADHD received more structural education. However, education strategies for those with SLD or epilepsy required improvement. Finally, SLD is possibly underdiagnosed in children, and children with epilepsy are affected in multiple aspects.What this paper adds Specific learning disorder (SLD), ADHD, autism, epilepsy, and intellectual disability can cause learning problems in children. Children with ADHD and autism showed more improvement in academic performance. SLD has been neglected and underdiagnosed, resulting in poor improvement. Children with epilepsy have multiple impairments and exhibited minimal improvement.
The Child and Adolescent Factors Inventory (CAFI) is a parent-report measure that assesses type a... more The Child and Adolescent Factors Inventory (CAFI) is a parent-report measure that assesses type and severity of impairments experienced by children and youth with a range of disabling conditions. The CAFI was translated from English into Traditional Chinese (CAFI-C) and has been used in the Disability Evaluation System (DES) in Taiwan. The aim of this study was to validate the use of the CAFI-C in the DES. Participants included 18,119 children and youth with disabilities between the ages of 6.0-17.9 (Mean=11.6; SD=3.46). The factor structure, internal consistency, convergent validity, and discriminant (known groups) validity were examined. The results indicated that the CAFI-C had a two-factor structure (Mental/speech and Physical/sensory impairment) that explained 54.3% of the variance, and had adequate internal consistency (α=0.80-0.90). Children and youth with higher CAFI-C scores had significantly more participation restrictions and environment barriers. CAFI-C scores were signi...
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