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Construct validity and reliability of the Selective Control Assessment of the Lower Extremity in children with
Julia Balzer1, Petra Marsico1, Elena Mitteregger2
1Pediatric Rehab Research Group, Rehabilitation Center for Children and Adolescents, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.
Insights
The Selective Control Assessment of the Lower Extremity (SCALE) is a valid and reliable tool for assessing leg movement control in children with cerebral palsy (CP). This study confirms its utility for evaluating selective voluntary movement in pediatric spastic CP.
Area of Science:
- Pediatric neurology
- Rehabilitation medicine
- Movement science
Background:
- Assessing selective voluntary movement control in children with cerebral palsy (CP) is crucial for targeted interventions.
- The Selective Control Assessment of the Lower Extremity (SCALE) is a tool designed for this purpose.
- Evaluating the psychometric properties of clinical assessment tools is essential for their valid application.
Purpose of the Study:
- To investigate the construct validity of the SCALE in children with spastic CP.
- To determine the intra- and interrater reliability of the SCALE.
- To establish the clinical utility of the SCALE for assessing lower extremity motor control.
Main Methods:
- Thirty-nine children with spastic CP (GMFCS levels I-IV) participated.
- SCALE scores were analyzed for differences based on limb involvement and GMFCS levels.
- Construct validity was assessed by correlating SCALE scores with established measures (Fugl-Meyer, MMT, MAS).
- Reliability was evaluated using intraclass correlation coefficients (ICC) and minimal detectable change (MDC).
Main Results:
- SCALE scores showed significant differences between less and more affected legs and across most joints (p<0.001).
- Significant differences in total SCALE scores were observed between GMFCS levels I and II.
- Strong correlations were found between SCALE and Fugl-Meyer Assessment (0.88) and Manual Muscle Test (0.88).
- Excellent intra- and interrater reliability (ICC > 0.9) and a low MDC (< 2 points) were demonstrated.
Conclusions:
- The SCALE is a valid instrument for assessing selective voluntary movement control in the legs of children with spastic CP.
- The SCALE demonstrates high reliability, making it suitable for clinical and research use.
- This tool aids in quantifying motor deficits and monitoring treatment outcomes in pediatric CP.
Aim:
Assessing impaired selective voluntary movement control in children with cerebral palsy (CP) has gained increasing interest. We investigated construct validity and intra- and interrater reliability of the Selective Control Assessment of the Lower Extremity (SCALE).
Method:
Thirty-nine children (21 males, 18 females) with spastic CP, mean age 12 years 6 months [range 6y 11mo-19y 9mo], Gross Motor Function Classification System (GMFCS) levels I to IV, participated. Differences in SCALE scores were determined on joint levels and between patients categorized according to their limb distribution and GMFCS levels. SCALE scores were correlated with the Fugl-Meyer Assessment, Manual Muscle Test, and Modified Ashworth Scale. To determine reliability, the SCALE was applied once and recorded on video.
Results:
SCALE scores differed significantly between the less and more affected leg (p<0.001) and between most leg joints. Total SCALE scores differed significantly between GMFCS levels I and II. Correlations with Fugl-Meyer Assessment, Manual Muscle Test, and Modified Ashworth Scale were 0.88, 0.88, and -0.55 respectively. Intraclass correlation coefficients were all above 0.9, with the minimal detectable change below 2 points.
Interpretation:
The SCALE appears to be a valid and reliable tool to assess selective voluntary movement control of the legs in children with spastic CP.
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