Roslyn Boyd - Profile on Academia.edu (original) (raw)

Papers by Roslyn Boyd

Research paper thumbnail of Study protocol for Running for health (Run4Health CP): a multicentre, assessor-blinded randomised controlled trial of 12 weeks of two times weekly Frame Running training versus usual care to improve cardiovascular health risk factors in children and youth with cerebral palsy

BMJ Open

IntroductionChildren and youth with moderate-severe (Gross Motor Function Classification System (... more IntroductionChildren and youth with moderate-severe (Gross Motor Function Classification System (GMFCS) levels II–V) cerebral palsy (CP) participate less frequently in physical activities compared with peers without CP and have elevated risk of cardiorespiratory morbidity and mortality in adulthood. Frame Running (RaceRunning) is a new athletics discipline that is an accessible option for physical activity participation for people with moderate-severe CP. There is no high-quality evidence for the effect of Frame Running on cardiovascular disease in children and young people with CP. The primary aim of this study is to conduct a randomised controlled trial of the effect of 12 weeks of Frame Running training on risk factors for cardiovascular disease.Methods and nalysisSixty-two children and youth with CP (age 8–20 years) in GMFCS levels II–V will be recruited across four sites and randomised to receive either 12 weeks of Frame Running training two times weekly for 60 min, or usual ca...

Research paper thumbnail of Early detection of Australian Aboriginal and Torres Strait Islander infants at high risk of adverse neurodevelopmental outcomes at 12 months corrected age: LEAP-CP prospective cohort study protocol

BMJ Open, 2022

IntroductionNeurodevelopmental disorders (NDD), including cerebral palsy (CP), autism spectrum di... more IntroductionNeurodevelopmental disorders (NDD), including cerebral palsy (CP), autism spectrum disorder (ASD) and foetal alcohol spectrum disorder (FASD), are characterised by impaired development of the early central nervous system, impacting cognitive and/or physical function. Early detection of NDD enables infants to be fast-tracked to early intervention services, optimising outcomes. Aboriginal and Torres Strait Islander infants may experience early life factors increasing their risk of neurodevelopmental vulnerability, which persist into later childhood, further compounding the health inequities experienced by First Nations peoples in Australia. The LEAP-CP prospective cohort study will investigate the efficacy of early screening programmes, implemented in Queensland, Australia to earlier identify Aboriginal and Torres Strait Islander infants who are ‘at risk’ of adverse neurodevelopmental outcomes (NDO) or NDD. Diagnostic accuracy and feasibility of early detection tools for i...

Figure 1 LEAP-CP prospective cohort study timeline. AOSI, Autism Observation Schedule in Infants; ASQ-TRAK, Ages and Stages Questionnaire-Aboriginal Adaptation; BSID-III, Bayley Scales of Infant Development third Edition; DASS-21, Depression Anxiety Stress Scale; FASD, facial photographic analysis; GMA, Prechtl’s General Movements Assessment; HINE, Hammersmith Infant Neurological Examination; ITSEA, Infant Toddler Social Emotional Assessment; MOS, General Movements Assessment Motor Optimality Score; PEDI-CAT, Paediatric Evaluation of Disability Inventory-Computer Adaptive Test; PMDS-2, Peabody Developmental Motor Scales second edition; RNDA, Rapid Neurodevelopmental Assessment.

Research paper thumbnail of Energy expenditure in children following femoral fracture in a randomised controlled trial

Research paper thumbnail of Day-to-day variability of energy intake in young children with cerebral palsy

Day-to-day variability of energy intake in young children with cerebral palsy

Developmental Medicine & Child Neurology, 2012

Research paper thumbnail of Reported Eating Ability of Young Children With Cerebral Palsy: Is There an Association With Gross Motor Function?

Archives of Physical Medicine and Rehabilitation, Mar 1, 2013

To examine the association between parent-reported ability of young children with cerebral palsy ... more To examine the association between parent-reported ability of young children with cerebral palsy (CP) to eat different food textures and gross motor functional abilities. Design: Prospective, longitudinal, representative cohort study. Setting: Community and tertiary pediatric hospital settings. Participants: Children (NZ170; 110 boys [65%]) were assessed on 396 occasions (range, 1e4 occasions), including 67 at 1 year 6 months (49 boys), 99 at 2 years (66 boys), 111 at 2 years 6 months (71 boys), and 119 at 3 years (64 boys). Interventions: Not applicable Main Outcome Measures: Gross motor function was determined using the Gross Motor Function Classification System (GMFCS). Parentreported eating ability was determined using 4 items of the Pediatric Evaluation of Disability Inventory. The association between capability to eat food textures and GMFCS level was examined using generalized estimating equations. Results: The distribution of GMFCS levels at initial presentation was as follows: I, nZ62; II, nZ32; III, nZ24; IV, nZ22; and V, nZ30. Reported capability to eat cut-up/chunky and "all textures" of table foods decreased significantly as GMFCS level increased. A decreased capability to eat pureed/blended and ground/lumpy foods compared with GMFCS I was significantly associated with GMFCS levels IV and V only. Conclusions: Reported attainment of eating skills was closely associated with GMFCS level in young children with CP across age levels. These results emphasize the need for early oral-motor and feeding screening in young children with CP across gross motor functional abilities.

Research paper thumbnail of Parent-reported indicators for detecting feeding and swallowing difficulties and undernutrition in preschool-aged children with cerebral palsy

Developmental Medicine & Child Neurology, Sep 6, 2017

To determine the most accurate parent-reported indicators for detecting (1) feeding/ swallowing d... more To determine the most accurate parent-reported indicators for detecting (1) feeding/ swallowing difficulties and (2) undernutrition in preschool-aged children with cerebral palsy (CP). METHOD This was a longitudinal, population-based study, involving 179 children with CP, aged 18 to 60 months (mean 34.1mo [SD 11.9] at entry, 111 males, 68 females [Gross Motor Function Classification System level I, 84; II, 23; III, 28; IV, 18; V, 26], 423 data points). Feeding/swallowing difficulties were determined by the Dysphagia Disorders Survey and 16 signs suggestive of pharyngeal phase impairment. Undernutrition was indicated by height-weight and skinfold composite z-scores less than À2. Primary parent-reported indicators included mealtime duration, mealtime stress, concern about growth, and respiratory problems. Other indicators were derived from a parent feeding questionnaire, including 'significant difficulty eating and drinking'. Data were analysed using multilevel mixed-effects regression and diagnostic statistics. RESULTS Primary parent-reported indicators associated with feeding/swallowing were 'moderate-severe parent stress' (odds ratio [OR]=3.2 [95% confidence interval {CI} 1.3-7.8]; p<0.01), 'moderate-severe concern regarding growth' (OR=4.5 [95% CI 1.7-11.9]; p<0.01), and 'any respiratory condition' (OR=1.8 [95% CI 1.4-5.8]; p<0.01). The indicator associated with undernutrition was 'moderate-severe concern regarding growth' (height-weight OR=13.5 [95% CI 3.0-61.3]; p<0.01; skinfold OR=19.1 [95% CI 3.7-98.9]; p<0.01). 'Significant difficulty eating and drinking' was most sensitive/specific for feeding outcome (sensitivity=58.6%, specificity=100.0%), and 'parent concern regarding growth' for undernutrition (sensitivity=77.8%, specificity=77.0%). INTERPRETATION Parent-reported indicators are feasible for detecting feeding and swallowing difficulties and undernutrition in children with CP, but need formal validation.

Research paper thumbnail of The Eating and Drinking Ability Classification System in a population-based sample of preschool children with cerebral palsy

The Eating and Drinking Ability Classification System in a population-based sample of preschool children with cerebral palsy

Developmental Medicine & Child Neurology, Mar 9, 2017

To determine (1) the reproducibility of the Eating and Drinking Ability Classification System (ED... more To determine (1) the reproducibility of the Eating and Drinking Ability Classification System (EDACS); (2) EDACS classification distribution in a population‐based cohort with cerebral palsy (CP); and (3) the relationships between the EDACS and clinical mealtime assessment, other classifications, and health outcomes.

Research paper thumbnail of Clinical signs suggestive of pharyngeal dysphagia in preschool children with cerebral palsy

Research in Developmental Disabilities, Mar 1, 2015

This study aimed to determine the discriminative validity, reproducibility, and prevalence of cli... more This study aimed to determine the discriminative validity, reproducibility, and prevalence of clinical signs suggestive of pharyngeal dysphagia according to gross motor function in children with cerebral palsy (CP). It was a cross-sectional population-based study of 130 children diagnosed with CP at 18-36 months (mean = 27.4, 81 males) and 40 children with typical development (TD, mean = 26.2, 18 males). Sixteen signs suggestive of pharyngeal phase impairment were directly observed in a videoed mealtime by a speech pathologist, and reported by parents on a questionnaire. Gross motor function was classified using the Gross Motor Function Classification System. The study found that 67.7% of children had clinical signs, and this increased with poorer gross motor function (OR = 1.7, p < 0.01). Parents reported clinical signs in 46.2% of children, with 60% agreement with direct clinical mealtime assessment (kappa = 0.2, p < 0.01). The most common signs on direct assessment were coughing (44.7%), multiple swallows (25.2%), gurgly voice (20.3%), wet breathing (18.7%) and gagging (11.4%). 37.5% of children with TD had clinical signs, mostly observed on fluids. Dysphagia cut-points were modified to exclude a single cough on fluids, with a modified prevalence estimate proposed as 50.8%. Clinical signs suggestive of pharyngeal dysphagia are common in children with CP, even those with ambulatory CP. Parent-report on 16 specific signs remains a feasible screening method. While coughing was consistently identified by clinicians, it may not reflect children's regular performance, and was not sufficiently discriminative in children aged 18-36 months.

Research paper thumbnail of Oropharyngeal dysphagia in preschool children with cerebral palsy: Oral phase impairments

Research in Developmental Disabilities, Dec 1, 2014

Context: Oropharyngeal dysphagia (OPD) is common in preschool children with cerebral palsy (CP), ... more Context: Oropharyngeal dysphagia (OPD) is common in preschool children with cerebral palsy (CP), and may negatively influence children's dietary intake and nutritional status. Prevalence estimates range from 19% to 99%, with this large variability owing to study methodology. Most studies detected OPD through parent report, and recruitment has focused on children with moderate-severe CP and from a broad age range. Understanding the prevalence and patterns of OPD in preschool children with CP across the full range of gross motor functional levels will promote earlier detection and interventions. Objective: The broad aim of this doctoral research was to determine the prevalence and patterns of OPD in preschool children with CP from 18 to 36 months; and its relationship to dietary intake, nutritional status and gross motor function. Design: This doctoral research forms part of 2 larger longitudinal cohort studies, CP Child: Growth, Nutrition and Physical Activity (GNPA); and CP Child: Brain Structure and Motor Function. Four substudies comprise this doctoral thesis: (1) systematic review of OPD measures, and validity and reproducibility, (2) cross-sectional studies of OPD, (3) longitudinal study of OPD, (4) cross-sectional study of OPD in a low-resource country. Participants: Participants in all substudies were children with a confirmed diagnosis of CP aged 18 to 36 months corrected age. One hundred and thirty children participated in the main GNPA sample; inclusion of Queensland-born children from birth years 2006-2009, and exclusion of children with neurodegenerative conditions or syndromes influencing growth. Forty children with typical development (TD) were recruited as a reference sample. Eighty-one Bangladesh-born children were recruited to the sample from a low-resource country. Procedure: Children attended the hospital for mealtime and gross motor assessment, and growth anthropometry. Mealtimes were evaluated using the Schedule for Oral Motor Assessment (SOMA), Dysphagia Disorders Survey (DDS), Pre Speech Assessment Scale (PSAS), 16 clinical signs suggestive of pharyngeal phase impairment, and the Thomas-Stonell & Greenberg Saliva Severity Scale. Parents reported on their child's mealtime using the Queensland CP Child Feeding Questionnaire, which was developed for the study. Gross motor function was classified on the Gross Motor Function Classification System (GMFCS), motor type (spasticity, dyskinesia, ataxia and hypotonia) and distribution. Parents completed a 3-day weighed food record at home, from which i

Research paper thumbnail of A prospective, longitudinal study of growth, nutrition and sedentary behaviour in young children with cerebral palsy

BMC Public Health, Apr 6, 2010

Background: Cerebral palsy is the most common cause of physical disability in childhood, occurrin... more Background: Cerebral palsy is the most common cause of physical disability in childhood, occurring in one in 500 children. It is caused by a static brain lesion in the neonatal period leading to a range of activity limitations. Oral motor and swallowing dysfunction, poor nutritional status and poor growth are reported frequently in young children with cerebral palsy and may impact detrimentally on physical and cognitive development, health care utilisation, participation and quality of life in later childhood. The impact of modifiable factors (dietary intake and physical activity) on growth, nutritional status, and body composition (taking into account motor severity) in this population is poorly understood. This study aims to investigate the relationship between a range of factors-linear growth, body composition, oral motor and feeding dysfunction, dietary intake, and time spent sedentary (adjusting for motor severity)-and health outcomes, health care utilisation, participation and quality of life in young children with cerebral palsy (from corrected age of 18 months to 5 years). Design/Methods: This prospective, longitudinal, population-based study aims to recruit a total of 240 young children with cerebral palsy born in Queensland, Australia between 1 st September 2006 and 31 st December 2009 (80 from each birth year). Data collection will occur at three time points for each child: 17-25 months corrected age, 36 ± 1 months and 60 ± 1 months. Outcomes to be assessed include linear growth, body weight, body composition, dietary intake, oral motor function and feeding ability, time spent sedentary, participation, medical resource use and quality of life. Discussion: This protocol describes a study that will provide the first longitudinal description of the relationship between functional attainment and modifiable lifestyle factors (dietary intake and habitual time spent sedentary) and their impact on the growth, body composition and nutritional status of young children with cerebral palsy across all levels of functional ability.

Research paper thumbnail of Food and fluid texture consumption in a population-based cohort of preschool children with cerebral palsy: relationship to dietary intake

Developmental Medicine & Child Neurology, May 15, 2015

AIM To determine the texture constitution of children's diets and its relationship to oropharynge... more AIM To determine the texture constitution of children's diets and its relationship to oropharyngeal dysphagia (OPD), dietary intake, and gross motor function in young children with cerebral palsy (CP). METHOD A cross-sectional, population-based cohort study comprising 99 young children with CP (65 males, 35 females) aged 18 to 36 months (mean age 27mo; Gross Motor Function Classification System [GMFCS] level I, n=45; II, n=13; III, n=14; IV, n=10; V, n=17). CP subtypes were classified as spastic unilateral (n=35), spastic bilateral (n=49), dyskinetic (n=5), and other (n=10), in accordance with the criteria of the Surveillance of Cerebral Palsy in Europe. Habitual dietary intake of food textures, energy, and water were determined from parentcompleted 3-day weighed food records. Parent-reported feeding ability of food textures was reported on the Pediatric Evaluation of Disability Inventory and a feeding questionnaire. OPD was classified based on clinical feeding assessment using the Dysphagia Disorders Survey (rated by a certified assessor, KAB) and a subjective Swallowing Safety Recommendation (classified by a paediatric speech pathologist, KAB).

Research paper thumbnail of Clinimetrics of measures of oropharyngeal dysphagia for preschool children with cerebral palsy and neurodevelopmental disabilities: a systematic review

Clinimetrics of measures of oropharyngeal dysphagia for preschool children with cerebral palsy and neurodevelopmental disabilities: a systematic review

Developmental Medicine & Child Neurology, May 14, 2012

Aim The aim of this study was to determine the psychometric properties and clinical utility of o... more Aim The aim of this study was to determine the psychometric properties and clinical utility of objective measures of oropharyngeal dysphagia (OPD) in children with cerebral palsy or neurodevelopmental disabilities aged 12 months to 5 years.Method Five electronic databases were searched to identify measures of OPD. The Consensus‐based Standards for the Selection of Measurement Instruments (COSMIN) Checklist was used to assess psychometric properties and a Modified CanChild Outcome Rating Form was used for clinical utility.Results Nine measures of OPD from 27 papers were assessed: the Brief Assessment of Motor Function – Oral Motor Deglutition Scale; the Behavioral Assessment Scale of Oral Functions in Feeding; the Dysphagia Disorders Survey; the Feeding Behaviour Scale; the Functional Feeding Assessment, modified; the Gisel Video Assessment; the Oral Motor Assessment Scale; the Pre‐Speech Assessment Scale; and the Schedule for Oral Motor Assessment.Interpretation The Schedule for Oral Motor Assessment and the Functional Feeding Assessment, modified, proved to be the strongest measures based on published psychometric properties of validity and reliability. The Schedule for Oral Motor Assessment and the Dysphagia Disorders Survey were found to have the strongest clinical utility. Further studies to test the psychometric properties of existing measures, in particular predictive validity, responsiveness, and test–retest reliability, would be beneficial for selecting an appropriate measure for both clinical and research contexts.

Research paper thumbnail of Oropharyngeal Dysphagia and Gross Motor Skills in Children With Cerebral Palsy

Pediatrics, Apr 15, 2013

WHAT'S KNOWN ON THIS SUBJECT: Oropharyngeal dysphagia (OPD) prevalence is 19-99%. OPD based on pa... more WHAT'S KNOWN ON THIS SUBJECT: Oropharyngeal dysphagia (OPD) prevalence is 19-99%. OPD based on parent-report is associated with gross motor skills in children with cerebral palsy (CP), however this underestimates prevalence. Almost all children with severe CP have dysphagia; little is known about mild CP.

Research paper thumbnail of Validity and reproducibility of measures of oropharyngeal dysphagia in preschool children with cerebral palsy

Validity and reproducibility of measures of oropharyngeal dysphagia in preschool children with cerebral palsy

Developmental Medicine & Child Neurology, Nov 7, 2014

The aim of the study was to determine the best measure to discriminate between those with orophar... more The aim of the study was to determine the best measure to discriminate between those with oropharyngeal dysphagia (OPD) and those without OPD, among young children with cerebral palsy (CP). We carried out a cross-sectional population-based study involving 130 children with CP aged between 18 months and 36 months (mean 27.4mo; 81 males, 49 females) classified according to the Gross Motor Function Classification Scale (GMFCS) as level I (n=57), II (n=15), III (n=23), IV (n=12), or V (n=23). Forty children with CP (mean 28.5mo; 21 males,19 females, eight for each GMFCS level) were included in the reproducibility sub-study, and 40 children with typical development (mean 26.2mo; 18 males, 22 females) were included in the validity sub-study. OPD was assessed using the Dysphagia Disorders Survey (DDS), Pre-Speech Assessment Scale (PSAS), and Schedule for Oral Motor Assessment (SOMA). We analysed reproducibility using inter- and intrarater agreement (percentage) and reliability (kappa values and intraclass correlation coefficients). Construct validity was assessed as concordance between measures (SOMA, DDS, and PSAS). In the absence of a criterion standard measure for OPD, prevalence was estimated using latent class variable analysis. Data from the children with typical development were used to propose modified OPD cut-points for discriminative validity. All measures had strong agreement (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;85%) for inter- and intrarater reliability. The SOMA had the best specificity (100.0%), but lacked sensitivity (53.0%), whereas the DDS and PSAS had high sensitivity (each 100.0%) but lacked specificity (47.1% and 70.6% respectively). OPD prevalence when calculated using the web-based estimation was 65.4%, which was similar to the estimate from the modified cut-points. Using the sample of children with typical development and modified cut-points, OPD prevalence was lower than estimates with standard scoring. We propose using these modified cut-points when administering the DDS, PSAS or SOMA in young children with CP.

Research paper thumbnail of Longitudinal Growth, Diet, and Physical Activity in Young Children With Cerebral Palsy

Pediatrics, Sep 7, 2016

OBJECTIVES: To describe the longitudinal relationship between height-forage z score (HZ), growth ... more OBJECTIVES: To describe the longitudinal relationship between height-forage 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Research paper thumbnail of Differences in body composition according to functional ability in preschool-aged children with cerebral palsy

Clinical Nutrition, Feb 1, 2015

Background & aims: Altered body composition is evident in school children with cerebral palsy (CP... more Background & aims: Altered body composition is evident in school children with cerebral palsy (CP). Fat free mass and fat mass amounts differ according to functional ability and compared to typically developing children (TDC). The extent to which body composition is altered in preschool-aged children with CP is unknown. We aimed to determine the fat free mass index (FFMI) and body fat percentage (BF%) of preschool-aged children with CP and investigate differences according to functional ability and compared to TDC. Methods: Eighty-five children with CP (68% male) of all functional abilities, motor types and distributions and 16 TDC (63% male) aged 1.4e5.1 years participated in this cross-sectional study. Body composition was determined via isotope dilution. Children with CP were classified into groups based on their Gross Motor Function Classification System (GMFCS) level. Statistical analyses were via ANOVA, ANCOVA, posthoc Tukey HSD tests, independent t-tests and multiple regressions. Results: There were no significant differences in FFMI or BF% when comparing all children with CP to TDC. Children classified as GMFCS levels III, IV and V had significantly lower FFMI levels compared to children classified as GMFCS I and II (p < 0.05). Children of GMFCS IV and V had the highest mean (AESD) BF% of all children (24.6% (AE10.7%)), significantly higher than children of GMFCS I and II (18.6% (AE6.8%), p < 0.05). Conclusions: Altered body composition is evident in preschool-aged children with CP, with a trend towards lower FFMI levels and greater BF% across functional ability levels from GMFCS I to V. Further Non-standard abbreviations: BF%, body fat percentage; BMI, body mass index; CP, cerebral palsy; DLW, doubly labelled water; DXA, dual energy X-ray absorptiometry; FFM, fat free mass; FFMI, fat free mass index; GMFCS, Gross Motor Function Classification System; TDC, typically developing children. q This material was presented as a free paper session at the following two conferences.

Research paper thumbnail of A systematic review of the clinimetric properties of oral motor dysfunction measures for preschool children with cerebral palsy

A systematic review of the clinimetric properties of oral motor dysfunction measures for preschool children with cerebral palsy

Developmental Medicine & Child Neurology, 2012

This systematic review evaluates assessments used to discriminate, predict, or evaluate the motor... more This systematic review evaluates assessments used to discriminate, predict, or evaluate the motor development of preterm infants during the first year of life. Eighteen assessments were identified; nine met the inclusion criteria. The Alberta Infant Motor Scale (AIMS), Bayley Scale of Infant and Toddler Development -- Version III, Peabody Developmental Motor Scales -- Version 2, Test of Infant Motor Performance (TIMP), and Toddler and Infant Motor Examination have good discriminative validity when examined in large populations. The AIMS, Prechtl&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Assessment of General Movements (GMs), Neuro Sensory Motor Development Assessment (NSMDA), and TIMP were designed for preterm infants and are able to detect more subtle changes in movement quality. The best predictive assessment tools are age dependent: GMs, the Movement Assessment of Infants, and TIMP are strongest in early infancy (age 4 mo or less) and the AIMS and NSMDA are better at older ages (8-12 mo). The TIMP is the only tool that has demonstrated a difference between groups in response to intervention in two randomized controlled trials. The AIMS, TIMP, and GMs demonstrated the highest levels of overall reliability (interrater and intrarater intraclass correlation coefficient or kappa&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.85). Selection of motor assessment tools during the first year of life for infants born preterm will depend on the intended purpose of their use for discrimination, prediction, and/or evaluation.

Research paper thumbnail of Reported and observed clinical signs of oropharyngeal aspiration in young children with cerebral palsy

Reported and observed clinical signs of oropharyngeal aspiration in young children with cerebral palsy

Developmental Medicine & Child Neurology, 2011

Research paper thumbnail of Relationship between body composition and functional ability in preschool children with cerebral palsy

Relationship between body composition and functional ability in preschool children with cerebral palsy

Developmental Medicine & Child Neurology, 2012

Research paper thumbnail of Energy intake and reported feeding dysfunction in pre-school children with cerebral palsy

Energy intake and reported feeding dysfunction in pre-school children with cerebral palsy

Research paper thumbnail of Study protocol for Running for health (Run4Health CP): a multicentre, assessor-blinded randomised controlled trial of 12 weeks of two times weekly Frame Running training versus usual care to improve cardiovascular health risk factors in children and youth with cerebral palsy

BMJ Open

IntroductionChildren and youth with moderate-severe (Gross Motor Function Classification System (... more IntroductionChildren and youth with moderate-severe (Gross Motor Function Classification System (GMFCS) levels II–V) cerebral palsy (CP) participate less frequently in physical activities compared with peers without CP and have elevated risk of cardiorespiratory morbidity and mortality in adulthood. Frame Running (RaceRunning) is a new athletics discipline that is an accessible option for physical activity participation for people with moderate-severe CP. There is no high-quality evidence for the effect of Frame Running on cardiovascular disease in children and young people with CP. The primary aim of this study is to conduct a randomised controlled trial of the effect of 12 weeks of Frame Running training on risk factors for cardiovascular disease.Methods and nalysisSixty-two children and youth with CP (age 8–20 years) in GMFCS levels II–V will be recruited across four sites and randomised to receive either 12 weeks of Frame Running training two times weekly for 60 min, or usual ca...

Research paper thumbnail of Early detection of Australian Aboriginal and Torres Strait Islander infants at high risk of adverse neurodevelopmental outcomes at 12 months corrected age: LEAP-CP prospective cohort study protocol

BMJ Open, 2022

IntroductionNeurodevelopmental disorders (NDD), including cerebral palsy (CP), autism spectrum di... more IntroductionNeurodevelopmental disorders (NDD), including cerebral palsy (CP), autism spectrum disorder (ASD) and foetal alcohol spectrum disorder (FASD), are characterised by impaired development of the early central nervous system, impacting cognitive and/or physical function. Early detection of NDD enables infants to be fast-tracked to early intervention services, optimising outcomes. Aboriginal and Torres Strait Islander infants may experience early life factors increasing their risk of neurodevelopmental vulnerability, which persist into later childhood, further compounding the health inequities experienced by First Nations peoples in Australia. The LEAP-CP prospective cohort study will investigate the efficacy of early screening programmes, implemented in Queensland, Australia to earlier identify Aboriginal and Torres Strait Islander infants who are ‘at risk’ of adverse neurodevelopmental outcomes (NDO) or NDD. Diagnostic accuracy and feasibility of early detection tools for i...

Figure 1 LEAP-CP prospective cohort study timeline. AOSI, Autism Observation Schedule in Infants; ASQ-TRAK, Ages and Stages Questionnaire-Aboriginal Adaptation; BSID-III, Bayley Scales of Infant Development third Edition; DASS-21, Depression Anxiety Stress Scale; FASD, facial photographic analysis; GMA, Prechtl’s General Movements Assessment; HINE, Hammersmith Infant Neurological Examination; ITSEA, Infant Toddler Social Emotional Assessment; MOS, General Movements Assessment Motor Optimality Score; PEDI-CAT, Paediatric Evaluation of Disability Inventory-Computer Adaptive Test; PMDS-2, Peabody Developmental Motor Scales second edition; RNDA, Rapid Neurodevelopmental Assessment.

Research paper thumbnail of Energy expenditure in children following femoral fracture in a randomised controlled trial

Research paper thumbnail of Day-to-day variability of energy intake in young children with cerebral palsy

Day-to-day variability of energy intake in young children with cerebral palsy

Developmental Medicine & Child Neurology, 2012

Research paper thumbnail of Reported Eating Ability of Young Children With Cerebral Palsy: Is There an Association With Gross Motor Function?

Archives of Physical Medicine and Rehabilitation, Mar 1, 2013

To examine the association between parent-reported ability of young children with cerebral palsy ... more To examine the association between parent-reported ability of young children with cerebral palsy (CP) to eat different food textures and gross motor functional abilities. Design: Prospective, longitudinal, representative cohort study. Setting: Community and tertiary pediatric hospital settings. Participants: Children (NZ170; 110 boys [65%]) were assessed on 396 occasions (range, 1e4 occasions), including 67 at 1 year 6 months (49 boys), 99 at 2 years (66 boys), 111 at 2 years 6 months (71 boys), and 119 at 3 years (64 boys). Interventions: Not applicable Main Outcome Measures: Gross motor function was determined using the Gross Motor Function Classification System (GMFCS). Parentreported eating ability was determined using 4 items of the Pediatric Evaluation of Disability Inventory. The association between capability to eat food textures and GMFCS level was examined using generalized estimating equations. Results: The distribution of GMFCS levels at initial presentation was as follows: I, nZ62; II, nZ32; III, nZ24; IV, nZ22; and V, nZ30. Reported capability to eat cut-up/chunky and "all textures" of table foods decreased significantly as GMFCS level increased. A decreased capability to eat pureed/blended and ground/lumpy foods compared with GMFCS I was significantly associated with GMFCS levels IV and V only. Conclusions: Reported attainment of eating skills was closely associated with GMFCS level in young children with CP across age levels. These results emphasize the need for early oral-motor and feeding screening in young children with CP across gross motor functional abilities.

Research paper thumbnail of Parent-reported indicators for detecting feeding and swallowing difficulties and undernutrition in preschool-aged children with cerebral palsy

Developmental Medicine & Child Neurology, Sep 6, 2017

To determine the most accurate parent-reported indicators for detecting (1) feeding/ swallowing d... more To determine the most accurate parent-reported indicators for detecting (1) feeding/ swallowing difficulties and (2) undernutrition in preschool-aged children with cerebral palsy (CP). METHOD This was a longitudinal, population-based study, involving 179 children with CP, aged 18 to 60 months (mean 34.1mo [SD 11.9] at entry, 111 males, 68 females [Gross Motor Function Classification System level I, 84; II, 23; III, 28; IV, 18; V, 26], 423 data points). Feeding/swallowing difficulties were determined by the Dysphagia Disorders Survey and 16 signs suggestive of pharyngeal phase impairment. Undernutrition was indicated by height-weight and skinfold composite z-scores less than À2. Primary parent-reported indicators included mealtime duration, mealtime stress, concern about growth, and respiratory problems. Other indicators were derived from a parent feeding questionnaire, including 'significant difficulty eating and drinking'. Data were analysed using multilevel mixed-effects regression and diagnostic statistics. RESULTS Primary parent-reported indicators associated with feeding/swallowing were 'moderate-severe parent stress' (odds ratio [OR]=3.2 [95% confidence interval {CI} 1.3-7.8]; p<0.01), 'moderate-severe concern regarding growth' (OR=4.5 [95% CI 1.7-11.9]; p<0.01), and 'any respiratory condition' (OR=1.8 [95% CI 1.4-5.8]; p<0.01). The indicator associated with undernutrition was 'moderate-severe concern regarding growth' (height-weight OR=13.5 [95% CI 3.0-61.3]; p<0.01; skinfold OR=19.1 [95% CI 3.7-98.9]; p<0.01). 'Significant difficulty eating and drinking' was most sensitive/specific for feeding outcome (sensitivity=58.6%, specificity=100.0%), and 'parent concern regarding growth' for undernutrition (sensitivity=77.8%, specificity=77.0%). INTERPRETATION Parent-reported indicators are feasible for detecting feeding and swallowing difficulties and undernutrition in children with CP, but need formal validation.

Research paper thumbnail of The Eating and Drinking Ability Classification System in a population-based sample of preschool children with cerebral palsy

The Eating and Drinking Ability Classification System in a population-based sample of preschool children with cerebral palsy

Developmental Medicine & Child Neurology, Mar 9, 2017

To determine (1) the reproducibility of the Eating and Drinking Ability Classification System (ED... more To determine (1) the reproducibility of the Eating and Drinking Ability Classification System (EDACS); (2) EDACS classification distribution in a population‐based cohort with cerebral palsy (CP); and (3) the relationships between the EDACS and clinical mealtime assessment, other classifications, and health outcomes.

Research paper thumbnail of Clinical signs suggestive of pharyngeal dysphagia in preschool children with cerebral palsy

Research in Developmental Disabilities, Mar 1, 2015

This study aimed to determine the discriminative validity, reproducibility, and prevalence of cli... more This study aimed to determine the discriminative validity, reproducibility, and prevalence of clinical signs suggestive of pharyngeal dysphagia according to gross motor function in children with cerebral palsy (CP). It was a cross-sectional population-based study of 130 children diagnosed with CP at 18-36 months (mean = 27.4, 81 males) and 40 children with typical development (TD, mean = 26.2, 18 males). Sixteen signs suggestive of pharyngeal phase impairment were directly observed in a videoed mealtime by a speech pathologist, and reported by parents on a questionnaire. Gross motor function was classified using the Gross Motor Function Classification System. The study found that 67.7% of children had clinical signs, and this increased with poorer gross motor function (OR = 1.7, p < 0.01). Parents reported clinical signs in 46.2% of children, with 60% agreement with direct clinical mealtime assessment (kappa = 0.2, p < 0.01). The most common signs on direct assessment were coughing (44.7%), multiple swallows (25.2%), gurgly voice (20.3%), wet breathing (18.7%) and gagging (11.4%). 37.5% of children with TD had clinical signs, mostly observed on fluids. Dysphagia cut-points were modified to exclude a single cough on fluids, with a modified prevalence estimate proposed as 50.8%. Clinical signs suggestive of pharyngeal dysphagia are common in children with CP, even those with ambulatory CP. Parent-report on 16 specific signs remains a feasible screening method. While coughing was consistently identified by clinicians, it may not reflect children's regular performance, and was not sufficiently discriminative in children aged 18-36 months.

Research paper thumbnail of Oropharyngeal dysphagia in preschool children with cerebral palsy: Oral phase impairments

Research in Developmental Disabilities, Dec 1, 2014

Context: Oropharyngeal dysphagia (OPD) is common in preschool children with cerebral palsy (CP), ... more Context: Oropharyngeal dysphagia (OPD) is common in preschool children with cerebral palsy (CP), and may negatively influence children's dietary intake and nutritional status. Prevalence estimates range from 19% to 99%, with this large variability owing to study methodology. Most studies detected OPD through parent report, and recruitment has focused on children with moderate-severe CP and from a broad age range. Understanding the prevalence and patterns of OPD in preschool children with CP across the full range of gross motor functional levels will promote earlier detection and interventions. Objective: The broad aim of this doctoral research was to determine the prevalence and patterns of OPD in preschool children with CP from 18 to 36 months; and its relationship to dietary intake, nutritional status and gross motor function. Design: This doctoral research forms part of 2 larger longitudinal cohort studies, CP Child: Growth, Nutrition and Physical Activity (GNPA); and CP Child: Brain Structure and Motor Function. Four substudies comprise this doctoral thesis: (1) systematic review of OPD measures, and validity and reproducibility, (2) cross-sectional studies of OPD, (3) longitudinal study of OPD, (4) cross-sectional study of OPD in a low-resource country. Participants: Participants in all substudies were children with a confirmed diagnosis of CP aged 18 to 36 months corrected age. One hundred and thirty children participated in the main GNPA sample; inclusion of Queensland-born children from birth years 2006-2009, and exclusion of children with neurodegenerative conditions or syndromes influencing growth. Forty children with typical development (TD) were recruited as a reference sample. Eighty-one Bangladesh-born children were recruited to the sample from a low-resource country. Procedure: Children attended the hospital for mealtime and gross motor assessment, and growth anthropometry. Mealtimes were evaluated using the Schedule for Oral Motor Assessment (SOMA), Dysphagia Disorders Survey (DDS), Pre Speech Assessment Scale (PSAS), 16 clinical signs suggestive of pharyngeal phase impairment, and the Thomas-Stonell & Greenberg Saliva Severity Scale. Parents reported on their child's mealtime using the Queensland CP Child Feeding Questionnaire, which was developed for the study. Gross motor function was classified on the Gross Motor Function Classification System (GMFCS), motor type (spasticity, dyskinesia, ataxia and hypotonia) and distribution. Parents completed a 3-day weighed food record at home, from which i

Research paper thumbnail of A prospective, longitudinal study of growth, nutrition and sedentary behaviour in young children with cerebral palsy

BMC Public Health, Apr 6, 2010

Background: Cerebral palsy is the most common cause of physical disability in childhood, occurrin... more Background: Cerebral palsy is the most common cause of physical disability in childhood, occurring in one in 500 children. It is caused by a static brain lesion in the neonatal period leading to a range of activity limitations. Oral motor and swallowing dysfunction, poor nutritional status and poor growth are reported frequently in young children with cerebral palsy and may impact detrimentally on physical and cognitive development, health care utilisation, participation and quality of life in later childhood. The impact of modifiable factors (dietary intake and physical activity) on growth, nutritional status, and body composition (taking into account motor severity) in this population is poorly understood. This study aims to investigate the relationship between a range of factors-linear growth, body composition, oral motor and feeding dysfunction, dietary intake, and time spent sedentary (adjusting for motor severity)-and health outcomes, health care utilisation, participation and quality of life in young children with cerebral palsy (from corrected age of 18 months to 5 years). Design/Methods: This prospective, longitudinal, population-based study aims to recruit a total of 240 young children with cerebral palsy born in Queensland, Australia between 1 st September 2006 and 31 st December 2009 (80 from each birth year). Data collection will occur at three time points for each child: 17-25 months corrected age, 36 ± 1 months and 60 ± 1 months. Outcomes to be assessed include linear growth, body weight, body composition, dietary intake, oral motor function and feeding ability, time spent sedentary, participation, medical resource use and quality of life. Discussion: This protocol describes a study that will provide the first longitudinal description of the relationship between functional attainment and modifiable lifestyle factors (dietary intake and habitual time spent sedentary) and their impact on the growth, body composition and nutritional status of young children with cerebral palsy across all levels of functional ability.

Research paper thumbnail of Food and fluid texture consumption in a population-based cohort of preschool children with cerebral palsy: relationship to dietary intake

Developmental Medicine & Child Neurology, May 15, 2015

AIM To determine the texture constitution of children's diets and its relationship to oropharynge... more AIM To determine the texture constitution of children's diets and its relationship to oropharyngeal dysphagia (OPD), dietary intake, and gross motor function in young children with cerebral palsy (CP). METHOD A cross-sectional, population-based cohort study comprising 99 young children with CP (65 males, 35 females) aged 18 to 36 months (mean age 27mo; Gross Motor Function Classification System [GMFCS] level I, n=45; II, n=13; III, n=14; IV, n=10; V, n=17). CP subtypes were classified as spastic unilateral (n=35), spastic bilateral (n=49), dyskinetic (n=5), and other (n=10), in accordance with the criteria of the Surveillance of Cerebral Palsy in Europe. Habitual dietary intake of food textures, energy, and water were determined from parentcompleted 3-day weighed food records. Parent-reported feeding ability of food textures was reported on the Pediatric Evaluation of Disability Inventory and a feeding questionnaire. OPD was classified based on clinical feeding assessment using the Dysphagia Disorders Survey (rated by a certified assessor, KAB) and a subjective Swallowing Safety Recommendation (classified by a paediatric speech pathologist, KAB).

Research paper thumbnail of Clinimetrics of measures of oropharyngeal dysphagia for preschool children with cerebral palsy and neurodevelopmental disabilities: a systematic review

Clinimetrics of measures of oropharyngeal dysphagia for preschool children with cerebral palsy and neurodevelopmental disabilities: a systematic review

Developmental Medicine & Child Neurology, May 14, 2012

Aim The aim of this study was to determine the psychometric properties and clinical utility of o... more Aim The aim of this study was to determine the psychometric properties and clinical utility of objective measures of oropharyngeal dysphagia (OPD) in children with cerebral palsy or neurodevelopmental disabilities aged 12 months to 5 years.Method Five electronic databases were searched to identify measures of OPD. The Consensus‐based Standards for the Selection of Measurement Instruments (COSMIN) Checklist was used to assess psychometric properties and a Modified CanChild Outcome Rating Form was used for clinical utility.Results Nine measures of OPD from 27 papers were assessed: the Brief Assessment of Motor Function – Oral Motor Deglutition Scale; the Behavioral Assessment Scale of Oral Functions in Feeding; the Dysphagia Disorders Survey; the Feeding Behaviour Scale; the Functional Feeding Assessment, modified; the Gisel Video Assessment; the Oral Motor Assessment Scale; the Pre‐Speech Assessment Scale; and the Schedule for Oral Motor Assessment.Interpretation The Schedule for Oral Motor Assessment and the Functional Feeding Assessment, modified, proved to be the strongest measures based on published psychometric properties of validity and reliability. The Schedule for Oral Motor Assessment and the Dysphagia Disorders Survey were found to have the strongest clinical utility. Further studies to test the psychometric properties of existing measures, in particular predictive validity, responsiveness, and test–retest reliability, would be beneficial for selecting an appropriate measure for both clinical and research contexts.

Research paper thumbnail of Oropharyngeal Dysphagia and Gross Motor Skills in Children With Cerebral Palsy

Pediatrics, Apr 15, 2013

WHAT'S KNOWN ON THIS SUBJECT: Oropharyngeal dysphagia (OPD) prevalence is 19-99%. OPD based on pa... more WHAT'S KNOWN ON THIS SUBJECT: Oropharyngeal dysphagia (OPD) prevalence is 19-99%. OPD based on parent-report is associated with gross motor skills in children with cerebral palsy (CP), however this underestimates prevalence. Almost all children with severe CP have dysphagia; little is known about mild CP.

Research paper thumbnail of Validity and reproducibility of measures of oropharyngeal dysphagia in preschool children with cerebral palsy

Validity and reproducibility of measures of oropharyngeal dysphagia in preschool children with cerebral palsy

Developmental Medicine & Child Neurology, Nov 7, 2014

The aim of the study was to determine the best measure to discriminate between those with orophar... more The aim of the study was to determine the best measure to discriminate between those with oropharyngeal dysphagia (OPD) and those without OPD, among young children with cerebral palsy (CP). We carried out a cross-sectional population-based study involving 130 children with CP aged between 18 months and 36 months (mean 27.4mo; 81 males, 49 females) classified according to the Gross Motor Function Classification Scale (GMFCS) as level I (n=57), II (n=15), III (n=23), IV (n=12), or V (n=23). Forty children with CP (mean 28.5mo; 21 males,19 females, eight for each GMFCS level) were included in the reproducibility sub-study, and 40 children with typical development (mean 26.2mo; 18 males, 22 females) were included in the validity sub-study. OPD was assessed using the Dysphagia Disorders Survey (DDS), Pre-Speech Assessment Scale (PSAS), and Schedule for Oral Motor Assessment (SOMA). We analysed reproducibility using inter- and intrarater agreement (percentage) and reliability (kappa values and intraclass correlation coefficients). Construct validity was assessed as concordance between measures (SOMA, DDS, and PSAS). In the absence of a criterion standard measure for OPD, prevalence was estimated using latent class variable analysis. Data from the children with typical development were used to propose modified OPD cut-points for discriminative validity. All measures had strong agreement (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;85%) for inter- and intrarater reliability. The SOMA had the best specificity (100.0%), but lacked sensitivity (53.0%), whereas the DDS and PSAS had high sensitivity (each 100.0%) but lacked specificity (47.1% and 70.6% respectively). OPD prevalence when calculated using the web-based estimation was 65.4%, which was similar to the estimate from the modified cut-points. Using the sample of children with typical development and modified cut-points, OPD prevalence was lower than estimates with standard scoring. We propose using these modified cut-points when administering the DDS, PSAS or SOMA in young children with CP.

Research paper thumbnail of Longitudinal Growth, Diet, and Physical Activity in Young Children With Cerebral Palsy

Pediatrics, Sep 7, 2016

OBJECTIVES: To describe the longitudinal relationship between height-forage z score (HZ), growth ... more OBJECTIVES: To describe the longitudinal relationship between height-forage 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Research paper thumbnail of Differences in body composition according to functional ability in preschool-aged children with cerebral palsy

Clinical Nutrition, Feb 1, 2015

Background & aims: Altered body composition is evident in school children with cerebral palsy (CP... more Background & aims: Altered body composition is evident in school children with cerebral palsy (CP). Fat free mass and fat mass amounts differ according to functional ability and compared to typically developing children (TDC). The extent to which body composition is altered in preschool-aged children with CP is unknown. We aimed to determine the fat free mass index (FFMI) and body fat percentage (BF%) of preschool-aged children with CP and investigate differences according to functional ability and compared to TDC. Methods: Eighty-five children with CP (68% male) of all functional abilities, motor types and distributions and 16 TDC (63% male) aged 1.4e5.1 years participated in this cross-sectional study. Body composition was determined via isotope dilution. Children with CP were classified into groups based on their Gross Motor Function Classification System (GMFCS) level. Statistical analyses were via ANOVA, ANCOVA, posthoc Tukey HSD tests, independent t-tests and multiple regressions. Results: There were no significant differences in FFMI or BF% when comparing all children with CP to TDC. Children classified as GMFCS levels III, IV and V had significantly lower FFMI levels compared to children classified as GMFCS I and II (p < 0.05). Children of GMFCS IV and V had the highest mean (AESD) BF% of all children (24.6% (AE10.7%)), significantly higher than children of GMFCS I and II (18.6% (AE6.8%), p < 0.05). Conclusions: Altered body composition is evident in preschool-aged children with CP, with a trend towards lower FFMI levels and greater BF% across functional ability levels from GMFCS I to V. Further Non-standard abbreviations: BF%, body fat percentage; BMI, body mass index; CP, cerebral palsy; DLW, doubly labelled water; DXA, dual energy X-ray absorptiometry; FFM, fat free mass; FFMI, fat free mass index; GMFCS, Gross Motor Function Classification System; TDC, typically developing children. q This material was presented as a free paper session at the following two conferences.

Research paper thumbnail of A systematic review of the clinimetric properties of oral motor dysfunction measures for preschool children with cerebral palsy

A systematic review of the clinimetric properties of oral motor dysfunction measures for preschool children with cerebral palsy

Developmental Medicine & Child Neurology, 2012

This systematic review evaluates assessments used to discriminate, predict, or evaluate the motor... more This systematic review evaluates assessments used to discriminate, predict, or evaluate the motor development of preterm infants during the first year of life. Eighteen assessments were identified; nine met the inclusion criteria. The Alberta Infant Motor Scale (AIMS), Bayley Scale of Infant and Toddler Development -- Version III, Peabody Developmental Motor Scales -- Version 2, Test of Infant Motor Performance (TIMP), and Toddler and Infant Motor Examination have good discriminative validity when examined in large populations. The AIMS, Prechtl&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Assessment of General Movements (GMs), Neuro Sensory Motor Development Assessment (NSMDA), and TIMP were designed for preterm infants and are able to detect more subtle changes in movement quality. The best predictive assessment tools are age dependent: GMs, the Movement Assessment of Infants, and TIMP are strongest in early infancy (age 4 mo or less) and the AIMS and NSMDA are better at older ages (8-12 mo). The TIMP is the only tool that has demonstrated a difference between groups in response to intervention in two randomized controlled trials. The AIMS, TIMP, and GMs demonstrated the highest levels of overall reliability (interrater and intrarater intraclass correlation coefficient or kappa&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.85). Selection of motor assessment tools during the first year of life for infants born preterm will depend on the intended purpose of their use for discrimination, prediction, and/or evaluation.

Research paper thumbnail of Reported and observed clinical signs of oropharyngeal aspiration in young children with cerebral palsy

Reported and observed clinical signs of oropharyngeal aspiration in young children with cerebral palsy

Developmental Medicine & Child Neurology, 2011

Research paper thumbnail of Relationship between body composition and functional ability in preschool children with cerebral palsy

Relationship between body composition and functional ability in preschool children with cerebral palsy

Developmental Medicine & Child Neurology, 2012

Research paper thumbnail of Energy intake and reported feeding dysfunction in pre-school children with cerebral palsy

Energy intake and reported feeding dysfunction in pre-school children with cerebral palsy