The content validity of the Tardieu Scale and the Ashworth Scale was assessed in 27 independently ambulant children with cerebral palsy (gender: 17 males, 10 females; age: 5-9 years; Gross Motor Function Classification: level I and II). Ashworth and Tardieu Scale scores and laboratory measures of spasticity and contracture were collected from the plantarflexor muscles by 2 examiners who were blinded to the results. The Tardieu Scale was more effective than the Ashworth Scale in identifying the presence of spasticity (88.9%, kappa = 0.73; P = .000), the presence of contracture (77.8%, kappa = 0.503; P = .008) and the severity of contracture (r = 0.49; P = .009). However, neither scale was able to identify the severity of spasticity. The Tardieu Scale can provide useful information in children with cerebral palsy because it differentiates spasticity from contracture. However, a more comprehensive clinical method of testing neural and non-neural contributions to impairments and function is needed.

Emotions and confidence are said to play an important role in the career decision-making process. The present study, comprising 472 students attending a large university in the United Kingdom, advances current thinking in this area in two ways. First, by identifying specific emotional intelligence (EI) abilities that are key to decision making, and second, by exploring the role of career decision self-efficacy (CDSE) as a potential mediator in the relationship between EI and career decision-making difficulties (CDD). Regression and mediation analyses indicated that EI was negatively related to CDD and that effects were strongest for self-emotion appraisal. EI was also positively related to CDSE, with use of emotion eliciting the strongest effect. Career decision self-efficacy was largely found to mediate the relationship between overall and specific abilities of EI and CDD, with full mediation effects observed for self-emotion appraisal and use of emotion and various difficulties. The findings and limitations are discussed with reference to the literature together with practical implications for career counseling and suggestions for future research.

AIM Previous studies have shown the efficacy of botulinum toxin type A (BoNT-A) in the management of ambulant individuals with cerebral palsy (CP). There is little evidence on its use in nonambulant children with CP. This review aimed to investigate indications and efficacy for BoNT-A use in managing pain, care, and comfort, and improving function in children with CP in Gross Motor Function Classification System (GMFCS) levels IV and V.METHOD Electronic databases were searched from the earliest available date to June 2012 using a combination of subject headings and free text. Inclusion criteria consisted of studies with (1) participants aged 18 or under, (2) participants with CP in GMFCS levels IV and V, (3) participants receiving BoNT-A treatment, and (4) studies published in English-language peer-reviewed journals. RESULTSThe search resulted in a total of 814 studies, of which 19 met the inclusion criteria.Eighteen studies provided level IV or V evidence and one level I evidence according to the American Academy for Cerebral Palsy and Developmental Medicine guidelines for the development of systematic reviews. Most of the studies were of weak to moderate methodological quality.INTERPRETATION The evidence that BoNT-A is effective in reducing postoperative pain in children with CP in GMCFS levels IV and V is limited, with only one level I study identified. Remaining indications were general pain reduction, maintaining hip integrity, achieving functional changes, and goal attainment. A high percentage of participants in the studies showed positive changes in these areas. With the poor level of evidence of the included studies, no definite conclusion could be drawn on the indications for BoNT-A use in children with CP in GMCFS levels IV and V. Further investigation by rigorous studies is required.

In patients with chronic CRPS, detailed clinical examination may reveal parietal dysfunction, with severity relating to the extent of allodynia.

ITB Intrathecal baclofenAIM Studies on the use of intrathecal baclofen (ITB) for ambulant adults with spasticity and ⁄ or dystonia of cerebral origin are scarce, and are even more limited for children and adolescents. This systematic review investigates the use of ITB to improve walking, transfer ability, and gross motor activities in ambulant children and adolescents with spasticity and ⁄ or dystonia of cerebral origin.METHOD Electronic databases (MEDLINE, CINAHL, PsycINFO, EMBASE, full Cochrane Library, and PEDro) were searched from the earliest date available until March 2011 using combined subject headings and free text if supported by the databases. Studies were included if they had examined individuals who: (1) received ITB therapy by any method (bolus injection, an external delivery system, or an implanted pump); (2) had spasticity and ⁄ or dystonia of cerebral origin; (3) were able to ambulate with or without a walking device, i.e. individuals with cerebral palsy (CP) who were in levels I to III of the Gross Motor Function Classification System or individuals with similar functional mobility if they did not have CP; and (4) were aged 18 years or under. Publications in English in peer-reviewed journals reporting any type of research design, except reviews and expert opinions, were included. Studies were excluded if participants had spasticity and ⁄ or dystonia of spinal origin and if baclofen was administered only orally. Studies that compared ITB with other interventions such as botulinum toxin were also excluded.RESULTS Two independent reviewers scored 16 studies against the guidelines for developing systematic reviews from the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM).INTERPRETATION Fifteen studies were of levels IV or V evidence and only one of level II according to the evidence levels of the AACPDM guidelines, but all were of low quality. No study was found on the use of ITB in ambulant children or adolescents with dystonia of cerebral origin. Not all studies used objective outcome measures to assess the ambulation, transfer ability, and gross motor activities of the participants. A proportion of participants showed improvement in all these areas but adverse events were common. A proportion of participants compromised their ambulatory and transfer abilities after ITB. There was no evidence to support the clinical use of ITB in ambulant individuals with hypertonicity without further rigorous longitudinal studies.Spasticity is a velocity-dependent increase in resistance of a muscle when stretched, 1 and is one of the common signs of an upper motor neuron lesion. Spasticity can make movements difficult and inefficient, which in turn contributes to the formation of contractures, discomfort, and muscle spasms, and thus interferes with activities of daily living such as feeding, toileting, dressing, and positioning. 2,3 One of the pharmacological agents used in treating spasticity is baclofen, an agonist of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). 4 Baclo...