Gait analysis, like all clinical assessments, is subject to measurement error. Specification of the extent of measurement error is imperative before drawing conclusions from any test. The purpose of this study was to determine the within-rater and between-rater reliability of observational gait analysis in a pediatric sample wearing knee-ankle-foot orthoses. Three expert observers, using a 3-point scale, rated videotaped gait kinematics of 15 children who had lower limb disability and who wore braces. The rating sessions were then repeated, with one month between sessions. Total agreement (identical ratings), both between-raters and within-raters, occurred in two-thirds of the observations, and an additional 29% of the observations differed by one point. Between-rater intraclass correlation coefficient type 2, 1 was .73; within-rater Pearson product-moment correlation averaged .60. Observational kinematic gait analysis appears to be a convenient, but only moderately reliable, technique.
A school-based asthma curriculum designed specifically for urban students has been shown to reduce symptoms, activity limitations, and health care utilization for intervention participants.
Children with amputations present challenging management problems. Surgical management, prosthetic fitting options, and training regimens have progressed substantially over the past several decades. Clinicians should be familiar with the available technological options to provide children with amputations the best possible care. The plethora of small components available for lower- and upper-limb prostheses indicates the desirability of managing juvenile patients in an interdisciplinary, specialized clinical setting where the advantages and disadvantages of prosthetic options can be related to the particular needs and wishes of each young client and the client's family. Although prostheses are not anatomical avatars, careful appliance prescription and training, coordinated with the child's growth and developmental changes, can optimize the benefits the child derives from the prosthesis.
Asthma is a leading cause of hospitalizations, acute care utilization, health care costs, and school absences in children. Asthma morbidity is disproportionately high in inner city populations. In general, community-based public health interventions to reduce asthma morbidity have had modest success due in part to their limited reach and low participation by the targeted population. Adolescents have been especially difficult to reach. A coalition of community organizations developed a school-based, population-level system to identify, prioritize, and provide interventions for middle school children with asthma in a large urban school district in Oakland, CA. Nearly 92% (n = 8,326) of students in the targeted schools took an asthma case identification survey. Of those students who took the survey, 17.5% (n = 1,458) had active asthma and were eligible for services. Among those identified with active asthma, 83% (n = 1,217) voluntarily attended asthma self-management classes at school. The 4-week curriculum previously has been shown to significantly improve several indicators of asthma control in this population. Retention was high-72% of students who enrolled attended at least three of the four curriculum sessions. Many higher-risk students were subsequently referred to and enrolled in off-site asthma services. Large school districts with incomplete or inadequate health records, high asthma prevalence, and internal or external services available for students with asthma may benefit from a similar model. A system such as the one described may be an effective public health strategy for school districts, health departments, and community coalitions addressing asthma or other conditions with high childhood prevalence.
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