Translation and cross cultural adaptation of the Pediatric Motor Activity Log-Revised scale

Abstract

Cerebral palsy (CP) describes a group of disorders of movement and posture that are attributed to a non-progressive disorder in the immature brain and often limit functional activities 1 . Children with spastic hemiplegia, which is one type of CP, can experience difficulty in using the affected upper limb (AUL) -the limb contralateral to the lesion -because of poor selective motor control, muscle weakness, a stereotyped posture, and sensory deficits. These difficulties make attempts to use the AUL less frequent, and favor compensatory strategies in which the unaffected limb is used to perform functional activities. This can culminate in a cycle that results in decreased cortical representation of the affected segment because of disuse, thus developing the phenomenon known as "learned nonuse" 2 .Traditionally, the functionality of the AUL has been evaluated by observing motor performance during tests conducted in the clinic. However, the use of the AUL in this context often fails to reflect how the child actually performs in the real world 3,4 . The relationship between performance assessed by tests in the clinic environment and the spontaneous use of the AUL outside the therapeutic setting has not been established. Clinic-based tests do not take into consideration the phenomenon of learned nonuse, and therefore the effects of rehabilitation on everyday function are not properly evaluated 3,4 . A standardized instrument developed specifically to evaluate the function and spontaneous use of the AUL in children aged 2-8 years with CP is the Pediatric Motor Activity Log AbsTRACTThe standardized instrument developed to assess the use of the affected upper limb in children with cerebral palsy (CP) is the Pediatric Motor Activity Log Revised (PMAL-R). Objectives: To translate PMAL-R and adapt for the Brazilian culture; analyze the reliability and the internal consistency of the Brazilian version. Method: Translation of PMAL-R to the Portuguese-Brazil and back translation. The back-translated version was revised by the authors of the scale. The final version was administered to a sample of 24 patients with spastic hemiparesis CP between 2-8 years. Results: The reliability intra and inter-rater were suitable (how often = 0.97 and 0.98, how well = 0.98 and 0.99 respectively) and so the internal consistency (0.98). Conclusion: The Brazilian version of PMAL-R has adequate internal consistency, reliability intra and inter raters and can be used to assess the spontaneous use of the upper limb of children with CP type spastic hemiparesis, aged 2-8 years.Keywords: cerebral palsy; upper extremity; activities of daily living; evaluation. ResuMoA Pediatric Motor Activity Log-Revised (PMAL-R) é um instrumento padronizado desenvolvido para avaliar o uso do membro superior afetado em crianças com paralisia cerebral (PC). Objetivos: Traduzir a PMAL-R e fazer sua adaptação transcultural para o Português do Brasil; analisar a confiabilidade e a consistência interna da versão brasileira. Métodos: Tradução e retrotradução da PMAL-R. A ve...