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Trunk Control Measurement Scale (TCMS)
Availability
Please see Appendix A in Heyrman et al., 2011 for more information about the instrument: TrunControl Measurement Scale.
Classification
Supplemental: Cerebral Palsy (CP)
Short Description of Instrument
Construct measured: Static and Dynamic Sitting Balance.
Generic vs. disease specific: Disease specific
Means of administration: Examiner administered.
Intended respondent: Administrator.
Background: The Trunk Control Measurement Scale (TCMS) was constructed, based on the Trunk Impairment Scale with with adaptations specifically for the clinical features of impaired trunk control in children with cerebral palsy (CP).The TCMS consists of two sections: static sitting balance and dynamic sitting balance. 'Dynamic sitting balance' is further divided into two subscales: selective movement control and dynamic reaching. The ‘static sitting balance’ evaluates static trunk control during movements of upper and lower limbs. The subscale ‘selective movement control’ measures selective trunk movements in three planes (flexion/extension, lateral flexion, rotation) within the base of support. The subscale ‘dynamic reaching’ evaluates the performance during three reaching tasks, requiring active trunk movements beyond the base of support. The total scale contains 15 items, with the subscales consisting of five, seven and three items, respectively.
Comments/Special Instructions
Children need to have some level of independent sitting ability. Testing should be performed without orthoses, shoes, or a trunk brace. The participant is positioned sitting on the edge of a treatment table without back, arm or feet support and posterior thighs in full contact with the table. The hands should be resting on the legs and close to the body. The participant should be instructed to sit upright at the start of each item and encouraged to maintain the upright position during the task. This position is as upright as the child can be and is the reference position for  identification of aberrations in performance and/or compensations. Each item is performed three times. The best performance counts for scoring. If the child  performs the tasks of subscale ‘static sitting balance’ with single arm support, only support with the hand flat on the table without grasping is allowed.
Scoring
Scoring: All items are scored on a two-, three- or four-point ordinal scale and administered bilaterally in case of clinical relevance. The total score of the TCMS ranges from 0 to 58, with a higher score indicating a better performance (Heyrman et al., 2011).
Rationale/Justification
Strength/Weaknesses: It has been used to measure trunk control in children with CP of GMFCS levels I-IV, but only validated in children with GMFCS levels I-III.
Psychometric Properties: Validated in 26 children with spastic CP ages 8–15 years; GMFCS level I-III . Intraclass correlation coefficients (ICC) ranged from 0.91 to 0.99   for inter-rater and test–retest reliability. Kappa and weighted kappa values ranged  for all but one item in the TCMS from 0.45 to 1, with lower scores in leg abduction (Item 5), reaching (Item 8), and lifting pelvis (Item 9). The standard error of measurement was 2.9% and 3.4%, and the smallest detectable difference for repeated measurements was 8% and 9.43% between raters and test–retest, respectively. Cronbach's alpha coefficients were 0.82 (static sitting balance subscale), 0.89 (selective movement control subscale), 0.90 (dynamic reaching subscale), 0.94 (total TCMS). Spearman rank correlation with the GMFM-88 was 0.88 with statistically significant correlations in dimensions B to E. Subscale and total TCMS scores showed significant differences between children with CP and TD children (p< 0.0001).
References
Heyrman L, Desloovere K, Molenaers G, Verheyden G, Klingels K, Monbaliu E, Feys H. Clinical characteristics of impaired trunk control in children with spastic cerebral palsy. Res Dev Disabil. 2013;34(1):327–334.
Heyrman L, Molenaers G, Desloovere K, Verheyden G, De Cat J, Monbaliu E, Feys H. A clinical tool to measure trunk control in children with cerebral palsy: the Trunk Control Measurement Scale. Res Dev Disabil. 2011;32(6):2624–2635.
Mitteregger E, Marsico P, Balzer J, van Hedel HJ. Translation and construct validity of the Trunk Control Measurement Scale in children and youths with brain lesions. Res Dev Disabil. 2015;45-46:343–352.
Pham HP, Eidem A, Hansen G, Nyquist A, Vik T, Saether R. Validity and Responsiveness of the Trunk Impairment Scale and Trunk Control Measurement Scale in Young Individuals with Cerebral Palsy. Phys Occup Ther Pediatr. 2016:1–13.
Saether R, Helbostad JL, Riphagen, II, Vik T. Clinical tools to assess balance in children and adults with cerebral palsy: a systematic review. Dev Med Child Neurol. 2013;55(11):988–999.
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