Upper Extremity Strength Measurement for Children With Cerebral Palsy: A Systematic Review of Available Instruments

Background In order to make inferences about strength related to development or treatment interventions, it is important to use measurement instruments that have sound clinimetric properties. Purpose The objective of this review is to systematically evaluate the level of evidence of the clinimetric properties of instruments for measuring upper extremity muscle strength at the “body functions & structures” level of the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) for children with cerebral palsy (CP). Data Sources A systematic search of the PubMed, EMBASE, OTseeker, CINAHL, PEDro, and MEDLINE databases up to November 2012 was performed. Study Selection Two independent raters identified and examined studies that reported the use of upper extremity strength measurement instruments and methods for children and adolescents with CP aged 0 to 18 years. Data Extraction The COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) checklist with 4-point rating scale was used by 2 independent raters to evaluate the methodological quality of the included studies. Best evidence synthesis was performed using COSMIN outcomes and the quality of the clinimetric properties. Data Synthesis Six different measurement instruments or methods were identified. Test-retest, interrater, and intrarater reliability were investigated. Two test-retest reliability studies were rated as “fair” for the level of evidence. All other studies were rated as “unknown” for the level of evidence. Limitations The paucity of literature describing clinimetric properties, especially other than reliability, of upper limb strength measurement instruments for children with CP was a limitation of the study. Conclusions For measuring grip strength, the Jamar dynamometer is recommended. For other muscle groups, handheld dynamometry is recommended. Manual muscle testing (MMT) can be used in case of limited (below MMT grade 4) wrist strength or for total upper limb muscle strength. Based on lacking information regarding other clinimetric properties, caution is advised regarding interpretation of the results.

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Comparison between the Melbourne Assessment of unilateral upper limb function and the quality of upper extremity skills test (QUEST) in children with hemiplegic cerebral palsy

Gait & Posture ◽

10.1016/j.gaitpost.2006.11.168 ◽

2006 ◽

Vol 24 ◽

pp. S245-S247 ◽

Cited By ~ 1

Author(s):

Katrijn Klingels ◽

Hilde Feys ◽

Kaat Desloovere ◽

Catherine Huenaerts ◽

Ine Van Nuland ◽

...

Keyword(s):

Cerebral Palsy ◽

Upper Extremity ◽

Upper Limb ◽

Limb Function ◽

Upper Limb Function ◽

Hemiplegic Cerebral Palsy

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Hand-held dynamometry for muscle strength measurement in children with cerebral palsy

Developmental Medicine & Child Neurology ◽

10.1111/j.1469-8749.2007.00106.x ◽

2007 ◽

Vol 49 (2) ◽

pp. 106-111 ◽

Cited By ~ 65

Author(s):

Jodi Crompton ◽

Mary P Galea ◽

Bev Phillips

Keyword(s):

Cerebral Palsy ◽

Muscle Strength ◽

Strength Measurement ◽

Children With Cerebral Palsy ◽

Muscle Strength Measurement

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Test-Retest and Inter- and Intrareliability of the Quality of the Upper-Extremity Skills Test in Preschool-Age Children With Cerebral Palsy

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2007.07.030 ◽

2007 ◽

Vol 88 (12) ◽

pp. 1686-1689 ◽

Cited By ~ 25

Author(s):

Nienke Haga ◽

Hélène C. van der Heijden-Maessen ◽

Jessika F. van Hoorn ◽

Anne M. Boonstra ◽

Mijna Hadders-Algra

Keyword(s):

Cerebral Palsy ◽

Upper Extremity ◽

Preschool Age ◽

Preschool Age Children ◽

Children With Cerebral Palsy

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An Instrumentation Approach for Assessing the Effects of a Hand Positioning Device on Reaching Motion of Children with Cerebral Palsy

The Occupational Therapy Journal of Research ◽

10.1177/153944929201200502 ◽

1992 ◽

Vol 12 (5) ◽

pp. 278-295 ◽

Cited By ~ 1

Author(s):

Denise T. Reid

Keyword(s):

Cerebral Palsy ◽

Upper Extremity ◽

Movement Time ◽

Single Point ◽

Three Dimensional ◽

Future Research ◽

Hand Position ◽

Children With Cerebral Palsy ◽

Positioning Device

The effects of a hand positioning device (HPD) on the quality of upper-extremity movement of five children with cerebral palsy were examined in this pilot study. Hand position was monitored during a reaching task using a single-point, 3°-of-freedom, three-dimensional tracker device. Three-dimensional path length, average velocity, movement time, response time, and the number of accelerations and decelerations (movement units) were measured. Operational definitions for each of these variables were developed for this study. Each subject performed 15 reaching trials at a pretest and posttest. A 6-week intervention period followed the pretest where each subject wore the HPD for 1 hour daily for functional activities. Group results showed no significant differences for any of the variables being measured. However, individual data analysis revealed that the HPD has the potential for modifying the quality of reaching motions in some children with cerebral palsy. The nature of the changes observed among these five subjects is discussed, as well as suggestions for future research studies. Finally, this initial study shows that the tracker is a sensitive method for recording qualitative changes in the upper-extremity motion of children with cerebral palsy in occupational therapy research.

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Effects of Virtual Reality-Based Rehabilitation on Upper Extremity Function among Children with Cerebral Palsy

Healthcare ◽

10.3390/healthcare8040391 ◽

2020 ◽

Vol 8 (4) ◽

pp. 391

Author(s):

Hyun Jung Chang ◽

Kyo Hun Ku ◽

Young Sook Park ◽

Jin Gee Park ◽

Eun Sol Cho ◽

...

Keyword(s):

Virtual Reality ◽

Cerebral Palsy ◽

Upper Extremity ◽

Medical Records ◽

Rehabilitation Program ◽

Upper Extremities ◽

Extremity Function ◽

Children With Cerebral Palsy ◽

Upper Extremity Function

Background: Deterioration in upper extremity function has been a common problem among children with cerebral palsy (CP). The present study evaluated the effects of virtual reality (VR)-based rehabilitation combined with conventional occupational therapy (COT) on upper extremity function and caregiver assistance among children with CP. Methods: Medical records of 17 children with CP who regularly participated in a rehabilitation program at Samsung Changwon Hospital were retrospectively reviewed. Ten children received VR-based rehabilitation, which utilized RAPAEL Smart Kids and video games combined with COT. Seven children received COT alone, which was provided by a trained occupational therapist and focused on their upper extremities. Clinical outcomes were determined using the Quality of Upper Extremity Skills Test (QUEST) and Pediatric Evaluation of Disability Inventory (PEDI), which were administered before and 8 weeks after the first intervention session. Results: The smart glove (SG) group showed significant improvements in all QUEST domains and five PEDI domains (p < 0.05), whereas the COT group showed a significant change only in total QUEST scores. A comparison between both groups revealed that the SG group had significantly greater improvements in five QUEST domains and two PEDI domains (p < 0.05). Conclusions: Our results suggest that VR-based rehabilitation combined with COT may improve the upper extremity functions and decrease caregiver burden among children with CP.

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