title: Quantification of upper extremity function and range of motion in children with cerebral palsy.
abstract: This study evaluated the hypothesis that upper extremity function and range of motion can be quantified reliably in children with cerebral palsy (CP) in a busy clinical setting. The specific aim was to determine the inter- and intrarater reliability of a modified House Functional Classification (MHC) system to evaluate upper extremity function and a standardized instrument to document upper extremity range of motion (Upper Extremity Rating Scale [UERS]). Sixty-five children with CP (43 males, 22 females, mean age 9y 2mo, SD 4y 1mo) with spasticity involving the upper extremity (quadriplegia n=22; hemiplegia n=36; diplegia n=7; Gross Motor Functional Classification System Levels I n=41, II n=6, III n=3, IV n=5, V n=10) were evaluated independently by occupational therapists and orthopedic surgeons using both instruments at several visits. Inter- and intrarater reliability were determined for both instruments by calculating measures of agreement (weighted kappa values and intraclass correlation coefficients [ICCs]). Interrater agreement (ICC=0.94) and intrarater agreement (ICC=0.96) on the MHC were good to excellent. Similarly, inter-rater agreement (kappa 0.66-0.81) and intrarater agreement (kappa 0.64-0.88) on the UERS was either good or excellent. The MHC and the UERS provide standardized, reliable, reproducible, and efficient instruments that can be used by occupational therapists and orthopedic surgeons to evaluate the upper extremities of children with CP.
authors.affiliation: Southern Orthopaedic Specialists, Panama City, FL, USA.
authors.forename: L Andrew
authors.initials: LA
authors.lastname: Koman
authors.forename: Rafael M M
authors.initials: RM
authors.lastname: Williams
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Evans
authors.forename: Rachel
authors.initials: R
authors.lastname: Richardson
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Naughton
authors.forename: Leah
authors.initials: L
authors.lastname: Passmore
authors.forename: Beth Paterson
authors.initials: BP
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology / Q000534:rehabilitation; D002648:Child; D002675:Child, Preschool; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008297:Male; D009460:Neurologic Examination / Q000706:statistics & numerical data*; D015588:Observer Variation; D009788:Occupational Therapy; D009985:Orthopedics; D011596:Psychomotor Disorders / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology / Q000534:rehabilitation; D016059:Range of Motion, Articular / Q000502:physiology*; D015203:Reproducibility of Results