Construct validity of the wrist position sense test and functional tactile object recognition test
Developmental Medicine & Child Neurology · 2015
sures of impairment, activity and participation, the standard indications for surgical treatment of upper extremity cerebral palsy (UECP) are impairment measures, primarily active and passive range of motion (ROM).Recently, validated activity measures have been developed for children with UECP.The purposes of this study were to determine the relationship between impairment and activity measures in this population, and whether measures of activity correlate with each other. Study Design: Prospective multi-center validating cohort study.Level of evidence: diagnostic level II.Study Participants and Setting: Children age 5-16 years with primarily spastic UECP, who were deemed candidates for upper extremity reconstruction (pronator teres release, flexor carpi ulnaris to extensor carpi radialis brevis transfer, adductor pollicis release and extensor pollicis longus re-routing) using standard indications for these operations under a protocol prospectively developed by participating surgeons and occupational therapists.Materials/Methods: 37 children ages 5-16 years who met standard ROM surgical indications for UECP were evaluated with the impairment measures of active and passive ROM and stereognosis, as well as three activity measures (Assisting Hand Assessment (AHA), Box and Blocks Test, and the Shriners Hospitals Upper Extremity Evaluation Dynamic Positional Analyses (SHUEE DPA)).Impairment measures were correlated with activity measures using Spearman's rank correlation co-efficients.Results: Impairment measures showed inconsistent correlation with activity measures.Of 12 comparisons, only four correlated: active forearm supination (q = 0.47, p = 0.003), wrist extension (q = 0.55, p = 0.001), and stereognosis scores (q = 0.54, p = 0.001) were correlated with AHA; and wrist extension was correlated with the SHUEE DPA (q = 0.41, p = 0.01).When the results of activity tests were compared, the AHA was correlated with the Box and Blocks tests (q = 0.63 p < 0.001), and the SHUEE DPA and Box and Blocks tests were correlated with each other (q = 0.35; p = 0.04).Conclusions/Significance: The goal of surgery in UECP is to improve the child's ability to perform activities, and ultimately to participate in life situations.Impairment measures, such as ROM, were inconsistently correlated with validated measures of activity.Some activity measures correlated with each other, although they did not correlate with the same impairment measures.We conclude that impairment measures, including ROM, do not consistently predict functional dynamic ROM used to perform activities for children with UECP.Activity limitation measures may provide more appropriate indicators than impairment measures for upper extremity surgery for this population.