Remote Assessment of Physical Function in Adults with Cerebral Palsy: A Feasibility Study

ABSTRACT

Background and Objective(s) In pediatric-onset conditions such as cerebral palsy (CP), physical function may continue to decline with age. For many individuals, however, these changes may not be addressed by health care providers once patients transition to adulthood. This has been further exacerbated by COVID-19 which has limited or suspended non-essential, in-person clinical visits. As a result, remote delivery of health care has taken on greater importance. The purpose of this study was to determine the feasibility of remotely assessing physical function in adults with cerebral palsy. The Short Physical Performance Battery (SPPB) was used as the primary outcome assessment since it covers balance, functional strength, and mobility. Study Design: Prognosis study with a cross-sectional design. Study Participants & Setting: Twenty adults with CP (Mean age=44.1+/-10.8) and GMFCS I to III were recruited using CP support groups on social media sites. The assessments were performed in the participant's home and monitored using video conferencing software. Participants were given written instructions as to how to set up their at-home testing area so that their movements could be properly observed. Materials/Methods: All components of the SPPB were administered, including timed measures of balance (side by side, semi-tandem, tandem), gait speed, and repeated chair stand. Additional tests included the Timed Up and Go, the Romberg Test, and the reaching and manipulation components of the Wolf Motor Function Test (WMFT). Result(s) Feasibility was assessed based on the number of participants who were able to complete all assessments, do so safely without any adverse events such as loss of balance, and complete the assessments so that their scores fell within the standardized norms. The average testing time was 32 +/-6.9 min. Nineteen adults (95%) completed all assessments. Sixteen (80%) adults were able to complete the assessments without any adverse events (momentary loss of balance). Ten adults had SPPB scores that fell within the normative SPPB range. Lower SPPB scores were indicative of a slower working pace or the use of an assistive device (e.g., posterior walker). All 20 participants fell within the normative values for the 9 WMFT items. Conclusions/Significance: This feasibility study shows that remote assessment of physical function can be performed accurately and efficiently in adults with CP who do not use assistive devices. For those with more limited mobility, assessing function remotely may still be of value. However, it is important that assessments of physical function are designed or adapted for those with mobility differences. Future studies are needed that incorporate modifications to existing assessment methods to gain a better understanding of physical ability in adults with CP regardless of functional status.