Reliability of the Clinical Measurement of Joint Motion and Muscle Length in the Upper and Lower Extremities of Children with Cerebral Palsy: A Systematic Review.

Reliability of joint motion and muscle length measurement in children with cerebral palsy was examined. Twenty-one studies of intraobserver and/or interobserver reliability were reviewed: joint motion of upper extremities in four and lower extremities in 13; muscle length of upper extremities in one and lower extremities in 15. Intraclass correlation coefficients for goniometric interobserver reliability varied widely for joint motion (range 0.38-0.92) and muscle length (range 0.20-0.95). Inclusion of an error measurement to provide clinicians with a value indicating true change was limited. Further research is required to determine intraobserver and interobserver reliability for these important pediatric clinical measurements.

Reliability of the Clinical Measurement of Upper and Lower Extremity Joint Motion in the Pediatric Population: A Systematic Review.

AIM: To examine intraobserver and interobserver reliability of the clinical measurement of pediatric joint motion of upper and lower extremities, based on participant condition and measurement technique. METHODS: PubMed, CINAHL, and Web of Science were searched using combinations of children or adolescents, range of motion, and reliability. Reference lists and citations of reviewed studies were searched for additional publications. RESULTS: Thirty-one studies of pediatric samples of developing typically, orthopedic injuries, athletes, cerebral palsy, and other diagnoses were reviewed. For techniques, measurements were made most frequently with a goniometer followed by visual estimation, inclinometer, smartphone apps, and specialized devices. The reliability of hip abduction measurements of participants with cerebral palsy was evaluated most often and varied widely for both intraobserver and interobserver. In general, goniometric results indicated greater reliability for upper than lower extremities and for intraobserver than interobserver. As the other techniques were each utilized in only a few studies, involving different participant conditions, joint motions and statistics, the analysis of their reliability was limited. CONCLUSIONS: Intraobserver and interobserver reliability have not been established for pediatric joint motion measurements. Further research should include various joint motion measurements for different pediatric conditions using appropriate statistics. Results would provide important information for making clinical decisions.

Design and Use of a 3D-Printed Dynamic Upper Extremity Orthosis for Children With Cerebral Palsy and Severe Upper Extremity Involvement: A Pilot Study.

IMPORTANCE: Children with cerebral palsy (CP) and severe hand impairment have limited options for upper extremity (UE) orthoses. OBJECTIVE: To (1) design and fabricate a customized low-cost, functional, three-dimensional (3D) printed dynamic upper extremity orthosis (DUEO) and (2) examine, using a comprehensive evaluation, the effect of the orthosis on the UE function of children with unilateral UE CP, Manual Ability Classification System (MACS) Levels III to V. DESIGN: Pilot study. Assessments were performed pretreatment and immediately posttreatment. SETTING: Hospital-based outpatient occupational therapy department. PARTICIPANTS: Five patients, ages 13 to 17 yr, with CP and unilateral UE involvement MACS Levels III to V. INTERVENTION: Custom forearm thumb opponens orthosis and the DUEO were designed and fabricated by a multidisciplinary team for use during eight 1-hr occupational therapy sessions targeting bimanual UE training. OUTCOMES AND MEASURES: Pretreatment and posttreatment assessments included the Assisting Hand Assessment (AHA), Melbourne Assessment 2 (MA-2), Pediatric Motor Activity Log-Revised (PMAL-R), and the Pediatric Quality of Life Inventory: CP Module (PedsQL:CP). RESULTS: All participants had higher posttreatment scores on at least one measure. Four had minimal clinically important differences (MCID) on the AHA. Three met MCID criteria on MA-2 subtests (one negative change). Four demonstrated improvement on the PMAL-R (one participant achieved an MCID score), and three reported improvements in more than one PedsQL:CP domain. CONCLUSIONS AND RELEVANCE: This novel 3D-printed device, in combination with occupational therapy, shows promising evidence that children who score in lower MACS levels can show gains in UE function. What This Article Adds: This study demonstrates that a customized, 3D-printed dynamic orthosis, in combination with occupational therapy intervention, can facilitate UE function in children with severe hand impairment.

Combined clinic and home-based therapeutic approach for the treatment of bilateral radial deficiency for a young child with Holt-Oram syndrome: A case report.

BACKGROUND: Holt-Oram syndrome (HOS) is a rare, genetic condition characterized by the combination of congenital heart defect and hypoplasia in one or both upper extremities. Children with HOS commonly present with varied joint and limb involvement including radial longitudinal deficiency impacting hand function. Evidence-based guidelines regarding orthotic wear and therapeutic techniques are lacking. PURPOSE: The aim of this case report was to present the results of a long-term occupational therapy program for a patient with HOS pre and postpollicization. STUDY DESIGN: Case report. METHODS: A 4-month-old patient with bilateral radial longitudinal deficiencies began outpatient occupational therapy for custom orthosis fabrication and treatment which included long term clinic and home-based intervention. Techniques included passive range of motion, orthosis wear, therapeutic taping, and modified constraint induced movement therapy. Longitudinal assessment of musculoskeletal alignment and functional hand use was performed using goniometry for passive and active range of motion, the Assisting Hand Assessment (AHA), and The Thumb Grasp and Pinch Assessment (T-GAP). RESULTS: Improvement in passive and active range of motion was achieved as well as improved activity level function as measured by the AHA and T-GAP postpollicization and intervention. CONCLUSIONS: A combined clinic and home-based therapeutic approach can be effective for children with HOS to improve alignment and function pre and postpollicization to further enhance hand function. Comprehensive, long-term assessment is necessary to fully evaluate and communicate improvement.