Upper limb kinematics: development and reliability of a clinical protocol for children

This study proposed a child-friendly measurement procedure for the three-dimensional analysis of upper limb movements, based on a comprehensive movement protocol. Within and between session reliability was tested in a group of 10 typically developing children (TDC) (mean age 10.3±3.2 years). The movement protocol was constructed for children with hemiplegic cerebral palsy (HCP) and contained three reach tasks (forwards, upwards, sideways), three reach-to-grasp tasks (with objects requiring different hand orientations) and three gross motor tasks. Upper limb kinematics were calculated following the ISB-guidelines. Reliability of movement duration/speed and endpoint joint angles was assessed with the intraclass correlation coefficient; similarity of the waveforms with the coefficient of multiple correlation; measurement errors were also calculated. Reliability coefficients were generally high for movement duration/speed and most kinematic parameters. Endpoint angles for scapular tilting, shoulder elevation plane and elevation, elbow flexion-extension and wrist ulnar-radial deviation showed highest reliability. Angular waveforms were best repeated for scapular medio-lateral rotation and pro-retraction, shoulder elevation plane and elevation, and elbow flexion-extension. Results also seemed task-dependent. This study indicated that the proposed procedure could be used reliably to quantify upper limb movements in TDC. However, to compose proper age-related standards for the different tasks, larger study samples are needed. This will also help with a well-founded task-selection depending on the joints of interest. Finally, further research will need to establish the reliability in children with HCP.