Development of a Clinical Framework for the Assessment of Dyskinesia and Function in the Upper Limb in Children with
Edward Ralph1, Kate Carroll2,3,4, Marcella Danks5
1Allied Health, Hummingbird House, Chermside, Australia.
Insights
A new framework helps assess upper limb function in children with cerebral palsy (CP) and dyskinesia. This guide improves consistent assessment and personalized management for better outcomes.
Area of Science:
- Neurology
- Pediatric Rehabilitation
- Movement Disorders
Background:
- Dyskinesia in cerebral palsy (CP) presents a significant challenge to upper limb function in children.
- Current assessment practices for upper limb function in children with CP and dyskinesia lack a standardized consensus.
- This variability hinders effective and individualized patient management strategies.
Purpose of the Study:
- To develop a comprehensive clinical framework for assessing the impact of dyskinesia on upper limb function in children with CP.
- To establish a consensus-based approach for selecting appropriate assessment tools.
- To guide clinicians toward more consistent and effective assessment practices.
Main Methods:
- A modified Delphi study was employed, utilizing expert consensus from a panel of six experienced Australian therapists.
- Therapists ranked assessment tools from evidence-based literature using a five-point Likert scale over two survey rounds.
- A third-stage discussion refined the selection, with tools rated as important by 80% of respondents being included.
Main Results:
- A framework was developed, incorporating 12 out of 21 initially reviewed assessment tools.
- The included tools were categorized into five key areas: screening for dyskinesia, measuring dyskinesia severity, classifying upper limb function, measuring upper limb function, and measuring upper limb movement.
- This structured approach provides a clear pathway for comprehensive assessment.
Conclusions:
- The developed framework offers guidance for clinicians to consistently assess the impact of dyskinesia on upper limb function in children with CP.
- Implementation of this framework is expected to facilitate more individualized and goal-directed management plans.
- Further validation with larger expert groups is recommended to enhance the framework's utility and applicability.
Objective:
Dyskinesia in cerebral palsy (CP) is a complex movement disorder that can significantly impact upper limb function. Despite a range of available tools, there is no consensus on best practice assessment of upper limb function in children with CP and dyskinesia. This study aimed to develop a clinical framework for the assessment of the impact of dyskinesia on upper limb function in children with CP.
Design:
Modified Delphi study using expert consensus.
Methods:
An expert panel of six highly experienced Australian therapists ranked assessment tools sourced from existing evidence-based literature using a five-point Likert scale. Tools rated as important for use "most" or "all" of the time, by 80% of respondents were accepted into the framework following two survey rounds and a third stage discussion.
Results:
Of 21 tools, 12 were included in the framework under five categories: (i) screening for dyskinesia; (ii) measuring the severity of dyskinesia; (iii) Classifying upper limb functional ability; (iv) measuring upper limb functional ability; and (v) measuring upper limb movement.
Conclusions:
The framework for assessing the impact of dyskinesia on upper limb function in CP aims to guide clinicians to improve assessment consistency and facilitate individualized goal-directed management. Further studies with a larger number of expert clinicians and researchers will further strengthen the utility of the framework.
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