Development of a Clinical Framework for the Assessment of Dyskinesia and Function in the Upper Limb in Children with Cerebral Palsy

Abstract

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.

Keywords:

• Assessment
• children
• dyskinesia
• framework
• upper limb

Acknowledgments

Expert input from Simon Garbellini, Jennifer Lewis, Melinda Randall, Nadine Smith, Kirsty Stewart, and Megan Thorley is gratefully acknowledged.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes

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Additional information

Notes on contributors

Edward Ralph

Edward Ralph, MAPP, BPhys, is at the Department of Physiotherapy, Tasmanian Health Service - North West Region, Burnie, Australia.

Kate Carroll

Kate Carroll, PhD, BAppSci is at the Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Brisbane, Australia; The Royal Children’s Hospital, Parkville, VIC, Australia; Murdoch Children’s Research Institute, Parkville, Australia.

Marcella Danks

Marcella Danks, PhD, BPhys, is at the School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Virginia, Australia.

Adrienne Harvey

Adrienne Harvey, PhD, MPhys, BPhys, is at the Neurodisability and Rehabilitation Group, Murdoch Children’s Research Institute, Melbourne, Australia.