Upper Extremity Strength in Cerebral Palsy
Condition: Cerebral Palsy
MeSH terms: Paralysis; Cerebral Palsy
Study type: Observational

Summary: 
      Rationale:

      Children with Cerebral Palsy (CP) experience limitations in motor activities and
      participation in the community, predominantly caused by impairments in muscle function. Aside
      from abnormal posturing due to spasticity, muscle weakness can significantly contribute to
      impaired muscle function and there is increasing evidence that muscle weakness significantly
      impairs upper limb motor function and ability to perform manual tasks in children with CP.
      Studies in the last decade have shown that muscle weakness, not spasticity, is the greatest
      limiting factor of motor function in children with CP. Furthermore, there is increasing
      evidence that the strength in the upper extremities of children with CP is less compared to
      their typically developing peers (TDP). A systematic review focused on the psychometric
      properties of strength measurement instruments has shown that the number of studies
      investigating psychometric properties of strength measurement instruments is limited and that
      the methodological quality of these studies is low.

      Aim:

      The present study aims to investigate the reproducibility of the following three isometric
      strength measurements in the upper extremity of children and adolescents with unilateral CP
      as well as in TDP: Hand Held Dynamometry (HHD), pinch and grip strength using the E-link
      system and functional strength. To study to which extent upper extremity strength, both in
      the affected side and the non-affected side, differs from the strength in the upper
      extremities of TDP, these measurements will also be performed by children without
      neurological problems.

      Study Design:

      A cross-sectional study in which the reproducibility of three strength measurement
      instruments, i.e. HHD, E-link and Functional strength, will be investigated in children and
      adolescents with unilateral CP and TDP.

      Population:

      Children with unilateral spastic CP (with perinatal acquired hypoxic ischemic incidents),
      aged 7 to 18 years, Manual Ability Classification System (MACS) levels I-III, who are
      mentally able to perform the measurements will be included and TDP.

      Outcome measures:

      The most important psychometric property in strength measurement instruments is
      reproducibility. Reproducibility will be investigated using the following factors: Intraclass
      Correlation Coefficient (ICC), Limits of Agreement (LOA), Standard Error of Measurement (SEM)
      and the Smallest Detectable Difference (SDD). Reference values will be determined using the
      Generalised Additive Models for Location, Scale, and Shape (GAMLSS) method.
    


Intervention name(s): reproducibility of upper extremity strength measurements
Intervention type(s): Other
Intervention description(s): inter-rater reliability and test-retest reliability
Other intervention name(s): Hand Held Dynamometry; E-link system; functional strength measurements
Observational model: Cohort
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Spastic unilateral Cerebral Palsy and Healthy Controls
      
Keywords: Cerebral Palsy; child; upper extremity; strength, reproducibility