Upper limb motor and sensory impairments in children with hemiplegic cerebral palsy. Can they be measured reliably?

Purpose. To establish interrater and test-retest reliability of a clinical assessment of motor and sensory upper limb impairments in children with hemiplegic cerebral palsy aged 5-15 years. Method. The assessments included passive range of motion (PROM), Modified Ashworth Scale (MAS), manual muscle testing (MMT), grip strength, the House thumb and Zancolli classification and sensory function. Interrater reliability was investigated in 30 children, test-retest reliability in 23 children. Results. For PROM, interrater reliability varied from moderate to moderately high (correlation coefficients 0.48-0.73) and test-retest reliability was very high (>0.81). For the MAS and MMT, total score and subscores for shoulder, elbow, and wrist showed a moderately high to very high interrater reliability (0.60-0.91) and coefficients of >0.78 for test-retest reliability. The reliability for the individual muscles varied from moderate to high. The Jamar dynamometer was found to be highly reliable. The House thumb classification showed a substantial reliability and the Zancolli classification an almost perfect reliability. All sensory modalities had a good agreement. Conclusions. For all motor and sensory assessments, interrater and test-retest reliability was moderate to very high. Test-retest reliability was clearly higher than interrater reliability. To improve intmater reliability, it, vas recommended to strictly standardize the test procedure, refine the scoring criteria and provide intensive rater trainings.