Development of a Clinical Assessment of Quality of Movement for Unilateral Upper‐limb Function

Abstract

SUMMARY Eleven subjects with cerebral palsy were assessed both with the Melbourne Assessment and by four clinical experts. Comparison of their assessment ratings revealed that the Melbourne Assessment was strongly related to the clinical judgement of the experts. A further 20 subjects were administered the Melbourne Assessment and two occupational therapists scored each subject's performance from videotaped assessments with substantial inter‐rater reliability (0–68); intra‐rater agreement after two weeks was 0–80. The Melbourne Assessment may provide a satisfactory objective measure of the quality of upper‐limb function. RÉSUMÉ Mise en place d'une évaluation clinique de qualité de mouvement dans la fonclion unilatéral du membre supérieur Onze IMC ont étéévalués par le Melbourne Assessement et quatre experts cliniques. La confrontation de leurs évaluations a montré que le Melbourne Assessement était fortement relié au jugement clinique des experts. 20 autres sujets furent évalués à partir de bandes vidéo par le Melbourne Assessement et deux ergothérapeutes, avec une bonne fidélité inter‐examinateur (0–68) et un accord intra‐examinateur de 0–80. Le Melbourne Assessement peut fournir une mesure objective de la qualité de la fonction du membre supérieur. ZUSAMMENFASSUNG Klinische Beurteilung der Bewegungsqualität bei unilateraler Funktion der oberen Extremitat 11 Patienten mit Cerebralparese wurden anhand der Melbourne Assessment, sowie von vier klinischen Experteh untersucht. Der Vergleich ihrer Beurieilungen zeigte, daß die Ergebnisse der Melbourne Assessment klar mit den Befunden der Experten korrelierten. Weitere 20 Patienten wurden mit der Melbourne Assessment getestet und zwei Beschäftigungsthcrapeuten beurteilten die Leistungen jedes Patienten anhand von Videoaufnahmen mit einer erstaunlichen Inter‐Rater Übereinstimmung (0–68); die Inter‐Rater Übereinstimmung nach zwei Wochen betrug 0–80. Die Melbourne Assessment mag eine zufriedenstellende objektive Methode zur Beurteilung der Bewegungsqualitat der oberen Exiremität sein. RESUMEN Desarrollo du una evaluación cli'nica de la calidad de movimiento en la extremidad su perior unilateral Once individuos con parálisis cerebral fueron evaluados por medio de la Evaluación de Melbourne y por cuatro expertos clinicos. La comparación de sus evaluaciones reveló que la Evaluación de Melbourne estaba fuertemente corelacionada con el juicio clinico de los expertos. A otros 20 individuos se les pasó la Evaluación de Melbourne y dos terapeutas ocupacionales puntuaron la realización de cada individuo a partir de cintas de video con una fiabilidad entre los promedios substancial. La coincidencia tras dos semanas era de 0,80. La Evaluación Melbourne puede proporcionar una medición objetiva satisfactoria de la calidad de la función de la extremidad superior.

Reliability of the Melbourne Assessment of Unilateral Upper Limb Function

“…In order to revise and refine test items the original 12-item assessment (Johnson et al 1994) was reviewed in 1994 by a panel of eight occupational therapists, each having 7 or more years of clinical experience with children with neurological impairment. The review resulted in modifications to the scoring criteria for two items: item 6 (release of crayon) and item 8 (release of pellet) and the addition of a further four items.…”

“…Initial studies investigated the validity and inter-and intrarater reliability of the Melbourne Assessment (Johnson et al 1994). Construct and content validity were established by the processes employed in the development and review of the assessment, that is, by examining relevant literature, reviewing existing clinical upper-limb assessments, and by workshops with clinicians experienced in working with children who have CP.…”

“…Since this time the Quality of Upper Extremities Skills Test (QUEST) has been developed specifically for children aged 18 months to 8 years with spastic CP. In 1990 however, the absence of any such tools led to the development of a 12-item assessment titled the Melbourne Assessment of Unilateral Upper Limb Function, abbreviated to the Melbourne Assessment (Johnson et al 1994). This assessment is a criterion-referenced test developed for use with children aged 5 to 15 years with neurological impairment.…”

Surgical Management of the Wrist in Children with Cerebral Palsy and Traumatic Brain Injury

“…These tools include the House Functional Classification [19], the International Classification of Functioning and Disability [20], the Melbourne Assessment of Unilateral Upper Limb Function [21,22], the Spasticity Scales [23][24][25], the modified House Functional Classification and the Upper Extremity Rating Scale [26], and the Gross Motor Performance Measure [27].…”

Assessment Tools and Classification Systems Used For the Upper Extremity in Children With Cerebral Palsy

“…The Melbourne Assessment of Unilateral Upper Limb Function (MUUL) is a video-based measurement that describes unilateral upper limb movements based on activities such as reach, grasp, release and manipulation [14,24]. The MUUL was designed for children with CP or neurologic impairment 5 to 15 years of age.…”