The Clinical Utility of the Comparative Analysis of Performance — Motor (CAP-M) for Children with Cerebral Palsy

Abstract

Background and aim: The focus of upper limb assessment for people with neurological damage has expanded beyond impairment factors. Assessments that evaluate the impact of impairment factors within tasks are needed to ensure that interventions address task performance. The Comparative Analysis of Performance-Motor (CAP-M) identifies upper limb impairments during performance of a client-chosen occupational task and uses this information to guide goal formulation. This study investigated the clinical utility of the CAP-M with children with cerebral palsy. Method: Ten occupational therapists each administered the CAP-M with one child with cerebral palsy. The participants were involved in a focus group or focused discussion. Constant comparative analysis was used to guide data collection and identify key themes. Findings and conclusion: The participants reported that the tool was a useful addition to the current upper limb assessments available for children with spastic cerebral palsy and some voluntary movement. Useful features of the tool were its focus on meaningful tasks, its effectiveness as an observational and educational tool and its usefulness in directing intervention selection. The findings support the development of upper limb assessment tools that span a range of ages and diagnoses and link impairment level factors with task performance.

Making Sense of the Clinical Picture

“…Participation refers to involvement in life situations (problems are termed restrictions), while activity refers to the execution of tasks (problems are termed limitations). However, rather than just gathering information within different levels of function, it is suggested that the critical component of assessment is linking this information across levels, so that it is clear how impairment factors are contributing to activity limitations and participation restrictions [6,7]. An important aspect of the ICF has been its influence on the development of assessment tools that measure activity and participation [2,3].…”

“…However, rather than just gathering information within different levels of function, it is suggested that the critical component of assessment is linking this information across levels, so that it is clear how impairment factors are contributing to activity limitations and participation restrictions [6,7]. Linking information across the activity, participation and body structure/function levels can therefore guide the second purpose of assessment, namely, forming an intervention plan that addresses activity and participation directly, and that also targets impairment factors which are limiting activity and participation [6,12,13]. For example, impairments such as spasticity, muscle tone, stiffness and reduced ROM were found to be significantly correlated with scores on the Action Research Arm Test (ARAT), an upper limb activity measure [8,9].…”

“…While positive and negative features and movement analysis might be more obviously connected with task performance, other impairment factors, such as ROM, spasticity and strength also need to be considered in relation to their effect on task performance [6,12]. It is only by individualising assessment of body structure and function impairments, and linking these impairment factors to activity (and ultimately, to participation) that the clinician can understand why activity limitations exist and identify priorities for intervention at each level of the ICF to optimise activity and participation outcomes.…”

“…Although the CAP-M was originally designed for use with adults post-stroke [54], its utility for assessing children with cerebral palsy has also been demonstrated [6]. Clinicians reported that use of the CAP-M with children facilitated more explicit observation and analysis of movement and positioning during the performance of meaningful tasks than other existing assessment tools.…”

Influence of functional mobility and manual function on play in preschool children with cerebral palsy

“…These changes may interfere with activities, including reaching, touching, manipulating, walking, writing, playing, etc. which are required for these children to function both at home and school (Beckung & Hagberg, 2002; Rae, Copley, & Ranka, 2010).…”