Ralph Edward, Carroll Kate, Danks Marcella, Harvey Adrienne
Allied Health, Hummingbird House, Chermside, Australia.
Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Brisbane, Australia.
Phys Occup Ther Pediatr. 2023;43(1):1-13. doi: 10.1080/01942638.2022.2104149. Epub 2022 Sep 12.
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.
Modified Delphi study using expert consensus.
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.
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.
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.
脑性瘫痪（CP）中的运动障碍是一种复杂的运动紊乱，会对上肢功能产生重大影响。尽管有一系列可用工具，但对于CP合并运动障碍患儿上肢功能的最佳评估方法尚无共识。本研究旨在建立一个临床框架，用于评估运动障碍对CP患儿上肢功能的影响。
采用专家共识的改良德尔菲研究。
由六位经验丰富的澳大利亚治疗师组成的专家小组，使用五点李克特量表对从现有循证文献中获取的评估工具进行排名。在两轮调查和第三阶段讨论后，被80%的受访者评为在“大多数”或“所有”时间使用都很重要的工具被纳入该框架。
在21种工具中，有12种被纳入该框架的五个类别：（i）运动障碍筛查；（ii）运动障碍严重程度测量；（iii）上肢功能能力分类；（iv）上肢功能能力测量；以及（v）上肢运动测量。
评估运动障碍对CP患儿上肢功能影响的框架旨在指导临床医生提高评估的一致性，并促进个性化的目标导向管理。更多专家临床医生和研究人员参与的进一步研究将进一步增强该框架的实用性。
