OTSystematic ReviewJournal of neuroengineering and rehabilitation2024

A systematic review of instrumented assessments for upper limb function in cerebral palsy: current limitations and future directions.

Julie Rozaire, Clémence Paquin, Lauren Henry and 5 others

PMID 38622731

WHAT IT FOUND

Instrumented upper limb assessments in cerebral palsy are mostly research tools, not ready guides for therapy.

Studies rarely linked movement data to clinical outcomes and often missed children with bilateral or severe impairment.

Key findings

01Only 39% of included studies compared kinematic results with clinical assessment findings, and only 20% used kinematic outcomes to distinguish functional impairment levels.

02The evidence mainly covered unilateral impairment and unimanual tasks, with 69 of 76 articles focusing on unilateral impairment and sixty-six of 76 articles examining unimanual tasks.

03Children with the lowest capacities were rarely represented: MACS IV had 25 participants over 9 studies, and MACS V had 1 participant in 1 study.

STILL TO COME

How it was doneWhat they foundWhat it means for OTs

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What it does not show

The review only covered kinematic upper limb assessments, so it does not summarise other instrumented measures such as body-worn sensors or force data. Most included studies were small and heterogeneous, so findings may not apply to one child. Children with severe manual ability limitations and bilateral CP were underrepresented, so the findings do not apply well to those patients. Many studies did not describe participant details or CP subtype clearly, making comparison and replication hard. The review did not analyse how task choice affects links between kinematic parameters and clinical outcomes.

The easy way to misread this

Do not conclude that instrumented upper limb assessment is ready to guide therapy. The review says existing protocols need further study before clinical use, and the analysed protocols did not provide direct therapeutic guidance.

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