Clinical assessments designed to measure body alignment posture in children with cerebral palsy.

Purpose

To critically review the clinical assessments used by therapists to assess and measure body alignment posture in children with CP. To determine if assessments have psychometric properties specifically measured for this population, and to identify the assessments main characteristics.

Only 2 assessments demonstrated
adequate evidence to support validity and reliability.
An assessment of body alignment
needs to be selective, accurate and discriminative to body alignment changes in children with CP.
Although this critical review identified a number of assessments are available,
evidence supporting their use for entire body alignment measurement is limited...
...as is the evidence supporting
the strength of their measurement properties.

Approach

A systematic literature search was performed in 5 electronic databases along with hand searching. The search included articles published in English to March 2019 Key terms included: Cerebral palsy, posture, body alignment, assessment(s) measure(s), outcome(s), child(ren). One reviewer screened titles, reviewed abstracts and identified full-text articles that met the inclusion criteria. Data extraction included study design, tool description and psychometric properties.

Outcomes

Of the 696 titles found in the search, 10 full-text articles met the inclusion criteria and 7 clinical assessments were identified. 6 assessments were observational measurements; 4 observed body alignment, whilst 2 observed gross functional movement and body alignment combined, and 1 assessment was a checklist. Evidence supporting reliability and validity varied, with small sample size influencing quality rating. Only 2 assessments demonstrated adequate evidence to support validity and reliability. Little information clinical utility and responsiveness was provided.

Although this critical review identified a number of assessments are available, evidence supporting their use for entire body alignment measurement is limited, as is the evidence supporting the strength of their measurement properties.

Cost and savings

In children with CP, many of the clinical assessments used to measure body alignment have limited psychometric properties.

Assessments which demonstrate validity, reliability and responsiveness are required to support therapists in their assessment of body alignment.

No costs with the study – undertaken as part of a PhD research project.

No direct costs as a result of this study.

Implications

In children with CP, many of the clinical assessments used to measure body alignment have limited psychometric properties. An assessment of body alignment needs to be selective, accurate and discriminative to body alignment changes in children with CP.

Top three learning points

  1. The use of observational assessments in assessing body alignment is part of everyday clinical practice. However the evidence of standardised clinical measurements of body alignment in children with CP is relatively sparse.
  2. Current standardised assessments of body alignment concentrate on body linkages rather than total body alignment, such as, x-ray. Although the psychometric properties of this approach are well documented, applicability of into clinical practice and therapist’s daily assessment of total body segment alignment is limited.
  3. Evidence supporting the use for measures of body alignment is limited, as is the evidence supporting the strength of the assessment properties.

Fund acknowledgements

No funding sources.

Additional notes

This work was presented at Physiotherapy UK 2019.

Please see the attached Innovations poster below. 

 

Further information on this study can be found in the below article:

  • George, F., Benham, A., Gabriel., L. 2020. Clinical assessments designed to measure body alignment posture in children with cerebral palsy – a systematized review. APCP Journal, 11(1), pp.4-16.

 

Links to further information which followed on as a result of this study into the development of a clinical assessment of body alignment measure:

 

For further information about this work please contact Frances Kathleen George

 

Reference(s):

Bartlett, D. and Purdie, B., 2005. Testing of the spinal alignment and range of motion measure: a discriminative measure of posture and flexibility for children with cerebral palsy. Developmental medicine and child neurology47(11), pp.739-743.

Fife, S.E., Roxborough, L.A., Armstrong, R.W., Harris, S.R., Gregson, J.L. and Field, D., 1991. Development of a clinical measure of postural control for assessment of adaptive seating in children with neuromotor disabilities. Physical Therapy71(12), pp.981-993.

Goldsmith, S., 2000. The Mansfield Project: Postural care at night within a community setting: A feedback study. Physiotherapy86(10), pp.528-534.

Goldsmith J, Goldsmith L., 2009. Goldsmith Indices of Body Symmetry: Protecting Body Shape. European Seating Symposium, pp.122-124.

Goldsmith, E., Golding, R.M., Garstang, R.A. and MacRae, A.W., 1992. A technique to measure windswept deformity. Physiotherapy78(4), pp.235-242.

Pountney, T.E., Cheek, L., Green, E., Mulcahy, C. and Nelham, R., 1999. Content and criterion validation of the Chailey levels of ability. Physiotherapy85(8), pp.410-416.

Rodby-Bousquet, E., Persson-Bunke, M. and Czuba, T., 2016. Psychometric evaluation of the Posture and Postural Ability Scale for children with cerebral palsy. Clinical rehabilitation30(7), pp.697-704.