Assessment of upper-limb capacity, performance, and developmental disregard in children with cerebral palsy: Validity and reliability of the revised Video-Observation Aarts and Aarts module: Determine Developmental Disregard (VOAA-DDD-R)

Abstract

Aim To investigate the validity and reliability of the revised Video-Observation Aarts and Aarts module: Determine Developmental Disregard (VOAA-DDD-R). Method Upper-limb capacity and performance were assessed in children with unilateral spastic cerebral palsy (CP) by measuring overall duration of affected upper-limb use and the frequency of specific behaviours during a task in which bimanual activity was demanded ('stringing beads') and stimulated ('decorating a muffin'). Developmental disregard was defined as the difference in duration of affected upper-limb use between both tasks. Raters were two occupational and one physical therapist who received 3hours of training. Construct validity was determined by comparing children with CP with typically developing children. Intrarater, interrater, and test-retest reliability were determined using the intraclass correlation coefficient. Standard errors of measurement and smallest detectable differences were also calculated. Results Twenty-five children with CP (15 females, 10 males; mean age 4y 9mo [SD 1y 7mo], range 2y 9mo-8y; Manual Ability Classification System levels I-III) scored lower on capacity (p=0.052) and performance (p<0.001), and higher on developmental disregard (p<0.001) than 46 age- and sex-matched typically developing children (23 males; mean age 5y 3mo [SD 1y 5mo], range 2y 6mo-8y). The intraclass correlation coefficients (0.79-1.00) indicated good reliability. Absolute agreement was high, standard errors of measurement ranged from 4.5 to 6.8%, and smallest detectable differences ranged from 12.5 to 19.0%. Interpretation The VOAA-DDD-R can be reliably and validly used by occupational and physical therapists to assess upper-limb capacity, performance, and developmental disregard in children (2y 6mo-8y) with CP. This article is commented on by Bialocerkowski. on pages 12-13 of this issue. © The Authors. Developmental Medicine & Child Neurology © 2012 Mac Keith Press.