Abstract
BackgroundIn 2003 new computer software, the VOAA (Video Observations Aarts and Aarts), was designed to score and evaluate two important aspects of spontaneous upper limb use, i.e. overall duration and frequency of specific behaviours. The aim of this study was to investigate the test-retest, interrater and intrarater reliability and the construct validity of a new module, the VOAA-DDD, to determine developmental disregard in children with spastic unilateral cerebral palsy (CP).MethodsA test-retest design with three raters for reliability and a two-group design for construct validity were used. Subjects were a total of 20 children with spastic unilateral CP equally divided in two age groups (2.5-5 and 5-8 years), and 56 healthy children of the same age groups. Overall duration and frequency of specific behaviours of the affected arm and hand were assessed during a task demanding ('stringing beads') and a task stimulating ('decorating a muffin') the use of both hands. Reliability was estimated by intraclass correlation coefficients (ICCs). Construct validity was assessed by comparing children with CP to healthy children.ResultsAll ICCs exceeded 0.87. In contrast with healthy children, children with CP used their affected hand less during the 'muffin' task compared to the 'beads' task. Of the children with CP, 90% in the age group of 2.5-5 years and 50% in the age group of 5-8 years showed values exceeding the extreme values of healthy controls, respectively, indicating developmental disregard.ConclusionThe VOAA-DDD is a reliable and valid instrument to assess spontaneous use of the affected arm and hand in order to determine developmental disregard in children with spastic unilateral CP.
Highlights
In 2003 new computer software, the VOAA (Video Observations Aarts and Aarts), was designed to score and evaluate two important aspects of spontaneous upper limb use, i.e. overall duration and frequency of specific behaviours
Several converging lines of evidence suggest that non-use of a deafferented limb in monkeys or of the paretic arm in patients with unilateral stroke or cerebral palsy (CP) is a learning phenomenon leading to a conditioned suppression of movement on the affected side, which is referred to as 'learned non-use' in adults and 'developmental disregard' in children[2,3]
Developmental disregard is not so much reflected in the individual capacity of the child to involve the affected limb in tasks that require bimanual performance, but rather in the overall duration of use and the frequencies of specific behaviours of the affected arm and hand during tasks that allow predominantly single-handed performance
Summary
In 2003 new computer software, the VOAA (Video Observations Aarts and Aarts), was designed to score and evaluate two important aspects of spontaneous upper limb use, i.e. overall duration and frequency of specific behaviours. Developmental disregard is not so much reflected in the individual capacity of the child to involve the affected limb in tasks that require bimanual performance, but rather in the overall duration of use and the frequencies of specific behaviours of the affected arm and hand during tasks that allow predominantly single-handed performance. Children with unilateral CP will tend to limit the use of their affected hand to simple functions, for example as a 'stabilizer' for the non-affected hand[4] In this perspective, many young children with an asymmetric upper limb function due to CP must be stimulated to improve their bimanual performance, especially in their pre-school and primary school age[5]
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