Assessment Of Upper Limb Function Research Articles

A single-subject study of robotic upper limb training in the subacute phase for four persons with cervical spinal cord injury.

Study designSingle-subject design, standard training (“B”) compared with Robotic training (“C”).ObjectivesTo explore the impact of robotic training on upper limb function, activities of daily living (ADL) and training experience in subacute tetraplegic inpatients.SettingInpatient subacute Norwegian spinal cord injury (SCI) unit.MethodsFour participants (C4–7, AIS A-C) completed 11 sessions of robotic training using a passive robotic exoskeleton (Armeo Spring®). Descriptive statistics and visual analyses were used for comparing standard occupational therapy and robotic training. Outcome measures included the Spinal Cord Independence Measure (SCIM-III), the Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP), and a questionnaire.ResultsAll of the participants exhibited an increase in assessments of upper limb function (GRASSP-total) right side (0.4%–61.2%), and all except for one participant (−8%) showed an increase on their left side (20.9%–106.2%). Three out of four participants had improvements in ADL function SCIM-III (ranging from 5.6% to 46.7%). Results demonstrated improvements during the robotic intervention period in five out of 28 measurements. The participants enjoyed the exercise, and found it motivating and relevant to their injury (median ranged from 3.5 to 6.5 on a 0–7 scale).ConclusionsThree out of four participants improved upper limb function and ADL independence, but the study could not confirm that improvements were due to the robotic intervention. The participants enjoyed the robotic training and found it relevant to their injury.

A comparative study of motion recognition methods for efficacy assessment of upper limb function

SummaryPhysical disorders are considered to be the most severe disability in patients with hemiplegia after stroke. Currently, most studies have used motion feature extraction methods and machine learning–based methods to evaluate the functional degree of post stroke in hemiplegic patients. This research collected feature data from patients under diverse experimental conditions and then fed them into different machine learning classifiers. However, few studies have compared which classifiers and experimental condition could achieve more precise assessments in a specific condition. In this paper, we compared the accuracy of four different classifiers in a conservative motion recognition method. A motion sensor was used for monitoring the upper limb action, and four conservative machine learning classifiers, which map the features to Fugl‐Meyer scale, were chosen for comparison. Ten post‐stroke hemiplegic‐simulated subjects performed a group of predefined actions, and these motion data were used to generate a group of features reflecting the information of each predefined action. We input the features into four classifiers to generate corresponding classifiers. With the Support Vector Machine classifier, prediction accuracy at 97.79% was achieved in the experiment data, which outperformed previous reports. In conclusion, Support Vector Machines perform better than the other three classifiers in the assessment of the degree of post‐stroke hemiplegics. It is encouraging that results have been generated with the proposed assessment method in this exploratory study.

Connectivity as a Predictor of Responsiveness to Transcranial Direct Current Stimulation in People with Stroke: Protocol for a Double-Blind Randomized Controlled Trial.

BackgroundStroke can have devastating consequences for an individual’s quality of life. Interventions capable of enhancing response to therapy would be highly valuable to the field of neurological rehabilitation. One approach is to use noninvasive brain stimulation techniques, such as transcranial direct current stimulation, to induce a neuroplastic response. When delivered in combination with rehabilitation exercises, there is some evidence that transcranial direct current stimulation is beneficial. However, responses to stimulation are highly variable. Therefore biomarkers predictive of response to stimulation would be valuable to help select appropriate people for this potentially beneficial treatment.ObjectiveThe objective of this study is to investigate connectivity of the stimulation target, the ipsilesional motor cortex, as a biomarker predictive of response to anodal transcranial direct current stimulation in people with stroke.MethodsThis study is a double blind, randomized controlled trial (RCT), with two parallel groups. A total of 68 participants with first ever ischemic stroke with motor impairment will undertake a two week (14 session) treatment for upper limb function (Graded Repetitive Arm Supplementary Program; GRASP). Participants will be randomized 2:1 to active:sham treatment groups. Those in the active treatment group will receive anodal transcranial direct current stimulation to the ipsilesional motor cortex at the start of each GRASP session. Those allocated to the sham treatment group will receive sham transcranial direct current stimulation. Behavioural assessments of upper limb function will be performed at baseline, post treatment, 1 month follow-up and 3 months follow-up. Neurophysiological assessments will include magnetic resonance imaging (MRI), electroencephalography (EEG) and transcranial magnetic stimulation (TMS) and will be performed at baseline, post treatment, 1 month follow-up (EEG and TMS only) and 3 months follow-up (EEG and TMS only).ResultsParticipants will be recruited between March 2018 and December 2018, with experimental testing concluding in March 2019.ConclusionsIdentifying a biomarker predictive of response to transcranial direct current stimulation would greatly assist clinical utility of this novel treatment approach.Trial RegistrationAustralia New Zealand Clinical Trials Registry ACTRN12618000443291; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618000443291 (Archived by WebCite at http://www.webcitation.org/737QOXXxt)Registered Report IdentifierRR1-10.2196/10848

Interrater Reliability of Three Versions of the Chedoke Arm and Hand Activity Inventory.

Purpose: The purpose of this study was to estimate the interrater reliability of three shortened versions of the Chedoke Arm and Hand Activity Inventory (CAHAI-7, CAHAI-8, CAHAI-9) when used with persons with acquired brain injury (ABI). The CAHAI is an assessment of upper limb function with high reliability in the stroke and ABI populations. In the stroke population, three shortened versions of the measure have established reliability. Clinicians report time constraints as a barrier to using standardized assessments; thus, establishing the reliability of the shortened versions of the CAHAI in the ABI population may increase the use of this measure. Method: This was an observational, parameter estimation study. The participants were recruited from an in-patient ABI rehabilitation programme. The administration of the CAHAI to six persons with ABI was video recorded, and the video recordings were assessed by six clinicians to estimate interrater reliability. A Latin square design was used to balance the order in which the raters evaluated the videos. A repeated-measures analysis of variance was performed, and the variance components were used to calculate an intra-class correlation coefficient (ICC) and standard error of measurement (SEM) with 95% confidence limits (CLs) for each of the shortened versions. Results: Interrater reliability was high for all three versions: CAHAI-7, ICC=0.96 (95% CL: 0.89, 0.99; SEM 2.65); CAHAI-8, ICC=0.96 (95% CL: 0.90, 0.99; SEM 2.72); and CAHAI-9, ICC=0.95 (95% CL: 0.85, 0.99; SEM 3.49). Conclusions: These results suggest that the three shortened versions of the CAHAI demonstrate high reliability in the ABI population. These versions may be particularly useful when time constraints or patient tolerance are an issue.

Development of the Hand Assessment for Infants: evidence of internal scale validity.

The aim of this study was to develop a descriptive and evaluative assessment of upper limb function for infants aged 3 to 12 months and to investigate its internal scale validity for use with infants at risk of unilateral cerebral palsy. The concepts of the test items and scoring criteria were developed. Internal scale validity and aspects of reliability were investigated on the basis of 156 assessments of infants at 3 to 12 months corrected age (mean 7.2mo, SD 2.5) with signs of asymmetric hand use. Rasch measurement model analysis and non-parametric statistics were used. The new test, the Hand Assessment for Infants (HAI), consists of 12 unimanual and five bimanual items, each scored on a 3-point rating scale. It demonstrated a unidimensional construct and good fit to the Rasch model requirements. The excellent person reliability enabled person separation to six significant ability strata. The HAI produced an interval-level measure of bilateral hand use as well as unimanual scores of each hand, allowing a quantification of possible asymmetry expressed as an asymmetry index. The HAI can be considered a valid assessment tool for measuring bilateral hand use and quantifying side difference between hands among infants at risk of developing unilateral cerebral palsy. The Hand Assessment for Infants (HAI) measures the use of both hands and quantifies a possible asymmetry of hand use. HAI is valid for infants at 3 to 12 months corrected age at risk of unilateral cerebral palsy.

Early involvement of the supinator muscle in Duchenne muscular dystrophy

In the last few years there has been increasing attention to the involvement of the upper limbs in Duchenne muscular dystrophy (DMD). Both clinical and MRI studies have shown that the first signs of upper limb weakness are related to shoulder muscles [ 1 Mercuri E. McDonald C. Mayhew A. Florence J. Mazzone E. Bianco F. et al. International workshop on assessment of upper limb function in Duchenne Muscular Dystrophy: Rome, 15–16 February 2012. Neuromuscul Disord. 2012; 22: 1025-1028 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar , 2 Ricotti V. Evans M.R. Sinclair C.D. Butler J.W. Ridout D.A. Hogrel J.Y. et al. Upper limb evaluation in duchenne muscular dystrophy: fat-water quantification by MRI, muscle force and function define endpoints for clinical trials. PLoS ONE. 2016; 11 (e0162542) Crossref Scopus (40) Google Scholar , 3 Willcocks R.J. Triplett W.T. Forbes S.C. Arora H. Senesac C.R. Lott D.J. et al. Magnetic resonance imaging of the proximal upper extremity musculature in boys with Duchenne muscular dystrophy. J Neurol. 2017; 264: 64-71 Crossref PubMed Scopus (28) Google Scholar ]. Arm and forearm muscles are subsequently progressively affected in older boys, generally after loss of ambulation.

Upper Limb Function, Kinematic Analysis, and Dystonia Assessment in Children With Spastic Diplegic Cerebral Palsy and Periventricular Leukomalacia.

Assessment of upper limb function, kinematic analysis, and dystonia in patients with spastic diplegia cerebral palsy and periventricular leukomalacia. Seven children with spastic diplegia cerebral palsy and 8 controls underwent upper limb kinematics. Movement duration, average and maximum linear velocity, index of curvature, index of dystonia, and target accuracy and stability were analyzed. In the patients with spastic diplegia, Gross Motor Function and Manual Ability Classification Systems were determined, and spasticity and dystonia were rated using the Modified Ashworth and the Burke-Fahn-Marsden Dystonia scales respectively. Children with spastic diplegia demonstrated a tendency toward higher index of dystonia reflecting overflow, higher index of curvature, lower velocities, and poor target accuracy and stability. All patients showed clinical evidence of dystonia in the upper limbs. Dystonia scores correlated with the Manual Ability Classification System (r = 0.86, P = .01) and with the index of dystonia (r = 0.82, P = .02). Children with spastic diplegia cerebral palsy present dystonia in the upper limbs. This is functionally relevant and can be measured with kinematic analysis.

Inter-rater reliability of the Chedoke Arm and Hand Activity Inventory.

The Chedoke Arm and Hand Activity Inventory (CAHAI) is an assessment of upper limb function designed for use in the stroke population. The CAHAI has strong reliability and validity in this population; however, it is unknown whether this measure can be used with other clinical populations such as acquired brain injury (ABI). The purpose of this study was to estimate the inter-rater reliability of the CAHAI when used with persons with ABI. The research design was an observational parameter estimation study. The administration of the CAHAI was videotaped for 6 persons with ABI. To estimate inter-rater reliability each video was assessed independently by 6 clinicians yielding a total of 36 assessments. A Latin square design was used to balance the order raters evaluated the videos. Shrout and Fleiss Type 2,1 intra class correlation coefficients (ICC) and standard error of measurement (SEM) were calculated to estimate inter-rater reliability of the CAHAI. Inter-rater reliability was high ICC = 0.96 (95% CL: 0.88, 0.99) and the SEM was 3.35 (95% CL: 2.63, 4.63) CAHAI points. These results suggest that the CAHAI, although designed for use in the stroke population, can be used reliably in the ABI population.

Towards a short questionnaire for stepwise assessment of upper limb function, pain and stiffness in Duchenne muscular dystrophy

Purpose: Duchenne muscular dystrophy can lead to upper extremity limitations, pain and stiffness. In a previous study, these domains have been investigated using extensive questionnaires, which are too time-consuming for clinical practice. This study aimed at gaining insight into the underlying dimensions of these questionnaires, and to construct a short questionnaire that can be used for clinical assessment.Methods: Exploratory factor analysis was performed on the responses of 213 participants to a web-based survey to find the underlying dimensions in the Capabilities of Upper Extremity questionnaire, the ABILHAND questionnaire, and questionnaires regarding pain and stiffness. Based on these underlying dimensions, a stepwise approach was formulated. In addition, construct validity of the factors was investigated.Results: In total, 14 factors were identified. All had high internal consistency (Cronbach's alpha >0.89) and explained 80–88% of the variance of the original questionnaires. Construct validity was supported, because participants in the early ambulatory stage performed significantly better (p< 0.001) than participants in the late non-ambulatory stage.Conclusion: The factors identified from the set of questionnaires provide a valid representation of upper extremity function, pain and stiffness in Duchenne muscular dystrophy. Based on the factor commonalities, the Upper Limb Short Questionnaire was formulated.Implications for RehabilitationNew insights into the underlying dimensions of upper extremity function, pain and stiffness in Duchenne muscular dystrophy are gained.Fourteen factors, with good internal consistency and construct validity, are identified regarding upper extremity function, pain and stiffness in Duchenne muscular dystrophy. Based on these factors, the Upper Limb Short Questionnaire is presented.The Upper Limb Short Questionnaire can be used as an identifier of arm-hand limitations and the start of more thorough clinical investigation.

On the assessment of coordination between upper extremities: towards a common language between rehabilitation engineers, clinicians and neuroscientists.

Well-developed coordination of the upper extremities is critical for function in everyday life. Interlimb coordination is an intuitive, yet subjective concept that refers to spatio-temporal relationships between kinematic, kinetic and physiological variables of two or more limbs executing a motor task with a common goal. While both the clinical and neuroscience communities agree on the relevance of assessing and quantifying interlimb coordination, rehabilitation engineers struggle to translate the knowledge and needs of clinicians and neuroscientists into technological devices for the impaired. The use of ambiguous definitions in the scientific literature, and lack of common agreement on what should be measured, present large barriers to advancements in this area. Here, we present the different definitions and approaches to assess and quantify interlimb coordination in the clinic, in motor control studies, and by state-of-the-art robotic devices. We then propose a taxonomy of interlimb activities and give recommendations for future neuroscience-based robotic- and sensor-based assessments of upper limb function that are applicable to the everyday clinical practice. We believe this is the first step towards our long-term goal of unifying different fields and help the generation of more consistent and effective tools for neurorehabilitation.

Outcomes after Open Reduction and Plate Fixation of Distal Humerus Fractures

Distal humerus fractures (DHFs) have been a serious challenge since the beginning of surgery. The outcome of surgical treatment of a DHF should not only be assessed with clinical ratings. It is also important to take into account the patient's subjective evaluation of limb function. The study involved 26 patients after surgical treatment of DHF. The Quick DASH (QDASH) scale was used to assess the subjective results of surgical treatment of DHF, and the objective Mayo Elbow Performance Score (MEPS) was used to assess the clinical outcome. Relationships between the subjective and objective scores were tested with Pearson's correlation coefficient. 85% of the patients had excellent or good QDASH scores, and 65% of patients had excellent or good MEPS scores. The Pearson correlation coefficient between the subjective and objective assessments was -0.91, indicating total dependence. Open reduction and internal fixation using two perpendicular plates allows for achieving good stability of fixation, early rehabilitation and quick return to the desired level of activity, which contributes to a high percentage of good objective and subjective results of treatment. Subjective assessment of upper limb function after DHF surgery fully correlates with objective assessment.

Automatic Assessment of Upper-Limb Function for Remote Monitoring During Home-Based Rehabilitation Using Videogames

Abstract Date Presented 4/17/2015 Automatic in-game assessment of clinically validated, upper-limb function in stroke patients—generated using low-cost, commodity hardware and rehabilitation videogames—demonstrates the potential for remote monitoring of patients during videogame-delivered, home-based rehabilitation programs.

PP06.8 – 2551: Face validity of the Global Upper Limb Deviation Index (GULDI)

Objective This study aimed to examine the face validity of the Global Upper Limb Deviation Index (GULDI), a measure that compiles 3D motion graph information from different joints and different motions in a single global index that quantifies motion pathology status. Methods Eight Typically Developing Children (TDC) and eight children with Bilateral Spastic Cerebral Palsy (BSCP) were tested using 3D motion analysis while performing four reach to grasp and four gross motor tasks. Motion Graph Deviation Indexes (MGDIs) were calculated to summarize the subject's deviation at each specific joint graph and each specific motion. Motion Indexes (MIs) and Graph Indexes (GIs) were estimated from the average of the respective MGDIs. Finally GULDI was calculated from the average of all MI's demonstrating the overall motion pathology. Independent samples t-tests were used to assess GULDI, MIs and GIs differences between the TDC and BSCP groups. Spearman correlation analysis was conducted between the indexes and four qualitative CP assessment tools: MACS, GMFCS, Dystonia Fahn-Marsden Scale and Modified Ashworth Scale. Results GULDI was significantly (p Conclusion The high correlation of GULDI with four qualitative assessment tools increases the validation of that index providing a quantitative analysis tool for the assessment of upper limb function.

Brain motor control assessment of upper limb function in patients with spinal cord injury

Background: The brain motor control assessment (BMCA) for the upper limb has been developed to add resolution to the clinical evaluation in patients with spinal cord injury (SCI). BMCA is a surface electromyography (sEMG)-based measure of motor output from the central nervous system during a variety of reflex and voluntary motor tasks performed under strictly controlled conditions.Method: Nine participants were recruited and assessed four times over a period of 1 year in a prospective cohort study design. The sEMG of 15 muscles (7 muscles from each upper limb and rectus abdominis) were recorded throughout the following stages of the BMCA protocol: (i) relaxation, (ii) reinforcement maneuvers, (iii) voluntary tasks, (iv) tendon-tap reflex responses, (v) vibration responses.Results: Similarity index (SI) values were significantly lower in the SCI group for unilateral shoulder abduction (P = 0.006) and adduction (P = 0.021), elbow extension (P = 0.038), wrist flexion/extension with palm up (P < 0.001; P < 0.001) and wrist flexion with palm down (P = 0.016). sEMG magnitudes were also significantly lower in the SCI group for wrist flexion/extension with palm up (P < 0.001; P = 0.042). SI changes over time were significant for tasks related to wrist joint (P = 0.002).Conclusion: Clinicians who are involved in rehabilitation of patients with SCI can use the BMCA to assess their patients’ motor control abilities and monitor their progression throughout their rehabilitation process. The results of this type of neurophysiological assessment might be useful to tailor therapeutic strategies for each patient.

Clinical evaluation of upper limb function: Patient’s impairment, disability and health-related quality of life

Musculoskeletal disorders substantially impacts physical activity, mental state, and quality of life (QOL). Generally, comprehensive assessment of upper limb function requires measures of impairment or disability as well as health-related quality of life. A growing number of outcome instrument have been introduced to evaluate upper limb function and disability, and these measures can be categorized as patient- or clinician-based, and as condition specific or general health-related QOL evaluations. The upper limb outcome instruments reviewed in this article assess different aspect of upper limb conditions, and the measures are affected by differences in cultural, psychological, and gender aspect of illness perception and behavior. Therefore, physician should select/interpret the outcome instruments addressing their primary purpose of research. Information about regional instruments for upper limb condition and health-related QOL in upper limb disorder may help us in decision-making for treatment priority or in interpretation of the treatment outcomes.

P.2.3 Assessment of Upper Limb function in DMD patients: Comparison with normative data

While there have been considerable advances for ambulant children with Duchenne Muscular Dystrophy (DMD), no prospective study has so far been devoted to outcome measures in non ambulant patients, with increasing complaints from families and patients. This information appears to be relevant not only for a better understanding of the disease progression but also for possible enrolment of patients in future trials. As a result of an international effort, a new tool, the Performance of Upper Limb (PUL) was specifically designed to assess upper limb function in DMD boys. The purpose of the PUL is to assess changes that occurs in motor performance of the upper limb over time from when a boy is still ambulant to the time he loses all arm function when non-ambulant. The aim of the present study was to use the PUL in: <ul><li>(1)a cohort of typically developing children from the age of 3years onwards in order to identify the age when the activities assessed in the individual items are consistently achieved.</li><li>(2)a cohort of DMD children and young adults to assess the range of findings at different ages.</li></ul> We collected normative data for the scale validation on 258 typically developing children from 3 to 14years old. A full score was consistently achieved (>85%) by the age of 3.5years. Below the age of 3.5years there was a significant number (>15%) who had difficulties in the items involving stacking cans, opening a Ziploc container, tearing a piece of paper and in lifting the heavier weights. After the age of 3.5years difficulties were only occasionally found in tearing a sheet of paper. When the PUL was performed in the 211 DMD patients (age range 2.8–23years), we observed a progressive deterioration of scores with age, with early involvement of the proximal muscles that was more obvious after the age of 10years. Even the oldest and weakest DMD patients were still able to perform some of the distal items, suggesting that the scale is capable of measuring small.

Assessment of upper limb function in young Friedreich ataxia patients compared to control subjects using a new three-dimensional kinematic protocol

BackgroundThe assessment of Friedreich ataxia effects on upper limb function in clinical follow-up remains a challenging issue. To complete the usual clinical scales, an upper limb kinematic protocol adapted to Friedreich ataxia children and young adults has been developed and applied to both patients and control subjects. MethodsNineteen Friedreich ataxia patients (7–24years old) and fifteen healthy controls (9–24) were examined twice during three tasks (drawing, pointing, pro-supination) inspired from the “International Cooperative Ataxia Rating Scale”. A custom-made and adjustable device allowed standardized positioning of the subject (in a seated position) and task execution. A three-dimensional kinematic analysis of the whole upper limb was performed using an electromagnetic device. The between session reliability and measurement errors of spatiotemporal and angular kinematic parameters were quantified before the analysis of their discriminative ability between healthy subjects and patients. FindingsMost of the parameters were significantly different between ataxia patients and controls, showing the discriminative ability between these two populations. In particular, the task duration, the drawing and pointing errors were higher for ataxia patients. In most of the cases, the between session reliability was found good to excellent for the spatiotemporal parameters and moderate to excellent for the kinematic parameters. InterpretationKinematic differences have been pointed out between Friedreich ataxia patients and controls, leading to a better understanding of the effect of this pathology on upper limb function. Discriminative ability and reliability of the developed protocol were demonstrated for many parameters, making it a relevant tool for clinical follow-up.

Robotic assessment of the influence of age on upper-limb sensorimotor function

PurposeThis paper examines the influence of age on several attributes of sensorimotor performance while performing a reaching task. Our hypothesis, based on previous studies, is that aged persons will show differences in one or more of the attributes of sensorimotor performance.Patients and methodsFifty-one subjects (aged 20–80 years) with no known neuromotor disorders of the upper limbs participated in the study. Subjects were asked to grasp the end-effector of a pneumatic robotic device with two degrees of freedom in order to reach peripheral targets (1.0 cm radius), “quickly and accurately”, from a centrally located target (1.0 cm radius). Subjects began each trial by holding the hand within the central target for 2000 milliseconds. Afterwards, a peripheral target was illuminated. Then participants were given 3000 milliseconds to complete the movement. When a target was reached, the participant had to return to the central target in order to start a new trial. A total of 64 trials were completed and each peripheral target was illuminated in a random block design.ResultsSubjects were divided into three groups according to age: group 1 (age 20–40 years), group 2 (age 41–60 years), and group 3 (age 61–80 years). The Kruskal–Wallis test showed significant differences (P < 0.05) between groups, except for the variables postural speed in the dominant arm, and postural speed and initial deviation in the non-dominant arm (P > 0.05). These results suggest that age introduces significant differences in upper-limb motor function.ConclusionOur findings show that there are objective differences in sensorimotor function due to age, and that these differences are greater for the dominant arm. Therefore for the assessment of upper-limb function, we should take into account the influence of age. Moreover, these results suggest that robotic systems can provide a new and effective approach in the assessment of sensorimotor function.

Wii™-habilitation of upper extremity function in children with Cerebral Palsy. An explorative study

Objective: Commercially available virtual reality systems can possibly support rehabilitation objectives in training upper arm function in children with Cerebral Palsy (CP). The present study explored the effect of the Nintendo Wii™ training on upper extremity function in children with CP.Methods: During six weeks, all children received twice a week training with the Wii™, with their most affected arm. The Melbourne Assessment of Upper Limb Function and ABILHAND-Kids were assessed pre- and post- training. In addition, user satisfaction of both children and health professionals was assessed after training. Enjoyment in gaming was scored on a visual analogue scale scale after each session by the children.Results: Fifteen children with CP participated in the study. The quality of upper extremity movements did not change (−2.1, p > 0.05), while a significant increase of convenience in using hands/arms during performance of daily activities was found (0.6, p < 0.05).Conclusion: Daily activities seem to be easier performed after Wii™ training for most of the included children with CP.

International workshop on assessment of upper limb function in Duchenne Muscular Dystrophy

Twenty clinicians, physiotherapists and representatives from advocacy groups and industries from six countries convened for a Parent Project sponsored workshop on ‘Assessment of Upper Limb Function in Duchenne Muscular Dystrophy (DMD)’. Following previous meetings [1,2] highlighting the lack of outcome measures in non ambulant patients, a number of exploratory studies have been planned to investigate the suitability of the available measures.