Feasibility, Validity, and Reliability of Lower Limb Tactile and Body Awareness Assessments in Children With Upper Motor Neuron Lesions

Petra Marsico; Lea Meier; Marietta L van der Linden; Tom H Mercer; Hubertus J A van Hedel

doi:10.1016/j.apmr.2023.02.017

Feasibility, Validity, and Reliability of Lower Limb Tactile and Body Awareness Assessments in Children With Upper Motor Neuron Lesions

Arch Phys Med Rehabil. 2023 Sep;104(9):1447-1455. doi: 10.1016/j.apmr.2023.02.017. Epub 2023 Mar 18.

Authors

Petra Marsico¹, Lea Meier², Marietta L van der Linden³, Tom H Mercer³, Hubertus J A van Hedel⁴

Affiliations

¹ Research Department, Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland; Children's Research Center CRC, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, Scotland. Electronic address: petra.marsico@kispi.uzh.ch.
² Research Department, Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland; Children's Research Center CRC, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; ZHAW, Institute for Physiotherapy, Zürich University of Applied Studies, Winterthur, Switzerland.
³ Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, Scotland.
⁴ Research Department, Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland; Children's Research Center CRC, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, Scotland.

PMID: 36935032
DOI: 10.1016/j.apmr.2023.02.017

Abstract

Objective: To investigate the feasibility, discriminative and convergent validity, and inter-rater reliability of a lower limb tactile function and 2 body awareness assessments in children with upper motor neuron (UMN) lesions.

Design: Cross-sectional psychometric study.

Setting: Pediatric rehabilitation center.

Participants: Forty individuals with UMN lesions (mean age 11.7 years, SD 3.4 years; 27 girls) and 40 neurotypically developing children of the same age participated (N=80).

Interventions: Not applicable.

Main outcome measures: We assessed the tactile threshold (TT) with monofilaments and body awareness with tactile localization tasks (TLTs) for structural (TLT_action) and spatial (TLT_perception) body representation at the foot sole. We compared the test outcomes between children with UMN lesions and neurotypically developing children with the Wilcoxon signed-rank test. Furthermore, we quantified the relations between the 3 tests with Spearman correlations (r_s) and the interrater reliability with quadratic weighted kappa (κ_QW).

Results: About 80% of the children with UMN lesions perceived the tests easy to perform. The children with UMN lesions had significantly reduced somatosensory function compared with the neurotypically developing children. For the more affected leg, we found good relations between the TT and the TLT_action (r_s=0.71; P<.001) and between the 2 TLTs (r_s=0.66; P<.001), and a fair relation between the TT and the TLT_perception (r_s=0.31; P=.06). The inter-rater reliability analyses for the sum scores showed almost perfect agreement for the TT (κ_QW more affected leg 0.86; less affected leg 0.81), substantial agreement for TLT_action (κ_QW more affected leg 0.76; less affected leg 0.63), and almost perfect agreement for TLT_perception (κ_QW more affected leg 0.88; less affected leg 0.74).

Conclusion: The 3 tests are feasible to assess lower limb somatosensory function in children with UMN lesions. Discriminative and convergent validity and reliability of the 3 tests were confirmed. Further studies should investigate responsiveness and association with motor function of these outcome measures.

Keywords: Body image; Cerebral palsy; Outcome measures; Perception; Psychometrics; Rehabilitation; Sensory threshold; Touch.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child
Cross-Sectional Studies
Feasibility Studies
Female
Humans
Lower Extremity*
Motor Neurons*
Reproducibility of Results
Upper Extremity