Feasibility, validity, and reliability of lower limb tactile and body awareness assessments in children with upper motor neuron lesions

Abstract

Objective: To investigated the feasibility, discriminative and convergent validity, and inter-rater reliability of a lower limb tactile function and two body awareness as-sessments 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 partici-pated. Interventions: Not applicable. Main Outcome Measures: We assessed the tactile threshold (TT) with monofila-ments and body awareness with tactile localization tasks (TLT) for structural (TLTaction) and spatial (TLTperception) body representation at the foot sole. We compared the test outcomes between children with UMN lesions and neurotypically develop-ing children with the Wilcoxon signed-rank test. Furthermore, we quantified the re-lationships between the three tests with Spearman correlations (rs) and the interrater reliability with quadratic weighted kappa (κQW). 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 to the neurotypically developing children. For the more affected leg, we found good relationships between the TT and the TLTaction (rs =0.71; p<0.001) and between the two TLTs (rs=0.66; p<0.001), and a fair relationship between the TT and the TLTperception (rs =0.31; p=0.06). The inter-rater reliability analyses for the sum scores showed almost perfect agreement for the TT (κQW more affected leg 0.86; less affected leg 0.81), substantial agreement for TLTaction (κQW more affected leg 0.76; less affected leg 0.63), and almost perfect agreement for TLTperception (κQW more af-fected leg 0.88; less affected leg 0.74). Conclusion: The three tests are feasible to assess lower limb somatosensory func-tion in children with UMN lesions. Discriminative and convergent validity and relia-bility of the three tests were confirmed. Further studies should investigate respon-siveness and association with motor function of these outcome measures.