Date Presented 4/18/2015
The Functional Composite Movement Scale (FCMS) is a promising clinical tool to assess quantitative changes in upper-extremity function. FCMS scores may be generalizable to the performance of activities of daily living (ADLs). When tested, the FCMS showed one statistically significant difference in functional movement of children with cerebral palsy (CP) after modified constraint induced movement therapy (mCIMT) intervention.
SIGNIFICANCE: Although modified constraint induced movement therapy (mCIMT) shows promise for promoting therapeutic gains, current assessments require extensive time to administer and focus on the hand rather than overall function of the affected upper extremity (UE). Photography is a promising way to monitor progress during mCIMT that has not been explored in current literature. We recently created the Functional Composite Movement Scale (FCMS) to bridge this assessment gap.
INNOVATION: The FCMS measures integrated movement of the UE using nine positions required for adequate engagement in activities of daily living (ADLs). It uses a numerical scale that quantifies how a desired position is achieved and allows the therapist to visualize and rate compensation and its impact on movement. The FCMS provides a measure to assess physical progress for documentation and may be used as objective data for third-party payers. The positions may be generalizable to occupational performance. Normalcy of functional movements may increase acceptance by peers, self-confidence, and independence in ADLs.
APPROACH: In this study, we attempted to answer the following research question: Is the FCMS an effective measure to rate before and after photos of participants in an mCIMT outpatient summer camp? Research in this area is necessary due to the lack of efficient assessments for composite UE movement and the ability to provide quantitative, objective data. The FCMS was created, and its reliability was investigated.
METHOD: A retrospective quasi-experimental design was used to assess photos of end range positions representing composite UE movement. Data were scored and examined for significant pre–post camp differences with SPSS.
A 3-wk pediatric mCIMT outpatient summer camp was held in 2012. Data were obtained with permission of the university and medical facility institutional review boards (IRBs). Participants included 13 children, aged 4 to 12 yr, with varying types and severity of cerebral palsy (CP). Twelve participants had spastic hemiplegia, and 1 participant had spastic triplegia.
Photos were taken by camp therapists and were scored by the researchers. FCMS was developed through collaboration among the researchers on the basis of functional movement and corresponding compensation. Objective criteria were drafted and tested for interrater reliability. Independent and dependent t tests were run with SPSS for data analysis.
RESULTS: Researchers had 93.6% interrater reliability within a window of 1.0 on the FCMS. The mean change in average pre- to post-FCMS scores across all participants was positive (0.07). Eight participants had an increase in average FCMS scores, 3 participants had a decrease in average FCMS scores, and 2 participants showed no change. There was a statistically significant difference in pre- to postgroup average FCMS scores for the overhead position, t(12) = 2.48, p = .029, which was one of the nine positions of the FCMS. This finding for the overhead position suggests that participants made functional improvements in shoulder range of motion—a movement that is critical to ADLs.
CONCLUSION: The FCMS demonstrates early stage interrater reliability. The findings of the overhead position suggest that participants made functional improvements in shoulder movement. Study limitations include a weakness in established photographic protocol and the retrospective nature of the study. The FCMS is a clinical tool that deserves more research.
