artifact 4: Pediatric upper extremity assessment

As initially the sole occupational therapist (OT) on an team comprising of predominantly physical therapists (PT), there was a heavy emphasis on gross motor function at our practice. As the OT, I found myself naturally being called upon as the go to person for assessing and treating upper extremity control. The PT department systematically utilized the Gross Motor Function Measure (GMFM), which is considered to be the gold standard for measuring motor function in children with cerebral palsy. The OT department however, lacked a uniform measure for establishing and measuring upper extremity function. As the name implies, the GMFM places heavy emphasis on gross motor movements and function, with little regard for the upper extremity. I sought to find and implement a gold standard equivalent for upper extremity assessment, though quickly learned the process would not be as straight forward as I had anticipated.

This artifact demonstrates my undertaking in reviewing literature, analyzing outcomes and critiquing the evidence to weight the pertinent options. What I found to be one of the most challenging aspects to implementing a singular measure, was the consideration for unimanual or bimanual functioning. Though I came across some valid and reliable measures, they would not be appropriate to be uniformly applied to all our patients. The relevance of particular measures was often dictated by the child's unimanual or bimanual impairment classification. Moreover, other factors including time constraints, cost effectiveness, and clinician skill set also had to be considered. Below are the clinical guidelines I developed specific to our practice. It offers our team of clinicians an efficient reference to guide their selection of the most appropriate measure, individualized to each patient.