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The need for standardized evaluation of upper extremity (UE) performance comes from the advancements in interventions that have helped realize the functional improvements for individuals living with tetraplegia1 and the demand for evidence-informed practice.2 Although notable UE assessments have been described, none have been uniformly adopted for research or clinical use and, until recently, few were designed to evaluate recovery of neurological UE function following spinal cord injury (SCI). However, over the last several years, Kalsi-Ryan and colleagues have developed and validated the Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP) for adults with tetraplegia.3 The GRASSP combines well-established methods of manual muscle strength testing and monofilament sensory testing with observation of grasp and pinch patterns during object manipulation.3 Although the GRASSP is capable of detecting neurological recovery and change due to interventions, and despite strong psychometric properties,4 its evaluation of functional hand performance is limited in scope (lateral pinch, three-jaw chuck, palmar grasp). In contrast to the limited performance component of the GRASSP, the Capabilities of Upper Extremity Test (CUE-T) evaluates 19 different performance aspects of UE function, including unilateral, bilateral, proximal, and distal functions.5 Taken together, the CUE-T items measure observed UE capabilities and have demonstrated a high level of reliability.6 The CUE-T is an SCI-specific instrument developed by Marino and colleagues based on the Capabilities of the Upper Extremity Questionnaire (CUE-Q).57 When used in combination, the CUE-T and CUE-Q provide an objective (CUE-T) and self-perceived (CUE-Q) assessment of UE function necessary for performance of basic and instrumental activities of daily living (ADL).
Given the relevance of the CUE-T items to persons with tetraplegia and preliminary indication of strong psychometric properties in adults, the purpose of this study was to evaluate the reliability of the CUE-T when administered repeatedly in children and to examine if it is a valid indictor of UE function of children with SCI.
Methods
This study was part of a larger multicenter repeated measures study aimed to examine the psychometric properties of instruments used for adult SCI clinical trials in children and youth and to determine the lower age in which the instruments have utility. The methods for the larger study have been described elsewhere8 and are briefly summarized here.
Children were recruited from seven facilities across the...