Validity and reliability of the Wall Arm Reaching Test in children with unilateral cerebral palsy

Abstract

Aims: Assessing reaching in children with unilateral cerebral palsy (uCP) is important, but no suitable quick and easy test exists for the clinic and home. This study aimed to evaluate the validity, discriminatory ability, and reliability of the Wall Arm Reaching Test (WART), a user-friendly reaching assessment. Methods: 43 children with typical development (TD) and 28 children with uCP (10-18 years) participated. During the WART, they alternated rapidly between touching their hip and a wall-mounted target at their height for 30 s. For reliability, children completed the WART three times on-site (twice with the same examiner) and once at home, evaluated with intraclass correlation coefficients (ICC) and Bland-Altman plots. For validity, the uCP group performed a subset of the Melbourne assessment (MA2-reach). Results: The WART demonstrated good validity, correlating with the MA2-reach (Spearman's rs=0.66). It showed strong discriminatory ability, with significant higher scores for the unaffected versus affected arm (p < 0.001), and for the TD group compared to the uCP group (p < 0.001). Reliability ICCs ranged from 0.72-0.93 for uCP and 0.39-0.92 for TD. Conclusions: The WART is a valid, reliable tool for assessing reaching in uCP in clinical and home environment, but poorly reliable at home in children with TD.