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Protocol helpful for young children with difficulties completing shoulder range of motion test
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A study scheduled to be presented at the EFORT Congress in London showed that the assessment of shoulder range of motion in young children is difficult due to a number of factors and they may be better served with a non-standard protocol.
Fabian Van De Bunt, MD, and colleagues found children younger than 3 years generally are not able to complete active shoulder range of motion (ROM) tests. He told Orthopaedics Today Europe the established tool to determine shoulder ROM, the Mallet Scale, may not be the best protocol to use, preferring the ABC Loops protocol, which is a more comprehensive system.
Van De Bunt, who is scheduled to present the study, said it was important to determine the proper age that children can reliably complete these two active ROM tests since clinical studies often use these tools to evaluate children younger than 1 year.
Too young
Images: Van De Bunt F
“Under 3 years old they just do not have the ability to reliably complete an active shoulder range of motion protocol. More often than not, they don’t understand the instructions, lack the neuromuscular coordination, are too anxious, or simply just don’t want to do it. That is what we took out of this for the most part,” Van De Bunt said. “The Mallet Scale is not dynamic. It evaluates only five motions with limited functional relevance and four of them weighted toward external rotation. The ABC Loops protocol, however, has a smooth arc movement that includes many functional positions in all directions of shoulder motion. You can see where the problem starts, how they cope with compensational movements or not. It helps in assessing their functional range of motion and seeing where the problem starts.”
Van De Bunt and colleagues assessed 65 children from local preschools and evaluated their shoulder ROM using the Mallet Scale and the ABC Loops measurement protocol. The study included 32 boys and 33 girls, with a mean age of 3.9 years (range 0.5 year to 7 years). Children were assessed on their ability to complete the examinations and how long it took to complete each measurement protocol, according to the study abstract.
Forty-eight children with a mean age of 4.4 years were able to complete both the Mallet and ABC Loops measurement protocols; 17 children with a mean age of 2.3 years failed to complete either test.
ABC Loops protocol
Van De Bunt told Orthopaedics Today Europe it was clear that children younger than 3 years could not accurately or consistently complete either of the two ROM systems. Unfortunately neither scale solves the problem of evaluating active motion in young children, but when testable the ABC Loops protocol provides better insight into the child’s function than the Mallet Scale. The literature on treatment of children with brachial plexus birth palsy using the Mallet Scale has been biased toward procedures that improve external rotation, while neglecting other measures and problems the intervention may have made worse, he noted.
“We think the ABC Loops protocol grades everything, meaning their full functional ROM, each position requiring an increase in at least one parameter (elevation, adduction/abduction, internal/external rotation) and does not favor one or the other, so you get a nice balanced result,” he said. “However, it is important to realize that ABC Loops measures one arm at a time, not both of them. As you can realize, it takes a lot longer to complete than the Mallet Scale.”
The next step of the study is to perform the tests on children with brachial plexus birth palsy, Van De Bunt said. – by Robert Linnehan
- Reference:
- Van De Bunt F. Paper #14-1027. Scheduled to be presented June 4 at: 15th EFORT Congress – A Combined Program in Partnership With the BOA; June 4-6, 2014; London.
- For more information:
- Fabian Van De Bunt, MD, can be reached at the VU University Medical Center, De Boelelaan 1117, 1081 HZ Amsterdam, Netherlands; email: fabianvdbunt@gmail.com.
Disclosure: Van De Bunt has no relevant financial disclosures.