This study aimed to verify the reliability of the grip strength measurement using visual aids to help children with ASD concentrate on the grip strength measurement.
Fourteen children with ASD (mean age 8.7 years) were included in the study. Of these, 10 had ASD only, and four had other neurodevelopmental disorders, such as ADHD.A Smedley grip strength meter (Tsutsumi) was used to measure grip strength, which a physical therapist and an assistant performed. The examiner was in charge of the orientation and measurement, while the assistant recorded and guided the patient. In the standing position, the upper limb was hung down, and the grip width was adjusted so that the PIP joint was 90°. Animal stickers were placed on the dial of the grip strength meter at the target grip strength values (5 kg, 10 kg, and 15 kg) to motivate the participants to achieve the goal through visual support. During the measurement practice, the children were instructed to visually confirm that the needle had moved when they grasped the grip and to hold the grip continuously. After the measurement, the achieved values and animal stickers were visually presented and praised. Two examiners performed the measurements to examine inter-rater reliability, and the order in which the children were measured was randomized. Statistical analysis was used to examine reliability by calculating intraclass correlation coefficients and analyzing systematic errors using Bland-Altman plots.
The mean (standard deviation) grip strength was 12.7 (3.4) kgf and 12.8 (2.9) kgf for examiners 1 and 2, in that order, with no significant differences. The intraclass correlation coefficients (2,1) showed good reliability with ICC = 0.96 (95% C.I = 0.90-0.99). Upon examination of systematic errors, significant proportional errors were found (P0.05).
Visual aids facilitate the understanding of grip strength measurement and increase reliability. It was assumed that the case in which a proportional error was observed was that of an older child with ADHD and other comorbidities, which may have caused variation in force output. In the future, it will be necessary to verify these results by considering the age of the participants and their comorbidities.
If the reliability of grip strength measurement for children with ASD is good, it will be a useful tool to determine the degree of physical function, strength, and motor impairment and can be widely used in clinical practice.
Grip strength measurement
Reliability
