Background: Assessment of bimanual movements, which are frequently impaired in children with cerebral palsy, is highly challenging in clinical practice. Instrumented measures have been developed to evaluate and help to understand impaired upper limb movement during bimanual tasks in these children. The aim of this review was to report instrumented measurement tools (3D motion analysis, sensors, etc.) used for bimanual task movement analysis, and the metrological properties of the measures in children with cerebral palsy.

Methods: A systematic review was conducted (Prospero CRD42022308517). PubMed, Web of Science, Cochrane and Scopus databases were searched with relevant keywords and inclusion/exclusion criteria. Article quality and biomechanical methods were evaluated with a customized scale and metrological properties with the COSMIN checklist.

Results: In total, 452 children, mostly with unilateral cerebral palsy, mean age 10.9 (SD 3.2) years, underwent quantitative bimanual assessments in the 31 included studies (mean quality score 22/32 points [SD 4.7]). The tools used were 3D motion analysis (n = 26), accelerometers (n = 2), and other instruments (cube, digitizer, etc.) (n = 3). Children performed 1-5 bimanual tasks in laboratory settings, mostly activities of daily living or game scenarios. Analyses focused mostly on spatiotemporal variables, 6 of which were specifically developed for bilateral measures (task completion time, goal synchronization, movement overlap time, interlimb coupling, continuous relative phase and asynchrony). These instrumented measurements had moderate to good discriminant and convergent validity, but reliability and responsiveness assessments were lacking.

Conclusions: A large number of quantitative bimanual assessments involving different tools, bimanual tasks and specific variables developed to evaluate bimanual function were found. Development of other relevant variables and validation of these tools are needed to further determine their usefulness, both as research outcomes and to guide therapies in clinical practice. Future research, involving younger children and real-life assessments, will improve our understanding of bimanual function in children with cerebral palsy.