Windmill-task as a New Quantitative and Objective Assessment for Mirror Movements in Unilateral Cerebral Palsy: A Pilot Study

Ingar Marie Zielinski, Bert Steenbergen, Anna Schmidt, Katrijn Klingels, Cristina Simon Martinez, Pascal de Water, Brian Hoare

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6 Citations (Scopus)


Objective: To introduce the Windmill-task, a new objective assessment tool to quantify the presence of mirror movements (MMs) in children with unilateral cerebral palsy (UCP), which are typically assessed with the observation-based Woods and Teuber scale (W&T). Design: Prospective, observational, cohort pilot study. Setting: Children's hospital. Participants: Prospective cohort of children (N=23) with UCP (age range, 6–15y, mean age, 10.5±2.7y). Interventions: Not applicable. Main Outcome Measures: The concurrent validity of the Windmill-task is assessed, and the sensitivity and specificity for MM detection are compared between both assessments. To assess the concurrent validity, Windmill-task data are compared with W&T data using Spearman rank correlations (ρ) for 2 conditions: affected hand moving vs less affected hand moving. Sensitivity and specificity are compared by measuring the mean percentage of children being assessed inconsistently across both assessments. Results: Outcomes of both assessments correlated significantly (affected hand moving: ρ=.520; P=.005; less affected hand moving: ρ=.488; P=.009). However, many children displayed MMs on the Windmill-task, but not on the W&T (sensitivity: affected hand moving: 27.5%; less affected hand moving: 40.6%). Only 2 children displayed MMs on the W&T, but not on the Windmill-task (specificity: affected hand moving: 2.9%; less affected hand moving: 1.4%). Conclusions: The Windmill-task seems to be a valid tool to assess MMs in children with UCP and has an additional advantage of sensitivity to detect MMs.

Original languageEnglish
Pages (from-to)1547-1552
Number of pages6
JournalArchives of Physical Medicine and Rehabilitation
Issue number8
Publication statusPublished - 1 Aug 2018


  • Child
  • Movement
  • Rehabilitation
  • Upper extremity

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