Children with a neurological condition may present with muscle weakness and sensory changes that limit their activities and restrict participation in daily life. To evaluate these impairments a neurological examination requires a battery of tests. Clinicians frequently measure a child’s strength, sensation, and reflex impairments to assess neural integrity, as part of a neurological examination. Interpretation of these test results can assist in tailoring interventions and evaluating their effectiveness over time. Lower limb neurological tests exist for use in children, but few have evidence of sound clinimetric properties. Evidence exists for neurodevelopmental tests used in infancy and early childhood, and additional evidence exists for the neurological examination of adults. Yet, it remains unclear what is typically used for individuals when neurodevelopmental examinations are no longer appropriate. Additionally, there is no consensus on the paediatric terms or age ranges that define this group, making it difficult to review current practices. In the absence of a gold standard, neurological test protocols designed for adults are modified for use in children and young people. Yet there is no consensus on which tests of strength, sensation and reflexes should form a neurological examination in children and young people. Without clinimetrically sound tests that are valid, reliable, responsive, and feasible to use in children and young people in a clinical setting, it is difficult for clinicians to select, perform, and appropriately interpret the results of neurological tests in clinical practice. This limits the ability to assess for neurological changes and select and monitor appropriate treatments to maximise health benefits in children and young people with a neurological condition.

Aim: In children and young people with a neurological condition, this doctoral research program aimed to (i) systematically review the literature to identify and define the terms and age ranges encompassing ‘paediatrics’ in the Australian health and health education context, (ii) systematically review the literature to identify lower limb neurological tests and evaluate the evidence on clinimetric properties of these tests in paediatrics, (iii) establish consensus from expert clinicians on the enablers, barriers and modifications to lower limb neurological testing in children and young people, (iv) establish consensus from clinicians on lower limb neurological testing protocols for testing children and young people with a neurological condition, (v) develop a new lower limb neurological examination and investigate the intra- and inter-rater reproducibility of the Portable Examination of the Lower Limb in young people and children – a Neurological (PeLLycaN) to measure lower limb neurological integrity in typically developing children and in a smaller sub-set of children with a neurological condition (Cerebral Palsy, [CP]). […]