Comparison of lip incompetence by remote video surveillance and clinical observation in children with and without cerebral palsy

This study aimed to compare two methods of assessing lip position so that an appropriate method could be used to assess whether a relationship existed between lip position and drooling in children with cerebral palsy. This investigation compared the use of a new, remote video surveillance (RVS) technique with direct clinical assessment of lip position by determination of intra- and inter-examiner agreement. Lip position was assessed in both techniques using the Jackson lip classification. Two groups of school children took part: one group suffered from cerebral palsy (CP), but the second group consisted of unaffected individuals. Based on Kappa statistics, intra- and inter-examiner agreements were generally found to be moderate for the individual methods (kappa = 0.48-0.54), whilst agreement between the two methods was found to be good (kappa = 0.68). The results showed moderately good examiner-agreement in the assessment of lip position, using either method and the Jackson lip classification. Consequently, lip position can be assessed by either RVS or direct clinical assessment, the choice depending on the physical circumstances surrounding the assessor and operator preference. However, RVS may offer a more unobtrusive approach.