Abstract
Aims: To assess children's acceptance to wear a 3D-accelerometer which is attached to the waist under real-world conditions, and also to compare gait speed during supervised testing with the non-supervised gait speed in every-day life.Methods: In a controlled observational, cross sectional study thirty subjects with cerebral palsy (CP), with level I&II of the Gross Motor Function Classification System (GMFCS) and 30 healthy control children (Ctrl), aged 3–12 years, were asked to perform a 1-min-walking test (1 mwt) under laboratory conditions, and to wear an accelerometric device for a 1-week wearing home measurement (1 WHM). Acceptance was measured via wearing time, and by a questionnaire in which subjects rated restrictions in their daily living and wearing comfort. In addition, validity of 3D-accelerometric gait speed was checked through gold standard assessment of gait speed with a mobile perambulator.Results: Wearing time amounted to 10.3 (SD 3.4) hours per day, which was comparable between groups (T = 1.10, P = 0.3). Mode for wearing comfort [CP 1, Range (1,4), Ctrl 1, Range (1,6)] and restriction of daily living [CP 1, Range (1,3), Ctrl 1, Range (1,4)] was comparable between groups. Under laboratory conditions, Ctrl walked faster in the 1 mwt than CP (Ctrl 1.72 ± 0.29 m/s, CP 1.48 ± 0.41 m/s, P = 0.018). Similarly, a statistically significant difference was found when comparing real-world walking speed and laboratory walking speed (CP: 1 mwt 1.48 ± 0.41 m/s, 1 WHM 0.89 ± 0.09 m/s, P = 0.012; Ctrl: 1mwt 1.72 ± 0.29, 1 WHM 0.97 ± 0.06, P < 0.001).Conclusion: 3D-accelerometry is well-enough accepted in a pediatric population of patients with CP and a Ctrl group to allow valid assessments. Assessment outside the laboratory environment yields information about real world activity that was not captured by routine clinical tests. This suggests that assessment of habitual activities by wearable devices reflects the functioning of children in their home environment. This novel information constitutes an important goal for rehabilitation medicine. The study is registered at the German Register of Clinical Trials with the title “Acceptance and Validity of 3D Accelerometric Gait Analysis in Pediatric Patients” (AVAPed; DRKS00011919).
Highlights
Successful rehabilitation enables patients to perform activities of daily living (ADL) in their own home setting
Assessment outside the laboratory environment yields information about real world activity that was not captured by routine clinical tests
This suggests that assessment of habitual activities by wearable devices reflects the functioning of children in their home environment
Summary
Successful rehabilitation enables patients to perform activities of daily living (ADL) in their own home setting. To monitor the success of rehabilitation will require assessments in the patient’s home setting In this respect, there is an obvious knowledge gap, as rehabilitation success is typically assessed in a clinical setting, which can only indirectly reflect the patients’ functioning in their free-living environment [1]. There is an obvious knowledge gap, as rehabilitation success is typically assessed in a clinical setting, which can only indirectly reflect the patients’ functioning in their free-living environment [1] This could lead to the result that patients are prepared to pass clinical assessments but fail in their ADL. It has become possible to assess patients in their free-living environment [2] Such wearable devices have great potential for medicine, and assessment of physical activity through commercial companies is already widespread in the public domain [3]. Accelerometric data can nowadays be used to accurately derive real-world gait speed, walking distance [6] and walking and running activity [7], and if worn at the wrist they are well-tolerated in healthy infant population [8]
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