Accelerometry-Based Metrics to Evaluate the Relative Use of the More Affected Arm during Daily Activities in Adults Living with Cerebral Palsy.

Isabelle Poitras,Jade Clouâtre,Catherine Mercier,Alexandre Campeau-Lecours

doi:10.3390/s22031022

Abstract

Adults living with cerebral palsy (CP) report bimanual and unimanual difficulties that interfere with their participation in activities of daily living (ADL). There is a lack of quantitative methods to assess the impact of these motor dysfunctions on the relative use of each arm. The objective of this study was to evaluate the concurrent and discriminative validity of accelerometry-based metrics when used to assess bimanual and unimanual functions. Methods: A group of control subjects and hemiplegic adults living with CP performed six ADL tasks, during which they were wearing an Actigraph GT9X on each wrist and being filmed. Four bimanual and unimanual metrics were calculated from both accelerometry-based and video-based data; these metrics were then compared to one other with an intraclass correlation coefficient (ICC). Some of these metrics were previously validated in other clinical population, while others were novel. The discriminative validity was assessed through comparisons between groups and between tasks. Results: The concurrent validity was considered as good to excellent (ICC = 0.61–0.97) depending on the experience of the raters. The tasks made it possible to discriminate between groups. Conclusion: The proposed accelerometry-based metrics are a promising tool to evaluate bimanual and unimanual functions in adults living with CP.

Highlights

The most predominant type of cerebral palsy (CP) is spastic hemiplegia [1] in which greater sensorimotor deficits are reported in the side of the body contralateral to the cerebral lesion [2,3] and weaker deficits are reported in the ipsilateral side [4]
The results of this study support the validity of the four accelerometry-based metrics proposed to assess the relative use of each upper limb during activities of daily living (ADL) in adults living with CP
Our study has identified three tasks that show good discrimination between groups, and that differ from each other in terms of bimanual vs. unimanual involvement for a rapid evaluation of bimanual and unimanual functions in adults living with CP

Summary

Introduction

The most predominant type of cerebral palsy (CP) is spastic hemiplegia [1] in which greater sensorimotor deficits are reported in the side of the body contralateral to the cerebral lesion [2,3] and weaker deficits are reported in the ipsilateral side [4]. The assessment of bimanual functions and of the relative use of each arm remain challenging: most assessment tools are based on either a person’s own judgement about their motor performance (e.g., ABIlHAND-Kids questionnaire [8]), on the extrapolation of unimanual functions of the more affected hand (e.g., Box and Blocks [9]), or on clinical observation (e.g., Assisting Hand Assessment [10]). Clinical observations are influenced by therapist bias [14]

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Conclusion