Abstract
BackgroundDetecting differences in upper limb use in children with unilateral cerebral palsy (UCP) is challenging and highly dependent on examiner experience. The recent introduction of technologies in the clinical environment, and in particular the use of wearable sensors, can provide quantitative measurement to overcome this issue.This study aims to evaluate ActiGraph GT3X+ as a tool for measuring asymmetry in the use of the two upper limbs (ULs) during the assessment with a standardized clinical tool, the Assisting Hand Assessment (AHA) in UCP patients aged 3–25 years compared to age-matched typically developing (TD) subjects.MethodsFifty children with UCP and 50 TD subjects were assessed with AHA while wearing ActiGraphs GT3X+ on both wrists. The mean activity of each hand (dominant and non-dominant, MADH and MANDH, respectively) and the asymmetry index (AI) were calculated. Two linear mixed model analyses were carried out to evaluate how dependent actigraphic variables (i.e. MANDH and AI) varied by group (TD vs UCP) and among levels of manual ability based on Manual Ability Classification System (MACS). In both models age, sex, side of hemiplegia, presence/absence of mirror movements were specified as random effects.ResultsThe MANDH was significantly lower in UCP compared to TD, while the AI was significantly higher in UCP compared to TD. Moreover, in UCP group there were significant differences related to MACS levels, both for MANDH and AI.None of the random variables (i.e. age, sex, side, presence/absence of mirror movements) showed significant interaction with MANDH and AI.ConclusionsThese results confirm that actigraphy could provide, in a standardized setting, a quantitative description of differences between upper limbs activity.Trial registrationClincalTrials.gov, NCT03054441. Registered 15 February 2017.
Highlights
Detecting differences in upper limb use in children with unilateral cerebral palsy (UCP) is challenging and highly dependent on examiner experience
The primary purpose of this study was to examine validity of ActiGraph GT3X+ worn on both wrists, to measure asymmetry in Upper Limb (UL) use during Assisting Hand Assessment (AHA) in subjects aged 3–25 years with UCP compared to age-matched typically developing (TD)
This study confirmed that actigraphs are valid tool, able to measure the amount of movement of ULs to quantify comparisons between limbs and confirmed construct validity between actigraphic data and Manual Ability Classification System (MACS) levels and severity of bimanual coordination on AHA, without requiring excessive time or effort
Summary
Detecting differences in upper limb use in children with unilateral cerebral palsy (UCP) is challenging and highly dependent on examiner experience. This study aims to evaluate ActiGraph GT3X+ as a tool for measuring asymmetry in the use of the two upper limbs (ULs) during the assessment with a standardized clinical tool, the Assisting Hand Assessment (AHA) in UCP patients aged 3–25 years compared to age-matched typically developing (TD) subjects. Unilateral Cerebral Palsy (UCP, motor impairment on one side), constitutes the most frequent form of CP, Clinicians interested in evaluation and treatment of ULs in children with UCP can choose from a wide range of assessment tools and classification systems. The best performance-based measure of bimanual ULs activity in children with UCP was ascribed to the Assisting Hand Assessment (AHA) [9]. Thanks to progresses of Information and Communication technology (ICT), the use of technological solutions increases and, in parallel with traditional clinical assessments, additional information are provided [11], such as quantitative data during motor activity and asymmetries in the circadian motor activities [12, 13]
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