Assessment of upper limb use in children with typical development and neurodevelopmental disorders by inertial sensors: a systematic review

Irene Braito,Giovanni Cioni,Emanuela Inguaggiato,Giuseppina Sgandurra,Francesca Cecchi,Martina Maselli,Elena Beani,Roslyn Boyd

doi:10.1186/s12984-018-0447-y

Abstract

Understanding development of bimanual upper limb (UL) activities in both typical and atypical conditions in children is important for: i) tailoring rehabilitation programs, ii) monitoring progress, iii) determining outcomes and iv) evaluating effectiveness of treatment/rehabilitation. Recent technological advances, such as wearable sensors, offer possibilities to perform standard medical monitoring. Body-worn motion sensors, mainly accelerometers, have shown very promising results but, so far, these studies have mainly focused on adults. The main aim of this review was to report the evidence of UL activity of both typically developing (TD) children and children with neurodevelopmental disorders (NDDs) that are reliably reported and comparable, using a combination of multiple wearable inertial sensors, both in laboratory and natural settings. Articles were selected from three research databases (PubMed, Web of Science and EBSCO). Included studies reported data on children aged 0–20 years old simultaneously wearing at least two inertial sensors on upper extremities. The collected and reported data were relevant in order to describe the amount of physical activity performed by the two ULs separately. A total of 21 articles were selected: 11 including TD, and 10 regarding NDDs. For each article, a review of both clinical and technical data was performed. We considered inertial sensors used for following aims: (i) to establish activity intensity cut-points; (ii) to investigate validity and reliability of specified markers, placement and/or number of inertial sensors; (iii) to evaluate duration and intensity of natural UL movements, defined motor tasks and tremor; and (iv) to assess efficacy of certain rehabilitation protocols. Our conclusions were that inertial sensors are able to detect differences in use between both hands and that all reviewed studies support use of accelerometers as an objective outcome measure, appropriate in assessing UL activity in young children with NDDs and determining intervention effectiveness. Further research on responsiveness to interventions and consistency with use in real-world settings is needed. This information could be useful in planning UL rehabilitation strategies.

Highlights

Upper limbs (ULs) function is fundamental for basic and instrumental daily life activities such as self-care, work, leisure, household routines and social communication
This systematic review addressed the following issues: 1) How valid are at least two bilaterally worn arm-hand sensors, regarding number and placement of devices, in order to i) describe UL motor capacity and performance in children and ii) investigate UL bilateral asymmetry using accelerometers; 2) Can assessment be generalized across different UL motor abilities and health conditions? 3) What types of accelerometers have been used and how should data be collected and analysed? 4) Do the obtained measurements conform to the outcomes obtained through the administration of standard clinical assessments?
Reasons for exclusion were grouped into four main categories: 1) unsuitable placement and/or number of sensors: n = 27; 2) no inertial sensors (i.e.: inertial eigenvectors, dynamometers, potentiometers): n = 3; 3) age (i.e.: adult): n = 17; 4) unsuitable data analysis (i.e.: absence of evaluations regarding potential bilateral asymmetry existing between two ULs): n = 19; 5) other reasons (i.e.: descriptive texts, unavailability of full article): n = 6

Summary

Introduction

Upper limbs (ULs) function is fundamental for basic and instrumental daily life activities such as self-care, work, leisure, household routines and social communication. Such activities encompass both gross and fine body movements and involve close cooperation between ULs [1]. The majority of the human manual activities involve two hands playing different roles and working in a coordinated fashion, basilar for the manipulative efficiency [1]. The left and the right hands are important in bimanual activities, since the assisting (or non-dominant) hand defines a steady environment in which the dominant hand can perform a specific activity, such as writing, or actively participates in the movement, like in playing instruments or sports [1], either

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