Wearable wrist activity monitor as an indicator of functional hand use in children with cerebral palsy

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The article by Howcroft et al.1 poses interesting questions regarding clinical measurement: what type of variables are measured during patient management, how are they measured, and the meaning of the information gained in the context of patient management. The sensor developed by Howcroft et al.1 aims to quantify typical hand function in children with cerebral palsy in everyday contexts such as home, school, and during play. Considering the availability of valid and reliable clinician-administered instruments that evaluate hand function (e.g. the Assisting Hand Assessment),2 some would argue that this use of complex technology may not be warranted. However, there is an increasing body of evidence regarding the need to evaluate patients in their own environment, outside the clinical setting. According to the International Classification of Functioning, Disability and Health,3 the ability to perform day-to-day tasks is defined as ‘activity’. Difficulties in performing these tasks are termed activity limitations. Activities can be evaluated using two methods. First, capacity describes an individual’s ability to undertake a task in a standardized environment, and is usually evaluated by a clinician observing a patient performing a task in a standardized, clinical environment. Consequently, it is not known whether these abilities can be transferred into day-to-day tasks undertaken by patients in their own, more unpredictable environment.3 In contrast, performance describes what individuals do in their own environment. This type of measure provides clinicians with information on whether the treatment effects are carried over into everyday situations. This valuable information is necessary for treatment planning, and was addressed in the current study using custom-designed wearable hand monitors. Thus, the information gained from the wearable monitors can be considered to address performance variables. Howcroft et al.1 also demonstrate the complexities which are associated with applying new technologies to patient measurement. Systems designed for use on adults are often not suitable to be applied to paediatric populations because of differences in the size of limbs and frequency of movements.4 Specialist teams, which may consist of biomedical engineers, information technology experts, as well as clinicians, are required to solve complex issues regarding data capture, processing, storage, and interpretation, in order for such systems to be deemed clinically valuable. However, clinicians would gain a thorough understanding of the impact of patient management on their patients’ lives, particularly in relation to whether clinical management has changed the way in which daily activities are performed. The benefits of such systems are, therefore, potentially huge.