Hand Use In Children Research Articles

Measuring functional hand use in children with unilateral cerebral palsy using accelerometry and machine learning.

To investigate wearable sensors for measuring functional hand use in children with unilateral cerebral palsy (CP). Dual wrist-worn accelerometry data were collected from three females and seven males with unilateral CP (mean age = 10 years 2 months [SD 3 years]) while performing hand tasks during video-recorded play sessions. Video observers labelled instances of functional and non-functional hand use. Machine learning was compared to the conventional activity count approach for identifying unilateral hand movements as functional or non-functional. Correlation and agreement analyses compared the functional usage metrics derived from each method. The best-performing machine learning approach had high precision and recall when trained on an individual basis (F1 = 0.896 [SD 0.043]). On an individual basis, the best-performing classifier showed a significant correlation (r = 0.990, p < 0.001) and strong agreement (bias = 0.57%, 95% confidence interval = -4.98 to 6.13) with video observations. When validated in a leave-one-subject-out scenario, performance decreased significantly (F1 = 0.584 [SD 0.076]). The activity count approach failed to detect significant differences in non-functional or functional hand activity and showed no significant correlation or agreement with the video observations. With further development, wearable accelerometry combined with machine learning may enable quantitative monitoring of everyday functional hand use in children with unilateral CP.

Bimanual hand use in children and adolescents with unilateral spastic cerebral palsy: an exploratory study

BackgroundIndividuals with unilateral spastic cerebral palsy (USCP) often show difficulties using their hands during activities of daily living. ObjectiveTo investigate the factors that interfere with hand use during bimanual activities in children and adolescents with USCP. MethodsWe conducted a cross-sectional study with 102 children and adolescents with USCP, aged 6 to 18 years. We collected information with the caregivers about the classification of the child's manual ability, according to the Manual Ability Classification System (MACS); child's age; side of the involvement; Children's Hand-Use Experience Questionnaire- CHEQ2.0. Cluster analysis identified groups of children and adolescents who performed CHEQ activities with or without assistance. Multiple linear regression analyses identified the contribution of the factors: age, sex, MACS level, side of hemiparesis, and clusters of assistance, on the outcomes of efficacy, time, and feeling bothered. ResultsMACS and clusters of assistance explained the variance in efficacy (p<0.05; R2=0.31) and time (p<0.05; R2=0.37). MACS explained 22% of the variance in feeling bothered. Children and adolescents with increased difficulty to perform activities that involve hand use (i.e., MACS III) and who receive assistance during most bimanual activities showed less efficacy of use, were slower in their performance, and presented greater feeling of being bothered. ConclusionAssistance in bimanual activities and MACS level contributed to explain the efficacy of use, time, and feeling bothered in performing bimanual activities. Intervention strategies aimed at promoting the performance of bimanual activities in the daily routine of children with USCP should consider these outcomes.

Longitudinal development of hand use in children with unilateral spastic cerebral palsy from 18 months to 18 years.

Linked Article: https://onlinelibrary.wiley.com/doi/full/10.1111/dmcn.15370

Longitudinal development of hand use in children with unilateral spastic cerebral palsy from 18 months to 18 years.

To describe the development of the use of the affected hand in bimanual tasks in children with unilateral cerebral palsy (CP) from 18 months to 18 years. Specifically, whether early development can be confirmed in a larger cohort and how development progresses during adolescence. In total, 171 participants (95 males, 76 females; mean age 3 years 1 month [SD 3 years 8 months], range 18 months-16 years at inclusion) were classified in Manual Ability Classification System (MACS) levels I (n=41), II (n=91), and III (n=39). Children were assessed repeatedly (median 7, range 2-16 times) with the Assisting Hand Assessment: in total 1197 assessments. Developmental trajectories were estimated using a nonlinear mixed effects model. To further analyse the adolescent period, a linear mixed model was applied. The developmental trajectories were different between participants in MACS levels (MACS I-II, II-III) in both rate (0.019, 95% confidence interval [CI] 0.006-0.031, p=0.034; 0.025, 95% CI 0.015-0.037, p < 0.001) and limit (19.9, 95% CI 16.6-23.3, p=0.001; 7.2, 95% CI 3.3-11.2, p < 0.003). The individual variations were large within each level. The developmental trajectories were stable over time for all MACS levels between 7 and 18 years (p > 0.05). Children and adolescents with unilateral CP have considerable development at an early age and a stable ability to use their affected hand in bimanual activities from 7 to 18 years in all MACS levels.

Concurrent Validity of Different Sensor-Based Measures: Activity Counts Do Not Reflect Functional Hand Use in Children and Adolescents With Upper Limb Impairments

ObjectiveTo investigate the concurrent validity of 4 different outcome measures to determine daily functional hand use with wrist-worn inertial sensors in children with upper limb impairments. We hypothesized that the commonly used activity counts are biased by walking and wheeling activities, while measures that exclude arm movements during these periods with activity detection algorithms or by limiting the analysis to a range of functional forearm elevation would lead to more valid estimates of daily hand use. DesignConcurrent validity study with video-based observations of functional hand use serving as the criterion measure. SettingThe participants were videotaped while performing an activity circuit at the rehabilitation center and wearing inertial sensors. ParticipantsA convenience sample of 30 school-aged children and adolescents with upper limb impairments. InterventionsNot applicable. Main Outcome MeasuresSpearman rank correlation coefficients ρ between the criterion measure and 4 sensor-based measures: activity counts, combining activity counts with activity detection algorithms (arm activity counts), limiting activity counts to a functional range of forearm elevation (functional activity counts), and a threshold-based approach limited to the same range of forearm elevation (gross arm movements). ResultsActivity counts (ρ=0.43) and gross arm movements (ρ=0.57) did not reveal valid estimates of daily hand use. In contrast, arm and functional activity counts correlated significantly stronger with the criterion measure and revealed valid correlation coefficients of 0.78 and 0.71, respectively. ConclusionsActivity counts should not be used to measure daily hand use because they are biased by walking and wheeling activities. Arm and functional activity counts provide better and valid alternatives. The selection of these 2 approaches depends on the availability and accuracy of activity detection algorithms and on the users' willingness to wear additional sensors in daily life.

The associations between vision level and early hand use in children aged 6–36 months with visual impairment: A cross-sectional, historical case note review

Vision level varies within the population of children born with visual impairment (VI). Children with profound visual impairment (PVI – with light awareness at best) are more developmentally vulnerable than peers born with typical sight or those with severe visual impairment (SVI – basic form vision). Many children with VI are dependent on their hand skills to support their development. However, the impact of vision level on the development of hand use is poorly understood. The aim of the study was to describe the associations between vision level and early hand use in children between 6 and 36 months of age with SVI and PVI. A historical case note review, including video footage of 19 children with SVI ([Formula: see text] = 19 months) and 12 children with PVI ([Formula: see text] = 16 months), was completed. Hand use was observed while the children completed the Reynell-Zinkin Scales. Observations were recorded using a data collection tool designed for the study. The tool included a checklist of developmentally appropriate hand skills expected to emerge in the first 3 years of life. The observer marked each skill as present, absent or emerging in the video clips. Children with SVI used 80.2% (95% confidence interval [CI] = [75.0, 87.5]) of the hand skills under observation. Those with PVI used 57.1% (95% CI = [46.4, 67.9]) of these skills. Vision level and hand use were positively correlated: rs = .564 (95% CI = [.263, .765]), p &lt; .01. This correlation was stronger than the association between developmental level and hand use: r = .364 (95% CI = [.012, .636]), p &lt; .05. Furthermore, 15.8% (95% CI = [0.0, 31.6]) of the children with SVI and 66.7% (95% CI = [41.7, 91.7]) with PVI showed some reluctance to touch objects ( p &lt; .05) by withdrawing their hands actively from items offered to them. Vision level and developmental level influenced hand use; however, vision level appeared to have the greater impact. Interventions that are tailored to promote hand use according to vision level have the potential to improve functional participation.

Inter- and Intrarater Reliability of the Thumb Grasp and Pinch Assessment for Children Following Index Pollicization for Congenital Thumb Hypoplasia

The Thumb Grasp and Pinch (T-GAP) assessment quantifies functional hand use in children with congenital thumb hypoplasia by categorizing grasp and thumb use patterns during assessment activities that encourage a variety of grasp and pinch styles. This study aims to demonstrate interrater and intrarater reliability results of the T-GAP. A retrospective review was performed of children who had undergone index finger pollicization for congenital thumb hypoplasia and subsequent evaluation with videotaping of the T-GAP assessment. Following a training period, 4 occupational therapists scored 11 T-GAP videos on 2 separate occasions, separated by at least 2 weeks. Intraclass correlation coefficients (ICCs), standard error of measurements, minimum detectable change (MDC), and Pearson correlation coefficients were calculated. The T-GAP raw scores were 16 to 55, demonstrating a range of mild to severe hand grasp differences. The ICCs for the interrater reliability trials were 0.887 and 0.901. Intrarater ICCs were all above 0.88. The MDC for each trial was 8.1 and 6.7 points. Pearson correlation coefficients calculated for each rater and each pair of raters were above 0.8 in all cases. Interrater and intrarater reliability testing results for the T-GAP were excellent in all cases; this strongly suggests that results from T-GAP assessments are reliable. The high ICCs suggest that raters can classify and score children's hand function consistently. This study, in conjunction with previous work, suggests that the T-GAP may be an ideal approach to assessing the outcomes of pollicization and provide a means of ongoing assessment of children's grip and pinch function.

Development and psychometric properties of the Hand-Use-at-Home questionnaire to assess amount of affected hand-use in children with unilateral paresis.

To describe the development of the parent-rated Hand-Use-at-Home questionnaire (HUH) assessing the amount of spontaneous use of the affected hand in children with unilateral paresis, and to test its internal structure, unidimensionality, and validity. Parents of children with unilateral cerebral palsy (CP) and professionals participated in the development of the HUH. To examine internal validity, data of 322 children (158 males, 164 females; mean age 6y 7mo, standard deviation [SD] 2y 1mo) with unilateral CP (n=131) or neonatal brachial plexus palsy (NBPP) (n=191) were collected. Rasch analysis was used to examine discriminative capacity of the 5-category rating scale as well as unidimensionality and hierarchy of the item set. Additionally, data of 55 children with typical development (24 males, 31 females; 6y 9mo, SD 2y 5mo) were used to examine construct validity. The 5-category rating scale was disordered in all items and was collapsed to obtain the best discriminating sum score. Ten misfitting or redundant items were removed. Eighteen hierarchically ordered bimanual items fitted the unidimensional model within acceptable range. The HUH significantly discriminated between the three groups (children with typical development, NBPP, unilateral CP; H(2) =118.985, p<0.001), supporting its construct validity. The HUH is a valid instrument to assess the amount of spontaneous use of the affected hand in children with unilateral upper-limb paresis.

Development and Validation of the Both Hands Assessment for Children With Bilateral Cerebral Palsy

ABSTRACTAims: To develop a hand function test for children with bilateral cerebral palsy (CP) measuring bimanual performance, including quantification of possible asymmetry of hand use. Method: The Both Hands Assessment (BoHA) content was developed through adaptation of the Assisting Hand Assessment (version 5.0). Data from 171 children with bilateral CP, 22-months to 13 years olds (75 females; mean age: 6 years and 6 months) classified at Manual Ability Classification System (MACS) levels I-III, was entered into Rasch measurement model analyses to evaluate internal scale validity and aspects of reliability. Results: Sixteen items (11 unimanual and 5 bimanual) exhibited evidence for good internal scale validity and item and person reliability when analyzed separately for children with asymmetric or symmetric hand use. By calibrating the BoHA logit measures into the same frame of reference through linking, the overall measure of bimanual performance is comparable between children with asymmetric or symmetric hand use, still allowing use of separate item difficulty hierarchies. Conclusions: The Both Hands Assessment (BoHA), showed strong evidence of internal construct validity for measuring effectiveness of bimanual performance and the extent of asymmetric hand use in children with bilateral cerebral palsy, MACS levels I-III.

Remind to move – A novel treatment on hemiplegic arm functions in children with unilateral cerebral palsy: A randomized cross-over study

Objective: To investigate the effects of ‘remind to move’ treatment on hemiplegic arm function in children with unilateral cerebral palsy (CP). Methodology: Twelve students with unilateral CP aged 6–18 were recruited from a special school and randomly assigned into two groups. Participants in the experimental group underwent a 3-week sensory cueing treatment followed by a 3-week sham treatment. Participants in the waitlist group completed the sham treatment first followed by the sensory-cueing treatment. There was a 4-week washout period between treatments. Results: Both functional hand use and arm impairment level significantxly improved after the 3-week sensory cueing treatment for the combined sample between groups. However, no significant carryover effects were found for either treatment. Conclusion: Three weeks of ‘remind to move’ treatment is useful in improving hemiplegic arm function and quantity of hand use in children with unilateral CP but the long-term carryover effect requires further investigation.

Bimanual Hand-use in Children with Unilateral Hand Dysfunction ? Differences Related to Diagnosis Investigated by the Children?s Hand-use Experience Questionnaire

Introduction: Everyday activities assume the use of two hands; hence, unilateral hand dysfunction is commonly targeted for interventions. Purpose: To explore how the use of the affected hand is experienced in bimanual activities, and the influence of diagnosis on use and experience. Methods: The Children’s Hand-use Experience Questionnaire (CHEQ) was completed for 110 individuals aged 6–18 years diagnosed with unilateral cerebral palsy (CP), obstetric brachial plexus palsy (OBPP), or upper limb reduction deficiency (ULRD) in a cross-sectional study. Results: The children experienced problems when performing the activities, with mean CHEQ experience scores (0–100) of: Time taken 66.9, Grasp efficacy 68.7, and Feeling bothered 68.7. Participants with unilateral CP had significantly lower scores on all scales. The ULRD group performed most activities and used both hands more than the unilateral CP or OBPP groups. Conclusion: Unilateral dysfunction has differential impact on use and experience of the hand depending on diagnosis.

Precocious hand use preference in reach‐to‐eat behavior versus manual construction in 1‐ to 5‐year‐old children

The variation in hand use as a function of task and developmental age poses a problem for understanding how and when "handedness," preferred use of one hand, develops. The present cross-section study is the first to contrast hand preference use for the natural and frequently used reach-to-eat movement with a constructional task that requires a very similar reach-to-grasp movement. Thirty children between the ages of 1 and 3 years completed an eating task, in which they grasped small food items (Cheerios™ or Froot Loops™) that they brought to the mouth for eating. Thirty children between the ages of 3 and 5 years completed the construction task, in which they grasped LEGO® pieces to construct 3D models. Hand use preference for grasping in the eating and construction tasks was calculated by comparing the percentage of grasps made by the right hand and by the left hand. There were two main findings: First, right hand preference for grasping in the eating task is present as early as 1 year of age, whereas right hand preference for grasping in the construction task does not develop until 4 years of age. Second, right hand preference for grasping is greater in the eating than in the construction task. The results are discussed in relation to the idea that a consideration for task constraints (e.g., unimanual vs. bimanual; eating vs. construction; natural vs. praxic) should be incorporated into the experimental design when measuring hand use in children.

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

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.

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

New tools that capture hand function in everyday activities and contexts are needed for assessing children with hemiplegic cerebral palsy. This study evaluates a wearable wrist monitor and tests the hypothesis that wrist extension frequency (FreqE) is an appropriate indicator of functional hand use. Fifteen children (four females, 11 males; age range 6-12y; mean age 10y [SD 2y]) with hemiplegia (seven at level I and eight at level II on the Manual Ability Classification System) participated in the Assisting Hand Assessment (AHA) while wearing the wrist monitor. FreqEs were captured via the wrist monitor and validated using video analysis. Correlations between FreqE and AHA scores were calculated and a multivariate linear regression was conducted to explore other measures of wrist activity. Wrist extensions observed in video analyses were reliably detected by the wrist monitor (intraclass correlation coefficient, r=0.88; p<0.001) and were strongly correlated with the AHA scores (r=0.93; p<0.001). AHA scores were significantly correlated with FreqE (r=0.80; p=0.001) and the range of wrist extensions/flexions (r=0.70; p=0.008). The multivariate linear regression combining the FreqE and range of wrist extensions/flexions yielded a strong correlation with AHA scores (r=0.84; p=0.0043). The wearable wrist monitor may offer a convenient, valid alternative to observer reports for functional assessments of the hemiplegic hand in everyday contexts.

The effect of intensive bimanual training on coordination of the hands in children with congenital hemiplegia

Recent studies have suggested efficacy of intensive bimanual training in improving the quality and quantity of affected hand use in children with hemiplegia. However, it is not known whether such training affects the coordination of the two hands. In the present study, 20 children with congenital hemiplegia (age 4-10 years; MACS levels I-II) were randomly assigned to either an intensive bimanual training (Hand-Arm Bimanual Intensive Therapy: HABIT) group, or a control group consisting of equally intensive unimanual treatment (Constraint-Induced Movement Therapy, CIMT) for 6h per day for 15 days (90h). To assess their bimanual coordination, children were asked to open a drawer with one hand and manipulate its contents with the other hand. 3-D movement kinematics were recorded and subsequently analyzed by a blind evaluator. The role of the two hands was varied. Following treatment, superior improvement in bimanual coordination was found for the bimanual training group as indicated by greater movement overlap (the percentage of time with both hands engaged in the task p = 0.047) and better goal synchronization (reduced time differences between the two hands completing the task goals, p = 0.005). The results suggest that bimanual training improves the spatial-temporal control of the two hands, and are in agreement with the principle of practice specificity.

Effects of constraint-induced movement therapy in young children with hemiplegic cerebral palsy: an adapted model

The aim of this study was to evaluate the effects of a modified version of constraint-induced (CI) movement therapy on bimanual hand-use in children with hemiplegic cerebral palsy (CP; age range 18mo to 4y) and to make a comparison with conventional paediatric treatment. Twenty-one children (13 females, eight males) completed the CI therapy programme and 20 children (12 males, eight females) served as a control group. Children in the CI therapy group were expected to wear a restraint glove for 2 hours each day over a period of 2 months. The training was based on principles of motor learning used in play and in motivational settings. To evaluate the effect of treatment, the Assisting Hand Assessment (AHA) was used. Assessments took place on three occasions: at onset, after 2 months, and 6 months after the first assessment. A significant interaction was found between group and AHA measure (ANOVA, F2,74=5.64, p=0.005). The children who received CI therapy improved their ability to use their hemiplegic hand significantly more than the children in the control group after 2 months, i.e. after treatment. Effect size was high after treatment and remained medium at 6 months. As the treatment was tailored to each child's capacity and interests, little frustration was experienced by the children.

Effects of constraint-induced movement therapy in young children with hemiplegic cerebral palsy: an adapted model

The aim of this study was to evaluate the effects of a modified version of constraint-induced (CI) movement therapy on bimanual hand-use in children with hemiplegic cerebral palsy (CP; age range 18 mo to 4 y) and to make a comparison with conventional paediatric treatment. Twenty-one children (13 females, eight males) completed the CI therapy programme and 20 children (12 males, eight females) served as a control group. Children in the CI therapy group were expected to wear a restraint glove for 2 hours each day over a period of 2 months. The training was based on principles of motor learning used in play and in motivational settings. To evaluate the effect of treatment, the Assisting Hand Assessment (AHA) was used. Assessments took place on three occasions: at onset, after 2 months, and 6 months after the first assessment. A significant interaction was found between group and AHA measure (ANOVA, F(2,74) = 5.64, p = 0.005). The children who received CI therapy improved their ability to use their hemiplegic hand significantly more than the children in the control group after 2 months, i.e. after treatment. Effect size was high after treatment and remained medium at 6 months. As the treatment was tailored to each child's capacity and interests, little frustration was experienced by the children.

A Case Study to Promote Hand Use in Children with Rett Syndrome

A Case Study to Promote Hand Use in Children with Rett Syndrome

Prescription of Functional Orthosis for the Spastic Hand in Cerebral Palsy: An Assessment Profile

Facilitation of functional hand use in children with cerebral palsy is a priority of occupational therapists working in this area. This paper describes an orthotic assessment profile developed at the Spastic Welfare Association of Western Australia to assist therapists in defining objectives for inclusion of a functional orthosis as part of the occupational therapy treatment programme. Several objectives of an orthotic regime for cerebral palsied children and some of the orthoses used to fulfil these objectives are also described.