Bimanual upper limb activity in children with typical development and unilateral cerebral palsy: Validation of a triaxial accelerometer approach

Abstract

Background and Objective(s): Bimanual upper limb activity is crucial for many activities of daily living, such as self-care, work, leisure, social communication. These activities encompass both gross and fine movements, and involve a tight form of cooperation between the upper limbs. The cooperation implies in the majority of cases by a distinction between right and left hand, since one conducts the action, whereas the contralateral helps in completing the motor task, playing a secondary role. For this reason, the two hands are commonly called 'dominant' and 'non dominant', respectively. In unilateral cerebral palsy (UCP) quantitatively measurement of the asymmetry in the use of upper limbs (ULs) could overcome the limitation of many outcome measures in which scores are dependent on the experience and training of the therapist. The main aim of this study was to determine the validity of Actigraph GXT3+ to measure asymmetry in the use of the two ULs during the Assisting Hand Assessment (AHA) in children and adolescents with UCP aged 5-19 years, compared to age-matched typically developing subjects (TD). Study Design: It is a validation in a prospective cohort study. Study Participants & Setting: 15 UCP (mean age 9.83±3.87; MACS I: 4; MACS II: 8; MACS III: 3) and 19 TD (mean age 8.88±4.32) subjects were assessed with AHA while wearing actigraphs on their both wrists. Materials/Methods: The mean activity of each hand (dominant DH and non dominant NDH) and the asymmetry index (AI: difference between the mean activities of the two arms) were calculated. Wilcoxon test was used to compare within UCP and TD group, respectively, the mean activity of DH with those of the NDH, while Mann-Whitney was used for comparing the mean activity of the DH, NDH and AI between the UCP and TD groups, respectively. In addition, Spearman rho correlation was used to correlate AI values with AHA scores in the UCP group. Differences in AI values with TD and different MACS levels of UCP were analysed with the Kruskall-Wallis tests. Results: In both groups the mean activity of the DH (TD: 83.06 ± 21.30 and UCP: 96.31 ± 18.88) was higher than the NDH (TD: 76.70 ± 14.00; UCP 34.12 ± 11.69) but the difference was statistically significant only in the UCP group (p<0.00001). Moreover, the difference between TD and UCP groups for the NDHs were highly significant (p<0.00001), while that for the DHs was not significant (p>0.05). The difference between the AI of the TD and UCP groups was statistically significant (p<0.00001); the UCP group values (47.60 ± 17.00) were remarkable higher than those of the TD group (3.98 ± 7.09). In addition, AI values of UCP group highly correlated with the AHA score (rho value: -0.87, p<0.0001). Moreover, AI values showed statistically significant differences among different MACS levels (p<0.0001). Conclusions/Significance: The obtained results suggest the feasibility of Actigraphs in detecting differences between TD and UCP children in the use of upper limbs and in quantifying the asymmetries in children with UCP. The strong correlations of the Actigraphs data with AHA clinical assessment suggests the further use of Actigraphs for the assessment of ULs in clinical research.L6184697542017-09-29 <br />