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Journal of NeuroEngineering and Rehabilitation

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Open Access 01-12-2019 | Hemiplegia | Research

Actigraph assessment for measuring upper limb activity in unilateral cerebral palsy

Authors: Elena Beani, Martina Maselli, Elisa Sicola, Silvia Perazza, Francesca Cecchi, Paolo Dario, Irene Braito, Roslyn Boyd, Giovanni Cioni, Giuseppina Sgandurra

Published in: Journal of NeuroEngineering and Rehabilitation | Issue 1/2019

Abstract

Background

Detecting 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.

Methods

Fifty 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, MA_DH and MA_NDH, respectively) and the asymmetry index (AI) were calculated. Two linear mixed model analyses were carried out to evaluate how dependent actigraphic variables (i.e. MA_NDH 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.

Results

The MA_NDH 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 MA_NDH and AI.

None of the random variables (i.e. age, sex, side, presence/absence of mirror movements) showed significant interaction with MA_NDH and AI.

Conclusions

These results confirm that actigraphy could provide, in a standardized setting, a quantitative description of differences between upper limbs activity.

Trial registration

ClincalTrials.gov, NCT03054441. Registered 15 February 2017.

Stavsky M, Mor O, Mastrolia SA, Greenbaum S, Than NG, Erez O. Cerebral palsy-trends in epidemiology and recent development in prenatal mechanisms of disease, treatment, and prevention. Frontiers in paediatrics. 2017;5(21).

Cioni G, Sgandurra G, Muzzini S, Paolicelli PB, Ferrari A. Forms of hemiplegia In: The spastic forms of cerebral palsy: a guide to the assessment of adaptive functions, edited by Cioni G and Ferrari A. Milano: Springer-Verlag, 2010, pp 331–356.

Novak I, Morgan C, Adde L, et al. Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment. JAMA Pediatr. 2017;171(9):897–907.CrossRef

Mailleux L, Jaspers E, Simon-Martinez C, et al. Clinical assessment and three-dimensional movement analysis: an integrated approach for upper limb evaluation in children with unilateral cerebral palsy. PLoS One. 2017;12(7):e0180196.CrossRef

Klingels K, Jaspers E, Van de Winckel A, De Cock P, Molenaers G, Feys H. A systematic review of arm activity measures for children with hemiplegic cerebral palsy. Clin Rehabil. 2010;24(10):887–900.CrossRef

Gerber CN, Plebani A, Labruyère R. Translation, reliability, and clinical utility of the Melbourne assessment 2. Disabil Rehabil. 2017;12:1–9.

Davids JR, Peace LC, Wagner LV, et al. Validation of the shriners hospital for children upper extremity evaluation (SHUEE) for children with hemiplegic cerebral palsy. J Bone Joint Surg Am. 2006;88(2):326–33.CrossRef

Thorley M, Lannin N, Cusick A, Novak I, Boyd R. Construct validity of the quality of upper extremity skills test for children with cerebral palsy. Dev Med Child Neurol. 2012;54(11):1037–43.CrossRef

Krumlinde-Sundholm L, Holmefur M, Kottorp A, Eliasson AC. The assisting hand assessment: current evidence of validity, reliability, and responsiveness to change. Dev Med Child Neurol. 2007;49(4):259–64.CrossRef

10.

Arnould C, Penta M, Renders A, Thonnard JL. ABILHAND-kids a measure of manual ability in children with cerebral palsy. Neurology. 2004;63(6):1045–52.CrossRef

11.

Rabuffetti M, Meriggi P, Pagliari C, Bartolomeo P, Ferrarin M. Differential actigraphy for monitoring asymmetry in upper limb motor activities. Physiol Meas. 2016;37(10):1798.CrossRef

12.

Natale V. Circadian motor asymmetries in humans. Neurosci Lett. 2002;320(1–2):102–4.CrossRef

13.

Violani C, Testa P, Casagrande M. Actigraphic motor asymmetries during sleep. Sleep. 1998;21(5):472–6.PubMed

14.

Nagels G, Mariön P, Pickut BA, Timmermans L, De Deyn PP. Actigraphic evaluation of handedness. Electroencephalography and Clinical Neurophysiology/Electromyography and Motor Control. 1996;101(3):226–32.CrossRef

15.

Rinehart JK, Singleton RD, Adair JC, Sadek JR, Haaland KY. Arm use after left or right hemiparesis is influenced by hand preference. Stroke. 2009;40(2):545–50.CrossRef

16.

Clanchy KM, Tweedy SM, Boyd R. Measurement of habitual physical activity performance in adolescents with cerebral palsy: a systematic review. Dev Med Child Neurol. 2011;53(6):499–505.CrossRef

17.

Mitchell LE, Ziviani J, Boyd R. Variability in measuring physical activity in children with cerebral palsy. Med Sci Sports Exerc. 2015;47(1):194–200.CrossRef

18.

Holmefur M, Aarts P, Hoare B, Krumlinde-Sundholm L. Test-retest and alternate forms reliability of the assisting hand assessment. J Rehabil Med. 2009;41(11):886–91.CrossRef

19.

Oldfield RC. The assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia. 1971;9(1):97–113.CrossRef

20.

Eliasson AC, Krumlinde-Sundholm L, Rösblad B, et al. The manual ability classification system (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Dev Med Child Neurol. 2006;48(7):549–54.CrossRef

21.

Donnelly C, Parkes J, McDowell B, Duffy C. Lifestyle limitations of children and young people with severe cerebral palsy: a population study protocol. J Adv Nurs. 2007;61(5):557–69.CrossRef

22.

Haak P, Lenski M, Hidecker MJ, Li M, Paneth N. Cerebral palsy and aging. Dev Med Child Neurol. 2009;51(Suppl 4):16–23.CrossRef

23.

Margre AL, Reis MG. Morais RL Caracterization of adults with cerebral palsy. Rev Bras Fisioter. 2010;14(5):417–25.CrossRef

24.

O’Dwyer M, Fairclough SJ, Ridgers ND, Knowles ZR, Foweather L, Stratton G. Patterns of objectively measured moderate-to-vigorous physical activity in preschool children. J Phys Act Health. 2014;11(6):1233–8.CrossRef

25.

Braito I, Maselli M, Sgandurra G, Inguaggiato E, Beani E, Cecchi F, Cioni G, Boyd R. Assessment of upper limb use in children with typical development and neurodevelopmental disorders by inertial sensors: a systematic review. J Neuroeng Rehabil 2018;15(1):94. doi: https://doi.org/10.1186/s12984-018-0447-y. Review.

26.

Lundh D, Coleman S, Riad J. Movement deviation and asymmetry assessment with three dimensional gait analysis of both upper- and lower extremity results in four different clinical relevant subgroups in unilateral cerebral palsy. Clin Biomech (Bristol, Avon). 2014;29(4):381–6. https://doi.org/10.1016/j.clinbiomech.2014.02.006 Epub 2014 Mar 12.CrossRef

27.

Coker-Bolt P, Downey RJ, Connolly J, Hoover R, Shelton D, Seo NJ. Exploring the feasibility and use of acceleromters before, during, and after a camp-based CIMT program for children with cerebral palsy. J Pediatr Rehabil Med. 2017;10(1):27–36. https://doi.org/10.3233/PRM-170408.CrossRefPubMed

28.

O'Neil ME, Fragala-Pinkham M, Lennon N, George A, Forman J, Trost SG. Reliability and validity of objective measures of physical activity in youth with cerebral palsy who are ambulatory. Phys Ther. 2016;96(1):37–45. https://doi.org/10.2522/ptj.20140201 Epub 2015 Jun 18.CrossRefPubMed

29.

Guiard Y. Asymmetric diversion of labor in human skilled bimanual action: the kinematic chain as a model. J Mot Behav. 1987;19(4):486–517.CrossRef

30.

Cooper J, Majnemer A, Rosenblatt B, Birnbaum R. The determination of sensory deficits in children with hemiplegic cerebral palsy. J Child Neurol. 1995;10:300–9.CrossRef

31.

Duqué J, Thonnard JL, Vandermeeren Y, Sébire G, Cosnard G, Olivier E. Correlation between impaired dexterity and corticospinal tract dysgenesis in congenital hemiplegia. Brain. 2003;126(3):732–47.CrossRef

32.

Rich TL, Menk JS, Rudser KD, Feyma T, Gillick BT. Less-affected hand function in children with hemiparetic unilateral cerebral palsy: a comparison study with typically developing peers. Neurorehabil Neural Repair. 2017;31(10–11):965–76.CrossRef

33.

Klingels K, Meyer S, Mailleux L, Simon-Martinez C, Hoskens J, Monbaliu E, Verheyden G, Verbeke G, Molenaers G, Ortibus E. Feys H time course of upper limb function in children with unilateral cerebral palsy: a five-year follow-up study. Neural Plast. 2018;2018:2831342. https://doi.org/10.1155/2018/2831342 Collection 2018.CrossRefPubMedPubMedCentral

34.

Klingels K, Feys H, De Wit L, Jaspers E, Van de Winckel A, Verbeke G, De Cock P, Molenaers G. Arm and hand function in children with unilateral cerebral palsy: a one-year follow-up study. Eur J Paediatr Neurol. 2012;16(3):257–65. https://doi.org/10.1016/j.ejpn.2011.08.001 Epub 2011 Sep 22.CrossRefPubMed

35.

Katz N, Cermak S, Shamir Y. Unilateral neglect in children with hemiplegic cerebral palsy. Percept Mot Skills. 1998;86(2):539–50.CrossRef

36.

Sterzi R, Bottini G, Celani MG, Righetti E, Lamassa M, Ricci S, Vallar G. Hemianopia, hemianaesthesia, and hemiplegia after right and left hemisphere damage. A hemispheric difference. J Neurol Neurosurg Psychiatry. 1993;56(3):308–10.CrossRef

37.

Gordon AM, Schneider JA, Chinnan A, Charles JR. Efficacy of a hand-arm bimanual intensive therapy (HABIT) in children with hemiplegic cerebral palsy: a randomized control trial. Dev Med Child Neurol. 2007;49(11):830–8.CrossRef

38.

Sgandurra G, Cecchi F, Beani E, et al. Tele-UPCAT: study protocol of a randomized controlled trial of a home-based tele-monitored UPperLimb children action observation training for participants with unilateral cerebral palsy. BMJ Open. 2018;8(5):e017819.PubMedPubMedCentral

Title: Actigraph assessment for measuring upper limb activity in unilateral cerebral palsy
Authors: Elena Beani
Martina Maselli
Elisa Sicola
Silvia Perazza
Francesca Cecchi
Paolo Dario
Irene Braito
Roslyn Boyd
Giovanni Cioni
Giuseppina Sgandurra
Publication date: 01-12-2019
Publisher: BioMed Central
Keyword: Hemiplegia
Published in: Journal of NeuroEngineering and Rehabilitation / Issue 1/2019
Electronic ISSN: 1743-0003
DOI: https://doi.org/10.1186/s12984-019-0499-7

At a glance: The STEP trials

Springer Medicine

Actigraph assessment for measuring upper limb activity in unilateral cerebral palsy

Abstract

Background

Methods

Results

Conclusions

Trial registration

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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