Free
Poster Session
Issue Date: August 2016
Published Online: August 01, 2016
Updated: January 01, 2021
Quantifying Real-World Activity and Upper-Limb Use in Children with Cerebral Palsy Using Accelerometers
Author Affiliations
  • Medical University of South Carolina
  • Medical University of South Carolina
  • Medical University of South Carolina
  • Medical University of South Carolina
  • Medical University of South Carolina
  • Medical University of South Carolina
Article Information
Neurologic Conditions / Pediatric Evaluation and Intervention / Assessment/Measurement
Poster Session   |   August 01, 2016
Quantifying Real-World Activity and Upper-Limb Use in Children with Cerebral Palsy Using Accelerometers
American Journal of Occupational Therapy, August 2016, Vol. 70, 7011500060. https://doi.org/10.5014/ajot.2016.70S1-PO5115
American Journal of Occupational Therapy, August 2016, Vol. 70, 7011500060. https://doi.org/10.5014/ajot.2016.70S1-PO5115
Abstract

Date Presented 4/8/2016

This study used accelerometers to quantify the real-world activity and affected upper-limb use of children with cerebral palsy who participated in constraint-induced movement therapy (CIMT). Use of accelerometers as an outcome measure for pediatric CIMT are promising but will need confirmation in a larger study with a higher therapy dosage.

Primary Author and Speaker: Patty Coker-Bolt

Additional Authors and Speakers: Jackie Connelly, Na Jin Seo, Reagin Hoover, Ryan Downey, Daniel Shelton

PURPOSE: To quantify the real-world activity and affected upper-limb (UL) use of children with cerebral palsy (CP) who participated in constraint-induced movement therapy (CIMT) and to (1) determine the feasibility of using accelerometers to quantify UL movements during CIMT, (2) compare activity level of children with hemiplegic CP with typical peers, and (3) determine the relationship between change in activity/duration of affected UL movements (as measured by accelerometer) and change in performance on standardized assessments.
BACKGROUND: CIMT is a high-dosage rehabilitation approach used for children with hemiplegic cerebral palsy (CP). Questions remain regarding how much movement is required during CIMT programs to change the real-world affected UL use of children with CP. Understanding optimal therapy dosage is important for maximizing outcomes and offering family-friendly, achievable interventions. Accelerometer data could further elucidate the relationship between high-intensity CIMT and changes in patterns of affected arm use.
DESIGN: A pretest–posttest design was used with 12 children with hemiplegic CP (mean = 4.9 yr) who completed a 30-hr camp-based CIMT program.
ASSESSMENTS: Three developmental assessments including the Melbourne Unilateral Upper Limb Assessment–2, the Children’s Hand-Use Experience Questionnaire, and the Pediatric Evaluation of Disability Inventory were administered pre–post CIMT program. Accelerometers using the ActiGraph GT9X Link were successfully worn before, during, and directly after program to collect UL and activity data.
ANALYSIS: Repeated-measures analysis of variance was used to examine changes in accelerometer data of the affected UL’s active duration and mean activity counts before, during, and after the CIMT program. Tukey’s procedure was used for pairwise post hoc comparisons between days. In addition, paired t tests were used to assess differences between pre- and posttest assessment scores. A p < .05 was considered statistically significant.
RESULTS: All 12 children successfully wore the accelerometers 6 hr/day before, during, and after the CIMT program to collect the UL and activity data. Children demonstrated lower levels of moderate to vigorous activity compared with typical peers (p < .05). Significant improvements were seen on all three developmental assessments (p < .05), and children demonstrated a significant increase in the duration of affected UL use during each camp day in comparison to pretest data (p < .01 for the main effect of day and p < .05 for Tukey post hoc).
Children also demonstrated a significant increase in the mean activity count of affected UL use during 3 of 5 days in comparison to pretest data (p < .01 for the main effect of day and p < .05 for Tukey post hoc). However, Tukey post hoc comparisons showed no significant changes in UL active duration/mean activity count pre- vs. post-CIMT (p > .05).
CONCLUSION: Although improvements were seen in assessment scores measuring capacity of affected UL use, accelerometer data suggests that some children may not have incorporated new movements into daily habits after a short-dosage CIMT program. These preliminary findings on the use of accelerometers as an outcome measure for pediatric CIMT are promising but will need confirmation in a larger study with a program that offers a higher dosage of intensive task-specific practice (e.g., 60 hr).
IMPACT STATEMENT: Wearable accelerometers could increase our understanding of repetitions required to change motor movements and lead to new ways to provide the active ingredients of intensive therapies in different practice settings (i.e., school based, early intervention, outpatient).