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Hedberg-Graff J, Bezuidenhout L, Krumlinde-Sundholm L, Hallgren J, Moulaee Conradsson D, Hagströmer M. Association between upper limb clinical tests and accelerometry metrics for arm use in daily life in children with unilateral cerebral palsy. Disabil Rehabil 2024:1-7. [PMID: 39192545 DOI: 10.1080/09638288.2024.2393801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 08/29/2024]
Abstract
PURPOSE To evaluate the association between upper-limb (UL) clinical tests and UL accelerometry-derived metrics in children with unilateral Cerebral Palsy (CP). METHODS In this cross-sectional study, twenty children with unilateral CP and Manual Ability Classification System level I-III were included. Outcomes of the Assisting Hand Assessment, Box and Block-Test and accelerometry metrics were collected in the clinical setting and in daily life. UL asymmetry index (i.e., the ratio between the well-functioning UL and the affected UL use) was evaluated in different physical activity levels and relative use of UL was evaluated during daily living. Spearman's correlation was used to determine the association between UL clinical tests and accelerometry metrics in a clinical setting and in daily life. RESULTS The strongest negative association was between the Assisting Hand Assessment units and accelerometry metrics during the sedentary time in daily life (rs = -0.64). The asymmetries between ULs were highest during the child's sedentary time (asymmetry index: 45.15) compared to when the child was in light (asymmetry index: 23.97) or higher intensity physical activity (asymmetry index: 13.39). The children used both ULs simultaneously for 44% of the time during daily life. CONCLUSION Accelerometry metrics may provide additional objective information to clinical tests by quantifying the amount of UL movements and the amount of asymmetry between the upper limbs in daily life.
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Affiliation(s)
- Jenny Hedberg-Graff
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- School of Health Sciences, Örebro University, Örebro, Sweden
| | - Lucian Bezuidenhout
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa
| | | | - Jenny Hallgren
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - David Moulaee Conradsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Occupational Therapy & Physiotherapy, Theme Women's Health and Allied Health Professional, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Hagströmer
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Avcademic Primary Health Care Centre, Stockholm, Sweden
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Miller AE, Lohse KR, Bland MD, Konrad JD, Hoyt CR, Lenze EJ, Lang CE. A Large Harmonized Upper and Lower Limb Accelerometry Dataset: A Resource for Rehabilitation Scientists. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.15.24312066. [PMID: 39185533 PMCID: PMC11343270 DOI: 10.1101/2024.08.15.24312066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Wearable sensors can measure movement in daily life, an outcome that is salient to patients, and have been critical to accelerating progress in rehabilitation research and practice. However, collecting and processing sensor data is burdensome, leaving many scientists with limited access to such data. To address these challenges, we present a harmonized, wearable sensor dataset that combines 2,885 recording days of sensor data from the upper and lower limbs from eight studies. The dataset includes 790 individuals ages 0 - 90, nearly equal sex proportions (53% male, 47% female), and representation from a range of demographic backgrounds (69.4% White, 24.9% Black, 1.8% Asian) and clinical conditions (46% neurotypical, 31% stroke, 7% Parkinson's disease, 6% orthopedic conditions, and others). The dataset is publicly available and accompanied by open source code and an app that allows for interaction with the data. This dataset will facilitate the use of sensor data to advance rehabilitation research and practice, improve the reproducibility and replicability of wearable sensor studies, and minimize costs and duplicated scientific efforts.
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Wilson RB, Vangala S, Reetzke R, Pierges A, Ozonoff S, Miller M. Objective measurement of movement variability using wearable sensors predicts ASD outcomes in infants at high likelihood for ASD and ADHD. Autism Res 2024; 17:1094-1105. [PMID: 38747403 PMCID: PMC11338043 DOI: 10.1002/aur.3150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/05/2024] [Indexed: 05/21/2024]
Abstract
Early motor delays and differences are common among children with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). Yet, little work has shown whether there are early atypical motor signs that differentiate these groups. Quantitative measures of movement variability hold promise for improving the identification of subtle and specific differences in motor function among infants and toddlers at high likelihood for ASD and ADHD. To this end, we created a novel quantitative measure of movement variability (movement curvature) and conducted a preliminary investigation as to whether this measure improves outcome predictions. We used a wearable triaxial accelerometer to evaluate continuous motion-based activity in infants at high and low likelihood for ASD and ADHD at 12, 18, 24, and 36 months of age. At 36 months, participants were categorized into three outcome groups: ASD (n = 19), ADHD concerns (n = 17), and a comparison group (n = 82). We examined group differences in movement curvature and whether movement curvature is predictive of a later ASD or ADHD concerns classification. We found that movement curvature was significantly lower in infants with later ASD diagnosis at 18, 24, and 36 months of age compared to infants with either ADHD concerns or those in the comparison group. Movement curvature was also a significant predictor of ASD at 18, 24, and 36 months (AUC 0.66-0.71; p = 0.005-0.039) and when adjusting for high ASD likelihood at 18 and 24 months (AUC 0.90, p = 0.05-0.019). These results indicate that lower movement curvature may be a feature of early motor differences in infants with later ASD diagnosis as early as 18 months of age.
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Affiliation(s)
- Rujuta B. Wilson
- UCLA Center for Autism Research and Treatment, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA
| | - Sitaram Vangala
- UCLA Department of Medicine Statistics Core, Los Angeles, California, USA
| | - Rachel Reetzke
- Center for Autism and Related Disorders, Kennedy Krieger Institute and Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Antonia Pierges
- UC Davis Department of Psychiatry & Biobehavioral Sciences and MIND Institute, Sacramento, California, USA
| | - Sally Ozonoff
- UC Davis Department of Psychiatry & Biobehavioral Sciences and MIND Institute, Sacramento, California, USA
| | - Meghan Miller
- UC Davis Department of Psychiatry & Biobehavioral Sciences and MIND Institute, Sacramento, California, USA
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Miller AE, Lang CE, Bland MD, Lohse KR. Quantifying the effects of sleep on sensor-derived variables from upper limb accelerometry in people with and without upper limb impairment. J Neuroeng Rehabil 2024; 21:86. [PMID: 38807245 PMCID: PMC11131201 DOI: 10.1186/s12984-024-01384-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/15/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Despite the promise of wearable sensors for both rehabilitation research and clinical care, these technologies pose significant burden on data collectors and analysts. Investigations of factors that may influence the wearable sensor data processing pipeline are needed to support continued use of these technologies in rehabilitation research and integration into clinical care settings. The purpose of this study was to investigate the effect of one such factor, sleep, on sensor-derived variables from upper limb accelerometry in people with and without upper limb impairment and across a two-day wearing period. METHODS This was a secondary analysis of data collected during a prospective, longitudinal cohort study (n = 127 individuals, 62 with upper limb impairment and 65 without). Participants wore a wearable sensor on each wrist for 48 h. Five upper limb sensor variables were calculated over the full wear period (sleep included) and with sleep time removed (sleep excluded): preferred time, non-preferred time, use ratio, non-preferred magnitude and its standard deviation. Linear mixed effects regression was used to quantify the effect of sleep on each sensor variable and determine if the effect differed between people with and without upper limb impairment and across a two-day wearing period. RESULTS There were significant differences between sleep included and excluded for the variables preferred time (p < 0.001), non-preferred time (p < 0.001), and non-preferred magnitude standard deviation (p = 0.001). The effect of sleep was significantly different between people with and without upper limb impairment for one variable, non-preferred magnitude (p = 0.02). The effect of sleep was not substantially different across wearing days for any of the variables. CONCLUSIONS Overall, the effects of sleep on sensor-derived variables of upper limb accelerometry are small, similar between people with and without upper limb impairment and across a two-day wearing period, and can likely be ignored in most contexts. Ignoring the effect of sleep would simplify the data processing pipeline, facilitating the use of wearable sensors in both research and clinical practice.
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Affiliation(s)
- Allison E Miller
- Program in Physical Therapy, Washington University School of Medicine, 4444 Forest Park Avenue, MSC: 8502-66-1101, St. Louis, MO, 63018, USA.
| | - Catherine E Lang
- Program in Physical Therapy, Washington University School of Medicine, 4444 Forest Park Avenue, MSC: 8502-66-1101, St. Louis, MO, 63018, USA
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, 63018, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63018, USA
| | - Marghuretta D Bland
- Program in Physical Therapy, Washington University School of Medicine, 4444 Forest Park Avenue, MSC: 8502-66-1101, St. Louis, MO, 63018, USA
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, 63018, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63018, USA
| | - Keith R Lohse
- Program in Physical Therapy, Washington University School of Medicine, 4444 Forest Park Avenue, MSC: 8502-66-1101, St. Louis, MO, 63018, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63018, USA
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Lang CE, Hoyt CR, Konrad JD, Bell KR, Marrus N, Bland MD, Lohse KR, Miller AE. Referent data for investigations of upper limb accelerometry: harmonized data from three cohorts of typically-developing children. Front Pediatr 2024; 12:1361757. [PMID: 38496366 PMCID: PMC10940427 DOI: 10.3389/fped.2024.1361757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/23/2024] [Indexed: 03/19/2024] Open
Abstract
Aim The rise of wearable sensing technology shows promise for addressing the challenges of measuring motor behavior in pediatric populations. The current pediatric wearable sensing literature is highly variable with respect to the number of sensors used, sensor placement, wearing time, and how data extracted from the sensors are analyzed. Many studies derive conceptually similar variables via different calculation methods, making it hard to compare across studies and clinical populations. In hopes of moving the field forward, this report provides referent upper limb wearable sensor data from accelerometers on 25 variables in typically-developing children, ages 3-17 years. Methods This is a secondary analysis of data from three pediatric cohorts of children 3-17 years of age. Participants (n = 222) in the cohorts wore bilateral wrist accelerometers for 2-4 days for a total of 622 recording days. Accelerometer data were reprocessed to compute 25 variables that quantified upper limb movement duration, intensity, symmetry, and complexity. Analyses examined the influence of hand dominance, age, gender, reliability, day-to-day stability, and the relationships between variables. Results The majority of variables were similar on the dominant and non-dominant sides, declined slightly with age, and were not different between boys and girls. ICC values were moderate to excellent. Variation within individuals across days generally ranged from 3% to 32%. A web-based R shiny object is available for data viewing. Interpretation With the use of wearable movement sensors increasing rapidly, these data provide key, referent information for researchers as they design studies, and analyze and interpret data from neurodevelopmental and other pediatric clinical populations. These data may be of particularly high value for pediatric rare diseases.
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Affiliation(s)
- Catherine E. Lang
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, United States
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Catherine R. Hoyt
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
| | - Jeffrey D. Konrad
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, United States
| | - Kayla R. Bell
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, United States
| | - Natasha Marrus
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Marghuretta D. Bland
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, United States
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Keith R. Lohse
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Allison E. Miller
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, United States
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Airaksinen M, Vaaras E, Haataja L, Räsänen O, Vanhatalo S. Automatic assessment of infant carrying and holding using at-home wearable recordings. Sci Rep 2024; 14:4852. [PMID: 38418850 PMCID: PMC10901884 DOI: 10.1038/s41598-024-54536-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 02/14/2024] [Indexed: 03/02/2024] Open
Abstract
Assessing infant carrying and holding (C/H), or physical infant-caregiver interaction, is important for a wide range of contexts in development research. An automated detection and quantification of infant C/H is particularly needed in long term at-home studies where development of infants' neurobehavior is measured using wearable devices. Here, we first developed a phenomenological categorization for physical infant-caregiver interactions to support five different definitions of C/H behaviors. Then, we trained and assessed deep learning-based classifiers for their automatic detection from multi-sensor wearable recordings that were originally used for mobile assessment of infants' motor development. Our results show that an automated C/H detection is feasible at few-second temporal accuracy. With the best C/H definition, the automated detector shows 96% accuracy and 0.56 kappa, which is slightly less than the video-based inter-rater agreement between trained human experts (98% accuracy, 0.77 kappa). The classifier performance varies with C/H definition reflecting the extent to which infants' movements are present in each C/H variant. A systematic benchmarking experiment shows that the widely used actigraphy-based method ignores the normally occurring C/H behaviors. Finally, we show proof-of-concept for the utility of the novel classifier in studying C/H behavior across infant development. Particularly, we show that matching the C/H detections to individuals' gross motor ability discloses novel insights to infant-parent interaction.
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Affiliation(s)
- Manu Airaksinen
- BABA Center, Pediatric Research Center, Department of Clinical Neurophysiology, New Children's Hospital and HUS Imaging, Helsinki University Hospital, Helsinki, Finland.
- Department of Physiology, University of Helsinki, Biomedicum 1, Room B129b, Haartmaninkatu 8, 00290, Helsinki, Finland.
| | - Einari Vaaras
- Unit of Computing Sciences, Tampere University, P.O. Box 553, 33101, Tampere, Finland
| | - Leena Haataja
- BABA Center, Pediatric Research Center, Department of Clinical Neurophysiology, New Children's Hospital and HUS Imaging, Helsinki University Hospital, Helsinki, Finland
- Department of Pediatric Neurology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Okko Räsänen
- Unit of Computing Sciences, Tampere University, P.O. Box 553, 33101, Tampere, Finland
| | - Sampsa Vanhatalo
- BABA Center, Pediatric Research Center, Department of Clinical Neurophysiology, New Children's Hospital and HUS Imaging, Helsinki University Hospital, Helsinki, Finland
- Department of Physiology, University of Helsinki, Biomedicum 1, Room B129b, Haartmaninkatu 8, 00290, Helsinki, Finland
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Poitras I, Gagné-Pelletier L, Clouâtre J, Flamand VH, Campeau-Lecours A, Mercier C. Optimizing Epoch Length and Activity Count Threshold Parameters in Accelerometry: Enhancing Upper Extremity Use Quantification in Cerebral Palsy. SENSORS (BASEL, SWITZERLAND) 2024; 24:1100. [PMID: 38400258 PMCID: PMC10892357 DOI: 10.3390/s24041100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/29/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
Various accelerometry protocols have been used to quantify upper extremity (UE) activity, encompassing diverse epoch lengths and thresholding methods. However, there is no consensus on the most effective approach. The aim of this study was to delineate the optimal parameters for analyzing accelerometry data to quantify UE use in individuals with unilateral cerebral palsy (CP). METHODS A group of adults with CP (n = 15) participated in six activities of daily living, while a group of children with CP (n = 14) underwent the Assisting Hand Assessment. Both groups performed the activities while wearing ActiGraph GT9X-BT devices on each wrist, with concurrent video recording. Use ratio (UR) derived from accelerometry and video analysis and accelerometer data were compared for different epoch lengths (1, 1.5, and 2 s) and activity count (AC) thresholds (between 2 and 150). RESULTS In adults, results are comparable across epoch lengths, with the best AC thresholds being ≥ 100. In children, results are similar across epoch lengths of 1 and 1.5 (optimal AC threshold = 50), while the optimal threshold is higher with an epoch length of 2 (AC = 75). CONCLUSIONS The combination of epoch length and AC thresholds should be chosen carefully as both influence the validity of the quantification of UE use.
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Affiliation(s)
- Isabelle Poitras
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, QC G1M 2S8, Canada; (I.P.); (L.G.-P.); (J.C.); (V.H.F.); (A.C.-L.)
- School of Rehabilitation Sciences, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Léandre Gagné-Pelletier
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, QC G1M 2S8, Canada; (I.P.); (L.G.-P.); (J.C.); (V.H.F.); (A.C.-L.)
- School of Rehabilitation Sciences, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Jade Clouâtre
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, QC G1M 2S8, Canada; (I.P.); (L.G.-P.); (J.C.); (V.H.F.); (A.C.-L.)
- Department of Mechanical Engineering, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Véronique H. Flamand
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, QC G1M 2S8, Canada; (I.P.); (L.G.-P.); (J.C.); (V.H.F.); (A.C.-L.)
- School of Rehabilitation Sciences, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Alexandre Campeau-Lecours
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, QC G1M 2S8, Canada; (I.P.); (L.G.-P.); (J.C.); (V.H.F.); (A.C.-L.)
- Department of Mechanical Engineering, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Catherine Mercier
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, QC G1M 2S8, Canada; (I.P.); (L.G.-P.); (J.C.); (V.H.F.); (A.C.-L.)
- School of Rehabilitation Sciences, Laval University, Quebec City, QC G1V 0A6, Canada
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8
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Konrad JD, Marrus N, Lohse KR, Thuet KM, Lang CE. Associations Between Coordination and Wearable Sensor Variables Vary by Recording Context but Not Assessment Type. J Mot Behav 2024; 56:339-355. [PMID: 38189355 PMCID: PMC10957306 DOI: 10.1080/00222895.2023.2300969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/27/2023] [Indexed: 01/09/2024]
Abstract
Motor coordination is an important driver of development and improved coordination assessments could facilitate better screening, diagnosis, and intervention for children at risk of developmental disorders. Wearable sensors could provide data that enhance the characterization of coordination and the clinical utility of that data may vary depending on how sensor variables from different recording contexts relate to coordination. We used wearable sensors at the wrists to capture upper-limb movement in 85 children aged 6-12. Sensor variables were extracted from two recording contexts. Structured recordings occurred in the lab during a unilateral throwing task. Unstructured recordings occurred during free-living activity. The objective was to determine the influence of recording context (unstructured versus structured) and assessment type (direct vs. indirect) on the association between sensor variables and coordination. The greatest associations were between six sensor variables from the structured context and the direct measure of coordination. Worse coordination scores were associated with upper-limb movements that had higher peak magnitudes, greater variance, and less smoothness. The associations were consistent across both arms, even though the structured task was unilateral. This finding suggests that wearable sensors could be paired with a simple, structured task to yield clinically informative variables that relate to motor coordination.
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Affiliation(s)
- Jeffrey D Konrad
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, USA
| | - Natasha Marrus
- Department of Psychiatry, Washington University School of Medicine, St. Louis, USA
| | - Keith R Lohse
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, USA
| | - Kayla M Thuet
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, USA
| | - Catherine E Lang
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, USA
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, USA
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Verhage CH, Gorter JW, Takken T, Benders MJNL, de Vries LS, van der Aa NE, Wagenaar N. Detecting Asymmetry of Upper Limb Activity with Accelerometry in Infants at Risk for Unilateral Spastic Cerebral Palsy. Phys Occup Ther Pediatr 2023; 44:1-15. [PMID: 37318108 DOI: 10.1080/01942638.2023.2218478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 06/16/2023]
Abstract
AIMS To examine whether accelerometry can quantitate asymmetry of upper limb activity in infants aged 3-12 months at risk for developing unilateral spastic cerebral palsy (USCP). METHOD A prospective study was performed in 50 infants with unilateral perinatal brain injury at high risk of developing USCP. Triaxial accelerometers were worn on the ipsilateral and contralesional upper limb during the Hand Assessment for Infants (HAI). Infants were grouped in three age intervals (3-5 months, 5-7.5 months and 7.5 until 12 months). Each age interval group was divided in a group with and without asymmetrical hand function based on HAI cutoff values suggestive of USCP. RESULTS In a total of 82 assessments, the asymmetry index for mean upper limb activity was higher in infants with asymmetrical hand function compared to infants with symmetrical hand function in all three age groups (ranging from 41 to 51% versus - 2-6%, p < 0.01), while the total activity of both upper limbs did not differ. CONCLUSIONS Upper limb accelerometry can identify asymmetrical hand function in the upper limbs in infants with unilateral perinatal brain injury from 3 months onwards and is complementary to the Hand Assessment for Infants.
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Affiliation(s)
- Cornelia H Verhage
- Center for Child Development, Exercise and Physical Literacy, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jan Willem Gorter
- Pediatric Rehabilitation Medicine, Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tim Takken
- Center for Child Development, Exercise and Physical Literacy, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Niek E van der Aa
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nienke Wagenaar
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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10
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Bard-Pondarré R, Al-Abiad N, Verdun S, Naaïm A, Agopyan H, Chaléat-Valayer E, Vuillerot C. Does accelerometry reflect hand function in infants at risk of unilateral cerebral palsy? A secondary analysis of BB-Bim results. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 139:104549. [PMID: 37327574 DOI: 10.1016/j.ridd.2023.104549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Infants at high-risk of unilateral Cerebral Palsy (UCP) may have asymmetry in upper extremity movement and function, which should be identified as soon as possible for management. AIMS To explore the feasibility of using two AX3 Axivity monitors in wrist-worn bracelets to quantify movements, and to identify whether accelerometry parameters are consistent with hand function. METHODS AND PROCEDURES 6 infants at high risk of UCP (aged 3 to -12 months) were included in a Single-Case Experimental Design to explore the impact of an 8-week bimanual stimulation home program. OUTCOMES Each week of the baseline (randomized duration 4-7 weeks) and 8-week program, the Hand Assessment for Infants (HAI) was performed and accelerometry parameters were collected during HAI and also during spontaneous activity, several times a week. RESULTS Actimetry was analyzed during HAI and 238 spontaneous activity sessions (mean 42 ± 21 min). Actimetry ratios distribution and evolution show a high variability, especially for spontaneous activity. No strong correlation was found between HAI scores and accelerometry parameters, either collected during HAI, or during spontaneous activity times. CONCLUSION AND IMPLICATIONS Despite its feasibility, using accelerometry bracelets looks unreliable for detecting and monitoring hand function in infants under one year.
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Affiliation(s)
- Rachel Bard-Pondarré
- Centre des Massues Croix-Rouge française, 92, rue Edmond Locard, 69322 Lyon, France.
| | - Nahime Al-Abiad
- Laboratoire de Biomécanique et Mécanique des Chocs LBMC UMR_T9406 (Univ Lyon - Univ Gustave Eiffel), 25, avenue François Mitterrand, 69675 Bron, France
| | - Stéphane Verdun
- Délégation à la Recherche Clinique et à l'Innovation, Groupement des Hôpitaux de l'Institut Catholique de Lille, Rue du Grand But, 59462 Lomme, France
| | - Alexandre Naaïm
- Laboratoire de Biomécanique et Mécanique des Chocs LBMC UMR_T9406 (Univ Lyon - Univ Gustave Eiffel), 25, avenue François Mitterrand, 69675 Bron, France
| | - Hovannes Agopyan
- Centre des Massues Croix-Rouge française, 92, rue Edmond Locard, 69322 Lyon, France
| | | | - Carole Vuillerot
- Department of Pediatric Physical Medicine and Rehabilitation, Hôpital Mère Enfant, CHU-Lyon, Lyon, France; Neuromyogen institute, CNRS UMR 5310 - INSERM U1217, Université de Lyon, Lyon, France
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11
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Porta M, Porceddu S, Leban B, Casu G, Mura GM, Campagna M, Pau M. Characterization of upper limb use in health care workers during regular shifts: A quantitative approach based on wrist-worn accelerometers. APPLIED ERGONOMICS 2023; 112:104046. [PMID: 37267772 DOI: 10.1016/j.apergo.2023.104046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 06/04/2023]
Abstract
Despite the high prevalence of upper limb (UL) work-related musculoskeletal disorders (WRMSD) among health care workers (HCWs), little is known about their relationship with exposure to biomechanical risk factors. This study aimed to assess UL activity features under actual working conditions using two wrist-worn accelerometers. Accelerometric data were processed to obtain duration, intensity, and asymmetry of UL use in 32 HCWs during the execution of commonly performed tasks (e.g., patient hygiene, transfer, and meal distribution) within a regular shift. The results show that such tasks are characterized by significantly different patterns of UL use, in particular, higher intensities and larger asymmetries were observed respectively for patient hygiene and meal distribution. The proposed approach appears, thus, suitable to discriminate tasks characterized by different UL motion patterns. Future studies could benefit from the integration of such measures with self-reported workers' perception to elucidate the relationship between dynamic UL movements and WRMSD.
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Affiliation(s)
- Micaela Porta
- Department of Mechanical, Chemical and Materials Engineering University of Cagliari, Italy.
| | - Simona Porceddu
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - Bruno Leban
- Department of Mechanical, Chemical and Materials Engineering University of Cagliari, Italy
| | - Giulia Casu
- Department of Mechanical, Chemical and Materials Engineering University of Cagliari, Italy
| | - Giovanni M Mura
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - Marcello Campagna
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering University of Cagliari, Italy
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12
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Konrad J, Marrus N, Lang CE. A Feasibility Study of Bilateral Wrist Sensors for Measuring Motor Traits in Children With Autism. Percept Mot Skills 2022; 129:1709-1735. [PMID: 36065830 PMCID: PMC9974780 DOI: 10.1177/00315125221125275] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Direct, quantitative measures of hyperactivity and motor coordination, two motor characteristics associated with impairment in autism, are limited. Wearable sensors can objectively index real-world movement variables that may relate to these behaviors. Here, we explored the feasibility of bilateral wrist accelerometers for measuring upper limb activity in 3-10-year-olds with autism (n = 22; 19 boys, 3 girls; M age = 5.64, SD = 2.73 years) and without autism (n = 26; 15 boys, 11 girls; M age = 6.26, SD = 2.47 years). We investigated the relationships between movement characteristics related to duration, intensity, complexity, and symmetry on the one hand and parent-reported hyperactivity and motor coordination on the other. Participants with and without autism wore the sensors for 12-hour periods. Sensor variables varied by age but not sex, with movement intensity and complexity moderately related to motor coordination. These findings lend preliminary support to wearable sensors as a means of providing ecologically-valid metrics of motor characteristics that impact adaptive function in children with autism.
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Affiliation(s)
- Jeffrey Konrad
- Program in Physical Therapy, 12275Washington University School of Medicine, St. Louis, Missouri, USA
| | - Natasha Marrus
- Department of Psychiatry, 12275Washington University School of Medicine, St. Louis, Missouri, USA
| | - Catherine E Lang
- Program in Physical Therapy, 12275Washington University School of Medicine, St. Louis, Missouri, USA
- Program in Occupational Therapy, 12275Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Neurology, 12275Washington University School of Medicine, St. Louis, Missouri, USA
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13
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Muhlestein WE, Chang KWC, Smith BW, Yang LJS, Brown SH. Quantifying long-term upper-limb activity using wearable motion sensors after nerve reconstruction for neonatal brachial plexus palsy. J Neurosurg Pediatr 2022:1-6. [PMID: 35334468 DOI: 10.3171/2022.2.peds21478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/02/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Standard, physician-elicited clinical assessment tools for the evaluation of function after nerve reconstruction for neonatal brachial plexus palsy (NBPP) do not accurately reflect real-world arm function. Wearable activity monitors allow for the evaluation of patient-initiated, spontaneous arm movement during activities of daily living. In this pilot study, the authors demonstrate the feasibility of using body-worn sensor technology to quantify spontaneous arm movement in children with NBPP 10 years after nerve reconstruction and report the timing and magnitude of recovered arm movement. METHODS Eight children with NBPP who underwent brachial plexus reconstruction approximately 10 years prior were recruited to take part in this single-institution prospective pilot study. Per the treatment protocol of the authors' institution, operated patients had severe, nonrecovering nerve function at the time of surgery. The patients were fitted with an activity monitoring device on each of the affected and unaffected arms, which were worn for 7 consecutive days. The duration (VT) and power (VM) with which each arm moved during the patient's normal daily activities were extracted from the accelerometry data and ratios comparing the affected and unaffected arms were calculated. Demographic data and standard physician-elicited clinical measures of upper-extremity function were also collected. RESULTS Three children underwent nerve grafting and transfer and 5 children underwent graft repair only. The mean (± SD) active range of motion was 98° ± 53° for shoulder abduction, 130° ± 24° for elbow flexion, and 39° ± 34° for shoulder external rotation. The median Medical Research Council grade was at least 2.5 for all muscle groups. The median Mallet grade was at least 2 for all categories, and 13.5 total. The VT ratio was 0.82 ± 0.08 and the VM ratio was 0.53 ± 0.12. CONCLUSIONS Wearable activity monitors such as accelerometers can be used to quantify spontaneous arm movement in children who underwent nerve reconstruction for NBPP at long-term follow-up. These data more accurately reflect complex, goal-oriented movement needed to perform activities of daily living. Notably, despite severe, nonrecovering nerve function early in life, postsurgical NBPP patients use their affected arms more than 80% of the time that they use their unaffected arms, paralleling results in patients with NBPP who recovered spontaneously. These data represent the first long-term, real-world evidence to support brachial plexus reconstruction for patients with NBPP.
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Affiliation(s)
| | | | - Brandon W Smith
- 2Department of Neurosurgery, Duke University, Durham, North Carolina
| | | | - Susan H Brown
- 3School of Kinesiology, University of Michigan, Ann Arbor, Michigan; and
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14
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Poitras I, Clouâtre J, Campeau-Lecours A, Mercier C. Accelerometry-Based Metrics to Evaluate the Relative Use of the More Affected Arm during Daily Activities in Adults Living with Cerebral Palsy. SENSORS 2022; 22:s22031022. [PMID: 35161767 PMCID: PMC8839842 DOI: 10.3390/s22031022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 01/27/2023]
Abstract
Adults living with cerebral palsy (CP) report bimanual and unimanual difficulties that interfere with their participation in activities of daily living (ADL). There is a lack of quantitative methods to assess the impact of these motor dysfunctions on the relative use of each arm. The objective of this study was to evaluate the concurrent and discriminative validity of accelerometry-based metrics when used to assess bimanual and unimanual functions. METHODS A group of control subjects and hemiplegic adults living with CP performed six ADL tasks, during which they were wearing an Actigraph GT9X on each wrist and being filmed. Four bimanual and unimanual metrics were calculated from both accelerometry-based and video-based data; these metrics were then compared to one other with an intraclass correlation coefficient (ICC). Some of these metrics were previously validated in other clinical population, while others were novel. The discriminative validity was assessed through comparisons between groups and between tasks. RESULTS The concurrent validity was considered as good to excellent (ICC = 0.61-0.97) depending on the experience of the raters. The tasks made it possible to discriminate between groups. CONCLUSION The proposed accelerometry-based metrics are a promising tool to evaluate bimanual and unimanual functions in adults living with CP.
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Affiliation(s)
- Isabelle Poitras
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, QC G1M 2S8, Canada; (I.P.); (J.C.); (A.C.-L.)
- Department of Rehabilitation, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Jade Clouâtre
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, QC G1M 2S8, Canada; (I.P.); (J.C.); (A.C.-L.)
- Department of Mechanical Engineering, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Alexandre Campeau-Lecours
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, QC G1M 2S8, Canada; (I.P.); (J.C.); (A.C.-L.)
- Department of Mechanical Engineering, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Catherine Mercier
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, QC G1M 2S8, Canada; (I.P.); (J.C.); (A.C.-L.)
- Department of Rehabilitation, Laval University, Quebec City, QC G1V 0A6, Canada
- Correspondence:
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15
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Hollis A, Cole L, Zewdie E, Metzler MJ, Kirton A. Bilateral actigraphic quantification of upper extremity movement in hemiparetic children with perinatal stroke: a case control study. J Neuroeng Rehabil 2021; 18:172. [PMID: 34915898 PMCID: PMC8680110 DOI: 10.1186/s12984-021-00962-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hemiparetic cerebral palsy impacts millions of people worldwide. Assessment of bilateral motor function in real life remains a major challenge. We evaluated quantification of upper extremity movement in hemiparetic children using bilateral actigraphy. We hypothesized that movement asymmetry correlates with standard motor outcome measures. METHODS Hemiparetic and control participants wore bilateral wrist Actiwatch2 (Philips) for 48 h with movement counts recorded in 15-s intervals. The primary outcome was a novel statistic of movement asymmetry, the Actigraphic Movement Asymmetry Index (AMAI). Relationships between AMAI and standard motor outcomes (Assisting Hand Assessment, Melbourne Assessment, and Box and Block Test [BB]) were explored with Pearson or Spearman correlation. RESULTS 30 stroke (mean 11 years 2 months (3 years 10 months); 13 female, 17 male) and 23 control (mean 11 years 1 month (4 years 5 months); 8 female, 15 male) were enrolled. Stroke participants demonstrated higher asymmetry. Correlations between AMAI and standard tests were moderate and strongest during sleep (BB: r = 0.68, p < 0.01). CONCLUSIONS Standard tests may not reflect the extent of movement asymmetry during daily life in hemiparetic children. Bilateral actigraphy may be a valuable complementary tool for measuring arm movement, potentially enabling improved evaluation of therapies with a focus on child participation.
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Affiliation(s)
- Asha Hollis
- Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Lauran Cole
- Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ephrem Zewdie
- Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Megan J Metzler
- Clinical Neurosciences, Alberta Children's Hospital, Calgary, Canada
| | - Adam Kirton
- Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada. .,Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada. .,Pediatric Neurology, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, T3B6A8, Canada.
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16
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Lang CE, Waddell KJ, Barth J, Holleran CL, Strube MJ, Bland MD. Upper Limb Performance in Daily Life Approaches Plateau Around Three to Six Weeks Post-stroke. Neurorehabil Neural Repair 2021; 35:903-914. [PMID: 34510934 DOI: 10.1177/15459683211041302] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Wearable sensors allow for direct measurement of upper limb (UL) performance in daily life. Objective. To map the trajectory of UL performance and its relationships to other factors post-stroke. Methods. Participants (n = 67) with first stroke and UL paresis were assessed at 2, 4, 6, 8, 12, 16, 20, and 24 weeks after stroke. Assessments captured UL impairment (Fugl-Meyer), capacity for activity (Action Research Arm Test), and performance of activity in daily life (accelerometer variables of use ratio and hours of paretic limb activity), along with other potential modifying factors. We modeled individual trajectories of change for each measurement level and the moderating effects on UL performance trajectories. Results. Individual trajectories were best fit with a 3-parameter logistic model, capturing the rapid growth early after stroke within the longer data collection period. Plateaus (90% of asymptote) in impairment (bootstrap mean ± SE: 32 ± 4 days post-stroke) preceded those in capacity (41 ± 4 days). Plateau in performance, as measured by the use ratio (24 ± 5 days), tended to precede plateaus in impairment and capacity. Plateau in performance, as measured by hours of paretic activity (41 ± 6 days), occurred at a similar time to that of capacity and slightly lagged impairment. Modifiers of performance trajectories were capacity, concordance, UL rehabilitation, depressive symptomatology, and cognition. Conclusions. Upper limb performance in daily life approached plateau 3 to 6 weeks post-stroke. Individuals with stroke started to achieve a stable pattern of UL use in daily life early, often before neurological impairments and functional capacity started to stabilize.
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Affiliation(s)
- Catherine E Lang
- Program in Physical Therapy, 12275Washington University School of Medicine, St Louis, MO, USA.,Program in Occupational Therapy, 12275Washington University School of Medicine, St Louis, MO, USA.,Department of Neurology, 12275Washington University School of Medicine, St Louis, MO, USA
| | - Kimberly J Waddell
- Program in Physical Therapy, 12275Washington University School of Medicine, St Louis, MO, USA
| | - Jessica Barth
- Program in Physical Therapy, 12275Washington University School of Medicine, St Louis, MO, USA
| | - Carey L Holleran
- Program in Physical Therapy, 12275Washington University School of Medicine, St Louis, MO, USA.,Department of Neurology, 12275Washington University School of Medicine, St Louis, MO, USA
| | - Michael J Strube
- Department of Psychological and Brain Sciences, Washington University, St Louis, MO, USA
| | - Marghuretta D Bland
- Program in Physical Therapy, 12275Washington University School of Medicine, St Louis, MO, USA.,Program in Occupational Therapy, 12275Washington University School of Medicine, St Louis, MO, USA.,Department of Neurology, 12275Washington University School of Medicine, St Louis, MO, USA
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17
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Hoyt CR, Sherman SK, Brown SK, Newbold DJ, Miller RL, Van AN, Shimony JS, Ortega M, Nguyen AL, Schlaggar BL, Dosenbach NUF. Toward a More Comprehensive Assessment of School Age Children with Hemiplegic Cerebral Palsy. Rehabil Process Outcome 2021; 10:11795727211010500. [PMID: 34497455 PMCID: PMC8282143 DOI: 10.1177/11795727211010500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 03/19/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Cerebral palsy (CP) is the leading cause of disability in children. While motor deficits define CP, many patients experience behavioral and cognitive deficits which limit participation. The purpose of this study was to contribute to our understanding of developmental delay and how to measure these deficits among children with CP. Methods: Children 5 to 15 years with hemiplegic CP were recruited. Cognition and motor ability were assessed. The brain injury associated with observed motor deficits was identified. Accelerometers measured real-world bilateral upper extremity movement and caregivers completed behavioral assessments. Results: Eleven children participated, 6 with presumed perinatal stroke. Four children scored below average intelligence quotient while other measures of cognition were within normal limits (except processing speed). Motor scores confirmed asymmetrical deficits. Approximately one third of scores indicated deficits in attention, behavior, or depression. Conclusions: Our findings corroborate that children with CP experience challenges that are broader than motor impairment alone. Despite the variation in brain injury, all participants completed study procedures. Implications: Our findings suggest that measuring behavior in children with CP may require a more comprehensive approach and that caregivers are amenable to using online collection tools which may assist in addressing the therapeutic needs of children with CP.
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Affiliation(s)
- Catherine R Hoyt
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
- Catherine R Hoyt, Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Blvd, MSC 8505-94-01, St. Louis, MO 63110, USA.
| | - Sarah K Sherman
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Shelby K Brown
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Dillan J Newbold
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ryland L Miller
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrew N Van
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Mario Ortega
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Annie L Nguyen
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Bradley L Schlaggar
- Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nico UF Dosenbach
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
- Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, MO, USA
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18
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Use of wrist-worn accelerometers to quantify bilateral upper limb activity and asymmetry under free-living conditions in people with multiple sclerosis. Mult Scler Relat Disord 2021; 53:103081. [PMID: 34166981 DOI: 10.1016/j.msard.2021.103081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/01/2021] [Accepted: 06/09/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Although upper limb (UL) dysfunctions are quite common among people with Multiple Sclerosis (pwMS), there is a scarcity of information about actual UL usage under free-living conditions. The aim of the present study is to quantitatively assess 'real-world' activity time, intensity and possible asymmetry of use among dominant and non-dominant ULs in pwMS. METHODS Twenty-eight pwMS (20 women, 8 men, average EDSS 4.3) and 28 age- and sex-matched unaffected individuals were required to wear a tri-axial accelerometer on each wrist 24h/day for 2 weekdays. Raw accelerations were processed to calculate parameters associated with time and intensity of use of UL both when engaged in uni- or bilateral activities. RESULTS During the 2-day monitoring period, pwMS were characterized by significantly lower overall activity, they used their dominant limb for a significantly longer time and, while performing bilateral activities, their dominant limb expressed movements of superior intensity in a proportion higher than what was observed in unaffected individuals. CONCLUSION The instrumental monitoring of UL activity with two wrist-worn sensors may represent an effective tool for assessing the contribution of each limb to uni- and bilateral movements. Such data can be employed to monitor the progression of UL dysfunctions and the effectiveness of pharmacologic and rehabilitative treatments.
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19
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Lang CE, Barth J, Holleran CL, Konrad JD, Bland MD. Implementation of Wearable Sensing Technology for Movement: Pushing Forward into the Routine Physical Rehabilitation Care Field. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5744. [PMID: 33050368 PMCID: PMC7601835 DOI: 10.3390/s20205744] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 01/01/2023]
Abstract
While the promise of wearable sensor technology to transform physical rehabilitation has been around for a number of years, the reality is that wearable sensor technology for the measurement of human movement has remained largely confined to rehabilitation research labs with limited ventures into clinical practice. The purposes of this paper are to: (1) discuss the major barriers in clinical practice and available wearable sensing technology; (2) propose benchmarks for wearable device systems that would make it feasible to implement them in clinical practice across the world and (3) evaluate a current wearable device system against the benchmarks as an example. If we can overcome the barriers and achieve the benchmarks collectively, the field of rehabilitation will move forward towards better movement interventions that produce improved function not just in the clinic or lab, but out in peoples' homes and communities.
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Affiliation(s)
- Catherine E. Lang
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63122, USA
| | - Jessica Barth
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
| | - Carey L. Holleran
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63122, USA
| | - Jeff D. Konrad
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
| | - Marghuretta D. Bland
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63122, USA
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20
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Newbold DJ, Laumann TO, Hoyt CR, Hampton JM, Montez DF, Raut RV, Ortega M, Mitra A, Nielsen AN, Miller DB, Adeyemo B, Nguyen AL, Scheidter KM, Tanenbaum AB, Van AN, Marek S, Schlaggar BL, Carter AR, Greene DJ, Gordon EM, Raichle ME, Petersen SE, Snyder AZ, Dosenbach NUF. Plasticity and Spontaneous Activity Pulses in Disused Human Brain Circuits. Neuron 2020; 107:580-589.e6. [PMID: 32778224 PMCID: PMC7419711 DOI: 10.1016/j.neuron.2020.05.007] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/12/2020] [Accepted: 05/06/2020] [Indexed: 11/16/2022]
Abstract
To induce brain plasticity in humans, we casted the dominant upper extremity for 2 weeks and tracked changes in functional connectivity using daily 30-min scans of resting-state functional MRI (rs-fMRI). Casting caused cortical and cerebellar regions controlling the disused extremity to functionally disconnect from the rest of the somatomotor system, while internal connectivity within the disused sub-circuit was maintained. Functional disconnection was evident within 48 h, progressed throughout the cast period, and reversed after cast removal. During the cast period, large, spontaneous pulses of activity propagated through the disused somatomotor sub-circuit. The adult brain seems to rely on regular use to maintain its functional architecture. Disuse-driven spontaneous activity pulses may help preserve functionally disconnected sub-circuits.
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Affiliation(s)
- Dillan J Newbold
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | - Timothy O Laumann
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Catherine R Hoyt
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jacqueline M Hampton
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - David F Montez
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Ryan V Raut
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Mario Ortega
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Anish Mitra
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Psychiatry, Stanford University, Stanford, CA 94305, USA
| | - Ashley N Nielsen
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA; Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL 60611, USA
| | - Derek B Miller
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Babatunde Adeyemo
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Annie L Nguyen
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Kristen M Scheidter
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Aaron B Tanenbaum
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Andrew N Van
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Scott Marek
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Bradley L Schlaggar
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA; Kennedy Krieger Institute, Baltimore, MD 21205, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Alexandre R Carter
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA; Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Deanna J Greene
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Evan M Gordon
- VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX 76711, USA; Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX 75080, USA; Department of Psychology and Neuroscience, Baylor University, Waco, TX 76706, USA
| | - Marcus E Raichle
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Steven E Petersen
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63110, USA; Department of Neuroscience, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Abraham Z Snyder
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Nico U F Dosenbach
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA; Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63110, USA; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA.
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21
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Hoyt CR, Brown SK, Sherman SK, Wood-Smith M, Van AN, Ortega M, Nguyen AL, Lang CE, Schlaggar BL, Dosenbach NUF. Using accelerometry for measurement of motor behavior in children: Relationship of real-world movement to standardized evaluation. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 96:103546. [PMID: 31783278 PMCID: PMC7584130 DOI: 10.1016/j.ridd.2019.103546] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/14/2019] [Accepted: 11/14/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND When detected, children with asymmetrical motor impairment are referred for therapeutic interventions to maximize the child's ability to reach their health and developmental potential. Referal is dependent on standardized evaluation, which rarely examines upper extremity (UE) function within the context of real-world activity. Accelerometry provides an efficient method to objectively measure movement in children. The purpose of this study was to compare accelerometry to clinical assessment, specifically the Melbourne Assessment of Unilateral Upper Limb Function-2 (MA-2). METHODS A total of 52 children between 1-17 years of age with asymmetrical motor deficits and age matched controls participated in this study. Participants wore bilateral accelerometers for 4 x 25 h. The use ratio (UR) and mono-arm use index (MAUI) were calculated to quantify asymmetrical impairment. The Melbourne Assessment of Unilateral Upper Limb Function-2 (MA-2) was administered and compared to accelerometry variables. RESULTS The UR and MAUI were significantly different in children with and without deficits. The MAUI was significantly correlated with all domains of the MA-2: accuracy (r = 0.44, p = 0.026); fluency (r = 0.52, p = 0.006); dexterity (r = 0.53, p = 0.005); and range of motion (r = 0.49, p = 0.011). CONCLUSIONS Our findings suggest a relationship between real-world movement and clinical evaluation.
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Affiliation(s)
- Catherine R Hoyt
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States; Washington University School of Medicine, Department of Neurology, St. Louis, MO, United States.
| | - Shelby K Brown
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States; Washington University School of Medicine, Department of Neurology, St. Louis, MO, United States
| | - Sarah K Sherman
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States; Washington University School of Medicine, Department of Neurology, St. Louis, MO, United States
| | - Melanie Wood-Smith
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States; Washington University School of Medicine, Department of Neurology, St. Louis, MO, United States
| | - Andrew N Van
- Washington University School of Medicine, Department of Neurology, St. Louis, MO, United States; Washington University School of Medicine, Department of Psychiatry, St. Louis, MO, United States; Washington University School of Medicine, Department of Neuroscience, St. Louis, MO, United States
| | - Mario Ortega
- Washington University School of Medicine, Department of Neurology, St. Louis, MO, United States; Washington University School of Medicine, Department of Neuroscience, St. Louis, MO, United States
| | - Annie L Nguyen
- Washington University School of Medicine, Department of Neurology, St. Louis, MO, United States; Washington University School of Medicine, Department of Psychiatry, St. Louis, MO, United States; Washington University School of Medicine, Department of Neuroscience, St. Louis, MO, United States
| | - Catherine E Lang
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States; Washington University School of Medicine, Department of Neurology, St. Louis, MO, United States; Washington University School of Medicine, Program in Physical Therapy, St. Louis, MO, United States
| | - Bradley L Schlaggar
- Washington University School of Medicine, Department of Neurology, St. Louis, MO, United States; Washington University School of Medicine, Department of Psychiatry, St. Louis, MO, United States; Washington University School of Medicine, Department of Neuroscience, St. Louis, MO, United States; Kennedy Krieger Institute, Baltimore, MD, United States; Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD, United States; Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, MD, United States
| | - Nico U F Dosenbach
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO, United States; Washington University School of Medicine, Department of Neurology, St. Louis, MO, United States; Washington University School of Medicine, Department of Radiology, St. Louis, MO, United States; Washington University School of Medicine, Department of Pediatrics, St. Louis, MO, United States; Washington University School of Medicine, Department of Psychiatry, St. Louis, MO, United States; Washington University School of Medicine, Department of Neuroscience, St. Louis, MO, United States; Washington University School of Medicine, Department of Biomedical Engineering, St. Louis, MO, United States
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22
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Lang CE, Cade WT. A step toward the future of seamless measurement with wearable sensors in pediatric populations with neuromuscular diseases. Muscle Nerve 2019; 61:265-267. [PMID: 31883126 DOI: 10.1002/mus.26795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 12/22/2019] [Accepted: 12/23/2019] [Indexed: 01/30/2023]
Affiliation(s)
- Catherine E Lang
- Program in Physical Therapy, Washington University School of Medicine, St Louis, Missouri
| | - W Todd Cade
- Program in Physical Therapy, Washington University School of Medicine, St Louis, Missouri
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