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Burahmah E, Shanmugam S, Williams D, Stansfield B. Validity and Reliability of the activPAL4 TM for Measurement of Body Postures and Stepping Activity in 6-12-Year-Old Children. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23094555. [PMID: 37177759 PMCID: PMC10181769 DOI: 10.3390/s23094555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 04/28/2023] [Accepted: 05/06/2023] [Indexed: 05/15/2023]
Abstract
A link between inappropriate physical behaviour patterns (low physical activity and high sedentary behaviour) and poor health outcomes has been observed. To provide evidence to quantify this link, it is important to have valid and reliable assessment tools. This study aimed to assess the validity and reliability of the activPAL4TM monitor for distinguishing postures and measuring stepping activity of 6-12-year-old children. Thirteen children (8.5 ± 1.8 years) engaged in pre-determined standardised (12 min) and non-standardised (6 min) activities. Agreement, specificity and positive predictive value were assessed between the activPAL4TM and direct observation (DO) (nearest 0.1 s). Between-activPAL4TM (inter-device) and between-observer (inter-rater) reliability were determined. Detection of sitting and stepping time and forward purposeful step count were all within 5% of DO. Standing time was slightly overestimated (+10%) and fast walking/jogging steps underestimated (-20%). For non-standardised activities, activPAL4TM step count matched most closely to combined backward and forward purposeful steps; however, agreement varied widely. The activPAL4TM demonstrated high levels of reliability (ICC(1, 1) > 0.976), which were higher in some instances than could be achieved through direct observation (ICC(2, 1) > 0.851 for non-standardised activities). Overall, the activPAL4TM recorded standardised activities well. However, further work is required to establish the exact nature of steps counted by the activPAL4TM.
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Affiliation(s)
- Esraa Burahmah
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
| | - Sivaramkumar Shanmugam
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
| | - Daniel Williams
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
| | - Ben Stansfield
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
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Comparison of Participation in Strength Activity Between Wearable Device Users and Nonusers: 2017 Behavioral Risk Factors Surveillance System. J Phys Act Health 2022; 19:673-680. [PMID: 36087931 DOI: 10.1123/jpah.2022-0155] [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: 03/22/2022] [Revised: 07/06/2022] [Accepted: 08/06/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND There are many benefits associated with engaging in strength physical activity. Many studies did not examine the engagement of strength activity among wearable device users. This study aimed to examine the association between wearable device usage and engagement of strength activity in free-living settings using nationally representative data. METHODS A total of 8250 adult wearable device users and nonusers from 8 states of the 2017 Behavioral Risk Factors Surveillance System were included in analysis. Multiple regression models were performed to determine the association between the dependent variables of strength activities and the independent variable of wearable devices. RESULTS Wearable device users were 1.26 (95% confidence interval, 1.01-1.81) times the odds of nonusers in engaging in strength activity. Users also had higher odds of meeting both the strength and aerobic physical activity guidelines than nonusers (odds ratio = 1.49; 95% confidence interval, 1.07-2.06; adjusted odds ratio = 1.43; 95% confidence interval, 1.02-2.00). No associations were found between wearable device utilization and frequency of strength activity per week. CONCLUSION Wearable device users were more likely to engage in strength activity than nonusers. However, additional studies are needed to determine the effectiveness of wearable devices in promoting strength activity.
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Moll I, Marcellis RGJ, Coenen MLP, Fleuren SM, Willems PJB, Speth LAWM, Witlox MA, Meijer K, Vermeulen RJ. A randomized crossover study of functional electrical stimulation during walking in spastic cerebral palsy: the FES on participation (FESPa) trial. BMC Pediatr 2022; 22:37. [PMID: 35027013 PMCID: PMC8756646 DOI: 10.1186/s12887-021-03037-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 11/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background Spastic cerebral palsy is the most common cause of motor disability in children. It often leads to foot drop or equinus, interfering with walking. Ankle-foot orthoses (AFOs) are commonly used in these cases. However, AFOs can be too restrictive for mildly impaired patients. Functional electrical stimulation (FES) of the ankle-dorsiflexors is an alternative treatment as it could function as a dynamic functional orthosis. Despite previous research, high level evidence on the effects of FES on activities and participation in daily life is missing. The primary aim of this study is to evaluate whether FES improves the activity and participation level in daily life according to patients, and the secondary aim is to provide evidence of the effect of FES at the level of body functions and activities. Furthermore, we aim to collect relevant information for decisions on its clinical implementation. Methods A randomized crossover trial will be performed on 25 children with unilateral spastic cerebral palsy. Patients aged between 4 and 18 years, with Gross Motor Functioning Classification System level I or II and unilateral foot drop of central origin, currently treated with AFO or adapted shoes, will be included. All participants will undergo twelve weeks of conventional treatment (AFO/adapted shoes) and 12 weeks of FES treatment, separated by a six-week washout-phase. FES treatment consists of wearing the WalkAide® device, with surface electrodes stimulating the peroneal nerve during swing phase of gait. For the primary objective, the Goal Attainment Scale is used to test whether FES improves activities and participation in daily life. The secondary objective is to prove whether FES is effective at the level of body functions and structures, and activities, including ankle kinematics and kinetics measured during 3D-gait analysis and questionnaire-based frequency of falling. The tertiary objective is to collect relevant information for clinical implementation, including acceptability using the device log file and side effect registration, cost-effectiveness based on quality adjusted life years (QALYs) and clinical characteristics for patient selection. Discussion We anticipate that the results of this study will allow evidence-based use of FES during walking in children with unilateral spastic cerebral palsy. Trial registration ClinicalTrials.gov: NCT03440632. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-03037-9.
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Xiong JSP, Reedman SE, Kho ME, Timmons BW, Verschuren O, Gorter JW. Operationalization, measurement, and health indicators of sedentary behavior in individuals with cerebral palsy: a scoping review. Disabil Rehabil 2021; 44:6070-6081. [PMID: 34334077 DOI: 10.1080/09638288.2021.1949050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To explore the operationalization and measurement of sedentary behavior (SB) in individuals with cerebral palsy (CP). MATERIALS AND METHODS We searched five databases from 2011 to 2020 for primary studies of experimental, qualitative, longitudinal, or observational designs measuring SB or postures typically characterized as sedentary (sitting, reclining, lying). RESULTS We screened 1112 citations and selected 47 studies. SB was operationalized through muscle activation, energy expenditure or oxygen consumption in typically sedentary postures (n = 9), and through thresholds and postures used by accelerometers, activity monitors, and a questionnaire to measure time spent in SB (n = 25). Seven out of the eight studies that measured energy expenditure found ≤1.5 metabolic equivalents of task (METs) for sitting and lying. While different accelerometer thresholds were used to measure SB, the behavior (SB) was consistently operationalized as sitting and lying. Little consistency existed in the subpopulation, instruments and cut-points for studies on validity or reliability of tools for measuring SB (n = 19). CONCLUSIONS Sitting and lying are considered sedentary postures, which is defined as ≤1.5 METs in individuals with CP. There is variability in the tools used to measure SB in individuals with CP. Therefore, consensus on the definition and reporting of SB is needed.Implications for rehabilitationAlthough sedentary behavior (SB) is increased in individuals with cerebral palsy (CP) compared to the typically developing population, there is no standard definition for SB for these individuals; this makes it difficult to synthesize data across studies.Sitting and lying are ≤1.5 METs in individuals with CP, suggesting we only need to measure posture to show change in SB.The commonly used accelerometer cut-point in the typically developing population of ≤100 counts per minute generally has excellent reliability across multiple devices in ambulatory children with CP.
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Affiliation(s)
- Julia Shi-Peng Xiong
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Institute of Applied Health Sciences, Hamilton, Canada
| | - Sarah E Reedman
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | - Michelle E Kho
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Institute of Applied Health Sciences, Hamilton, Canada.,Department of Physiotherapy, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Brian W Timmons
- Department of Pediatrics, Child Health and Exercise Medicine Program, McMaster University, Hamilton, Canada.,Department of Kinesiology, McMaster University, Hamilton, Canada
| | - Olaf Verschuren
- UMC Utrecht Brain Center and Center of Excellence for Rehabilitation Medicine, Utrecht University, Utrecht and De Hoogstraat Rehabilitation, Utrecht, Netherlands
| | - Jan Willem Gorter
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Institute of Applied Health Sciences, Hamilton, Canada.,Department of Pediatrics, CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada.,Department of Pediatrics, McMaster University, Hamilton, Canada
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O'Sullivan R, French HP, Van Rossom S, Jonkers I, Horgan F. The association between gait analysis measures associated with crouch gait, functional health status and daily activity levels in cerebral palsy. J Pediatr Rehabil Med 2021; 14:227-235. [PMID: 33896854 DOI: 10.3233/prm-200676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The aim of this study was to examine the relationship between gait analysis measures associated with crouch gait, functional health status and daily activity in ambulant cerebral palsy (CP). METHODS Three-dimensional gait analysis was carried out on 35 ambulant participants with bilateral CP crouch gait (knee flexion at mid-stance (KFMS) ⩾ 190). KFMS, knee-flexion at initial contact, gait speed and step-lengths were extracted for analysis. Steps/day and sedentary time/day were assessed using an ActivPAL accelerometer. Functional health status was assessed using the five relevant domains of the Pediatric Outcomes Data Collection Instrument (PODCI) questionnaire. Associations between variables were assessed with correlation coefficients and multivariable linear regression. RESULTS There were no significant correlations between KFMS and PODCI domains (ρ=-0.008-0.110) or daily activity (ρ=-0.297-0.237) variables. In contrast, multivariable analysis found that step-length was independently associated with the Sports and Physical Function (p= 0.030), Transfers and Basic Mobility (p= 0.041) and Global Function (< 0.001) domains of the PODCI assessment. Gait speed was independently associated with mean steps/day (p< 0.001). CONCLUSIONS Step length and gait speed are more strongly associated with functional health status and daily activity than knee flexion during stance in children and adolescents with CP crouch gait.
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Affiliation(s)
- Rory O'Sullivan
- Gait Analysis Laboratory, Central Remedial Clinic, Dublin, Ireland.,School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Helen P French
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sam Van Rossom
- Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
| | - Ilse Jonkers
- Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
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Ng K, Kokko S, Tammelin T, Kallio J, Belton S, O'Brien W, Murphy M, Powell C, Woods C. Clusters of Adolescent Physical Activity Tracker Patterns and Their Associations With Physical Activity Behaviors in Finland and Ireland: Cross-Sectional Study. J Med Internet Res 2020; 22:e18509. [PMID: 32667894 PMCID: PMC7492981 DOI: 10.2196/18509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/14/2020] [Accepted: 06/14/2020] [Indexed: 12/22/2022] Open
Abstract
Background Physical activity trackers (PATs) such as apps and wearable devices (eg, sports watches, heart rate monitors) are increasingly being used by young adolescents. Despite the potential of PATs to help monitor and improve moderate-to-vigorous physical activity (MVPA) behaviors, there is a lack of research that confirms an association between PAT ownership or use and physical activity behaviors at the population level. Objective The purpose of this study was to examine the ownership and use of PATs in youth and their associations with physical activity behaviors, including daily MVPA, sports club membership, and active travel, in 2 nationally representative samples of young adolescent males and females in Finland and Ireland. Methods Comparable data were gathered in the 2018 Finnish School-aged Physical Activity (F-SPA 2018, n=3311) and the 2018 Irish Children’s Sport Participation and Physical Activity (CSPPA 2018, n=4797) studies. A cluster analysis was performed to obtain the patterns of PAT ownership and usage by adolescents (age, 11-15 years). Four similar clusters were identified across Finnish and Irish adolescents: (1) no PATs, (2) PAT owners, (3) app users, and (4) wearable device users. Adjusted binary logistic regression analyses were used to evaluate how PAT clusters were associated with physical activity behaviors, including daily MVPA, membership of sports clubs, and active travel, after stratification by gender. Results The proportion of app ownership among Finnish adolescents (2038/3311, 61.6%) was almost double that of their Irish counterparts (1738/4797, 36.2%). Despite these differences, the clustering patterns of PATs were similar between the 2 countries. App users were more likely to take part in daily MVPA (males, odds ratio [OR] 1.27, 95% CI 1.04-1.55; females, OR 1.49, 95% CI 1.20-1.85) and be members of sports clubs (males, OR 1.37, 95% CI 1.15-1.62; females, OR 1.25, 95% CI 1.07-1.50) compared to the no PATs cluster, after adjusting for country, age, family affluence, and disabilities. These associations, after the same adjustments, were even stronger for wearable device users to participate in daily MVPA (males, OR 1.83, 95% CI 1.49-2.23; females, OR 2.25, 95% CI 1.80-2.82) and be members of sports clubs (males, OR 1.88, 95% CI 1.55-2.88; females, OR 2.07, 95% CI 1.71-2.52). Significant associations were observed between male users of wearable devices and taking part in active travel behavior (OR 1.39, 95% CI 1.04-1.86). Conclusions Although Finnish adolescents report more ownership of PATs than Irish adolescents, the patterns of use and ownership remain similar among the cohorts. The findings of our study show that physical activity behaviors were positively associated with wearable device users and app users. These findings were similar between males and females. Given the cross-sectional nature of this data, the relationship between using apps or wearable devices and enhancing physical activity behaviors requires further investigation.
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Affiliation(s)
- Kwok Ng
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland.,Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland.,Physical Activity for Health Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Sami Kokko
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyväskylä, Finland
| | - Tuija Tammelin
- LIKES Research Centre for Physical Activity and Health, Jyväskylä, Finland
| | - Jouni Kallio
- LIKES Research Centre for Physical Activity and Health, Jyväskylä, Finland
| | - Sarahjane Belton
- School of Health and Human Performance, Faculty of Science and Health, Dublin City University, Dublin, Ireland
| | - Wesley O'Brien
- School of Education, University College Cork, Cork, Ireland
| | - Marie Murphy
- School of Sport, Ulster University, Belfast, United Kingdom
| | - Cormac Powell
- Physical Activity for Health Cluster, Health Research Institute, University of Limerick, Limerick, Ireland.,Performance Department, Swim Ireland, Irish Sport HQ, Dublin, Ireland
| | - Catherine Woods
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland.,Physical Activity for Health Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
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Xing R, Huang WY, Sit CHP. Validity of accelerometry for predicting physical activity and sedentary time in ambulatory children and young adults with cerebral palsy. J Exerc Sci Fit 2020; 19:19-24. [PMID: 32922459 PMCID: PMC7473995 DOI: 10.1016/j.jesf.2020.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 06/26/2020] [Accepted: 06/27/2020] [Indexed: 11/30/2022] Open
Abstract
Background /Objectives: This study aimed to validate five published ActiGraph (AG) cut-off points for the measurements of physical activity (PA) and sedentary time (ST) in ambulatory children and young adults with cerebral palsy (CP). Additionally, four energy expenditure (EE) prediction equations based on AG counts and activPAL (AP) steps were examined in this population, using oxygen uptake (VO2) as the criterion. Methods Four male and six female participants with CP (Gross Motor Function Classification System levels I-III, ages 9-21 years) completed seven activities while simultaneously wearing an AG, AP monitor and indirect calorimetry unit. VO2 was measured on a breath-by-breath basis using the indirect calorimetry and was converted into EE using metabolic equivalents. AG counts were classified as sedentary, light PA (LPA) or moderate-to-vigorous PA (MVPA) using five cut-off points: Puyau, Evenson, Romanzini, Clanchy and Baque. The predicted EE was computed using three AG-based equations (Freedson, Trost and Treuth) and an AP step-based equation. Results Based on 1920 available data points from the 10 participants, Baque (r = 0.896, κ = 0.773) and Clanchy (r = 0.935, κ = 0.721) AG cut-off points classified PA and ST most accurately. All the equations overestimated EE during sitting activities and underestimated EE during rapid walking. The Freedson, Treuth and AP equations exhibited systematic bias during rapid walking, as their differences from the criterion measure increased progressively with increasing activity intensity. Conclusions The AG accurately classified PA and ST when the Baque and Clanchy cut-off points were used. However, none of the available AG or AP equations accurately predicted the EE during PA and ST in children and young adults with CP. Further development is needed to ensure that both devices can estimate EE accurately in this population.
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Affiliation(s)
- Ruirui Xing
- Department of Sport and Physical Education, Hong Kong Baptist University, Hong Kong, China
| | - Wendy Yajun Huang
- Department of Sport and Physical Education, Hong Kong Baptist University, Hong Kong, China
| | - Cindy Hui-Ping Sit
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
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Claridge EA, van den Berg-Emons RJG, Horemans HLD, van der Slot WMA, van der Stam N, Tang A, Timmons BW, Gorter JW, Bussmann JBJ. Detection of body postures and movements in ambulatory adults with cerebral palsy: a novel and valid measure of physical behaviour. J Neuroeng Rehabil 2019; 16:125. [PMID: 31665030 PMCID: PMC6821000 DOI: 10.1186/s12984-019-0594-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accurate measurement of physical behaviour is paramount to better understand lifestyle, health, and functioning, particularly in adults with physical disability as they may be at higher risk of sedentary lifestyle and subsequent negative health consequences. This study aimed: 1) to evaluate the criterion validity of a novel and clinically applicable activity monitor (AM, Activ8), in the detection of body postures and movements in adults with spastic cerebral palsy (CP); and 2) to evaluate the extent that the AM's positioning affects validity. METHODS In this cross-sectional study, 14 ambulatory adults with CP [9 men; mean (SD) age, 35.4 (13.1) years] performed standardized activities while wearing three Activ8 monitors - frontolateral thigh (primary position), frontal thigh, and pant pocket - and being video recorded (criterion measure). AM activity output was compared to synchronized video recordings. Absolute (seconds) and relative [(video time-AM time)/mean time, %] time differences between methods were calculated. Relative time differences of < 10% were indicative of good validity. Comparison of AM attachment positions was completed using Spearman Rho correlation coefficients and Meng's tests. RESULTS Criterion validity of the AM (frontolateral thigh) was good (average relative time differences: 0.25% for sitting, 4.69% for standing, 2.46% for walking, 1.96% for upright activity, 3.19% for cycling), except for running (34.6%). Spearman Rho correlation coefficients were greater between video/frontolateral thigh position than video/frontal thigh position and video/pant pocket position for body posture and movement categories sitting, standing, walking, and upright activity (p < 0.01 for all). CONCLUSIONS The AM, positioned on the frontolateral thigh, demonstrated good criterion validity in ambulatory adults with CP. Though the Activ8 offers potential as an objective measure of physical activity, appropriate positioning is paramount for valid measurement.
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Affiliation(s)
- Everett A Claridge
- School of Rehabilitation Sciences, McMaster University, 1400 Main St. W, Hamilton, Ontario, L8S 1C7, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, 1400 Main St. W, Hamilton, Ontario, L8S 1C7, Canada.,Department of Rehabilitation Medicine, Erasmus MC University Medical Centre, P.O. Box 2040, 3000, Rotterdam, CA, Netherlands
| | - Rita J G van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus MC University Medical Centre, P.O. Box 2040, 3000, Rotterdam, CA, Netherlands
| | - Herwin L D Horemans
- Department of Rehabilitation Medicine, Erasmus MC University Medical Centre, P.O. Box 2040, 3000, Rotterdam, CA, Netherlands
| | - Wilma M A van der Slot
- Department of Rehabilitation Medicine, Erasmus MC University Medical Centre, P.O. Box 2040, 3000, Rotterdam, CA, Netherlands.,Rijndam Rehabilitation, Westersingel 300, 3015, Rotterdam, LJ, Netherlands
| | - Nick van der Stam
- Department of Rehabilitation Medicine, Erasmus MC University Medical Centre, P.O. Box 2040, 3000, Rotterdam, CA, Netherlands
| | - Ada Tang
- School of Rehabilitation Sciences, McMaster University, 1400 Main St. W, Hamilton, Ontario, L8S 1C7, Canada
| | - Brian W Timmons
- CanChild Centre for Childhood Disability Research, McMaster University, 1400 Main St. W, Hamilton, Ontario, L8S 1C7, Canada.,Child Health & Exercise Medicine Program, Department of Pediatrics, McMaster University, 1280 Main St. W, Hamilton, Ontario, L8S 4L8, Canada
| | - Jan Willem Gorter
- School of Rehabilitation Sciences, McMaster University, 1400 Main St. W, Hamilton, Ontario, L8S 1C7, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, 1400 Main St. W, Hamilton, Ontario, L8S 1C7, Canada
| | - Johannes B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC University Medical Centre, P.O. Box 2040, 3000, Rotterdam, CA, Netherlands.
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Lankhorst K, van den Berg-Emons RJ, Bussmann JBJ, Horemans HLD, de Groot JF. A Novel Tool for Quantifying and Promoting Physical Activity in Youths With Typical Development and Youths Who Are Ambulatory and Have Motor Disability. Phys Ther 2019; 99:354-363. [PMID: 30649497 DOI: 10.1093/ptj/pzy152] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 08/22/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Several device-based instruments have been validated in the pediatric population, but none of these are clinically applicable and provide real-time feedback on actual physical activity in terms of postures and movements. A new device (Activ8) is promising for that purpose. OBJECTIVE The objective was to investigate the criterion validity of the Activ8 for measuring static (sitting, standing) and dynamic (walking, bicycling, running) activities, and for separating postures and movements within basic and complex activities in children and adolescents (youths) with typical development (TD) and peers with motor disability (not typical development [NTD]). DESIGN This was a criterion validation study. METHODS Ten participants with TD (mean age [standard deviation] = 14 [2.5] years) and 10 participants with NTD (mean age = 12.9 [2.1] years) performed a standardized series of basic and daily life (complex) activities. The Activ8 measured postures and movements, while camera recording served as a reference. The outcome measures were the mean time differences between the Activ8 output and video data for the merged categories "static" and "dynamic" and for the separate postures and movements. RESULTS For the merged categories static and dynamic, the criterion validity was found to be excellent both in participants with TD and participants with NTD within basic activities, and was found to be good to excellent in participants with TD and moderate to good in participants with NTD within complex activities. The detection of separate postures and movements was found to be poor to excellent in both groups within complex activities. LIMITATIONS The sample of youths with NTD was small and limited to youths who could be considered to be at least ambulatory within a household. CONCLUSIONS Activ8 is a valid tool when the merged categories static and dynamic are used to interpret physical activity in daily life in both youths with TD and youths with NTD and mild motor impairment. To optimize the quantification of separate postures and movements, adjustment of the existing algorithm is required.
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Affiliation(s)
- Kristel Lankhorst
- Partner of Shared Utrecht Pediatric Exercise Research (SUPER) Lab, Utrecht, the Netherlands; and Research Group Lifestyle and Health, Institute of Human Movement Studies, University of Applied Sciences, PO Box 85083, 3508 AB, Utrecht, the Netherlands
| | - Rita J van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | | | | | - Janke F de Groot
- Partner of Shared Utrecht Pediatric Exercise Research (SUPER) Lab; Research Group Lifestyle and Health, Institute of Human Movement Studies, University of Applied Sciences; and Netherlands Institute for Health Services Research, Utrecht, the Netherlands
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10
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Paraschiv-Ionescu A, Newman CJ, Carcreff L, Gerber CN, Armand S, Aminian K. Locomotion and cadence detection using a single trunk-fixed accelerometer: validity for children with cerebral palsy in daily life-like conditions. J Neuroeng Rehabil 2019; 16:24. [PMID: 30717753 PMCID: PMC6360691 DOI: 10.1186/s12984-019-0494-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 01/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical therapy interventions for ambulatory youth with cerebral palsy (CP) often focus on activity-based strategies to promote functional mobility and participation in physical activity. The use of activity monitors validated for this population could help to design effective personalized interventions by providing reliable outcome measures. The objective of this study was to devise a single-sensor based algorithm for locomotion and cadence detection, robust to atypical gait patterns of children with CP in the real-life like monitoring conditions. METHODS Study included 15 children with CP, classified according to Gross Motor Function Classification System (GMFCS) between levels I and III, and 11 age-matched typically developing (TD). Six IMU devices were fixed on participant's trunk (chest and low back/L5), thighs, and shanks. IMUs on trunk were independently used for development of algorithm, whereas the ensemble of devices on lower limbs were used as reference system. Data was collected according to a semi-structured protocol, and included typical daily-life activities performed indoor and outdoor. The algorithm was based on detection of peaks associated to heel-strike events, identified from the norm of trunk acceleration signals, and included several processing stages such as peak enhancement and selection of the steps-related peaks using heuristic decision rules. Cadence was estimated using time- and frequency-domain approaches. Performance metrics were sensitivity, specificity, precision, error, intra-class correlation coefficient, and Bland-Altman analysis. RESULTS According to GMFCS, CP children were classified as GMFCS I (n = 7), GMFCS II (n = 3) and GMFCS III (n = 5). Mean values of sensitivity, specificity and precision for locomotion detection ranged between 0.93-0.98, 0.92-0.97 and 0.86-0.98 for TD, CP-GMFCS I and CP-GMFCS II-III groups, respectively. Mean values of absolute error for cadence estimation (steps/min) were similar for both methods, and ranged between 0.51-0.88, 1.18-1.33 and 1.94-2.3 for TD, CP-GMFCS I and CP-GMFCS II-III groups, respectively. The standard deviation was higher in CP-GMFCS II-III group, the lower performances being explained by the high variability of atypical gait patterns. CONCLUSIONS The algorithm demonstrated good performance when applied to a wide range of gait patterns, from normal to the pathological gait of highly affected children with CP using walking aids.
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Affiliation(s)
- Anisoara Paraschiv-Ionescu
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne (EPFL), Station 9, CH-1015, Lausanne, Switzerland.
| | - Christopher J Newman
- Paediatric Neurology and Neurorehabilitation Unit, Department of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
| | - Lena Carcreff
- Laboratory of Kinesiology Willy Taillard, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Corinna N Gerber
- Paediatric Neurology and Neurorehabilitation Unit, Department of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
| | - Stephane Armand
- Laboratory of Kinesiology Willy Taillard, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Kamiar Aminian
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne (EPFL), Station 9, CH-1015, Lausanne, Switzerland
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11
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Sellers C, Dall P, Grant M, Stansfield B. Agreement of the activPAL3 and activPAL for characterising posture and stepping in adults and children. Gait Posture 2016; 48:209-214. [PMID: 27318305 DOI: 10.1016/j.gaitpost.2016.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 05/18/2016] [Accepted: 05/23/2016] [Indexed: 02/02/2023]
Abstract
Characterisation of physical activity and sedentary behaviour under free-living conditions is becoming increasingly important in light of growing evidence for the health implications of these behaviours. The integrity of long-term follow-up and the ability to compare outcomes between studies is critically dependent on the agreement of outcomes from successive generations of monitors. This study evaluated the agreement of the activPAL and second generation activPAL3 devices. Agreement was assessed in both adults (median 27.6y IQR 22.6) (n=20) and young people (median 12.0y IQR 4.1) (n=8) during standardised and daily living (ADL) test activities. During standardised activities; sedentary duration, upright duration, stepping duration and overall number of steps were all detected within small limits of agreement (≤5%). However, the activPAL characterised more steps during jogging than the activPAL3 (adults +8.36%, young people +6.80%). Also during ADL differences arose due to different posture characterisation in young people and lower step detection in the activPAL than the activPAL3 (adults -20.58%, young people -11.43%). Second-by-second posture analysis demonstrated high levels (>90%) of agreement for all activities between monitors. However, sensitivity (68.7%) and positive predictive value (78.8%) for adult stepping demonstrated disagreement between monitor interpretation of movement patterns during ADL. Agreement between monitor outcomes for standardised activities provides confidence that these outcomes can be considered almost equivalent. However, for characterisation of jogging and smaller movements during ADL, it is likely that significant differences between monitor outcomes will arise.
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Affiliation(s)
- Ceri Sellers
- Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.
| | - Philippa Dall
- Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.
| | - Margaret Grant
- Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.
| | - Ben Stansfield
- Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.
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12
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Sellers C, Dall P, Grant M, Stansfield B. Validity and reliability of the activPAL3 for measuring posture and stepping in adults and young people. Gait Posture 2016; 43:42-7. [PMID: 26669950 DOI: 10.1016/j.gaitpost.2015.10.020] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 10/19/2015] [Accepted: 10/21/2015] [Indexed: 02/02/2023]
Abstract
Characterisation of free-living physical activity requires the use of validated and reliable monitors. This study reports an evaluation of the validity and reliability of the activPAL3 monitor for the detection of posture and stepping in both adults and young people. Twenty adults (median 27.6y; IQR22.6y) and 8 young people (12.0y; IQR4.1y) performed standardised activities and activities of daily living (ADL) incorporating sedentary, upright and stepping activity. Agreement, specificity and positive predictive value were calculated between activPAL3 outcomes and the gold-standard of video observation. Inter-device reliability was calculated between 4 monitors. Sedentary and upright times for standardised activities were within ±5% of video observation as was step count (excluding jogging) for both adults and young people. Jogging step detection accuracy reduced with increasing cadence >150stepsmin(-1). For ADLs, sensitivity to stepping was very low for adults (40.4%) but higher for young people (76.1%). Inter-device reliability was either good (ICC(1,1)>0.75) or excellent (ICC(1,1)>0.90) for all outcomes. An excellent level of detection of standardised postures was demonstrated by the activPAL3. Postures such as seat-perching, kneeling and crouching were misclassified when compared to video observation. The activPAL3 appeared to accurately detect 'purposeful' stepping during ADL, but detection of smaller stepping movements was poor. Small variations in outcomes between monitors indicated that differences in monitor placement or hardware may affect outcomes. In general, the detection of posture and purposeful stepping with the activPAL3 was excellent indicating that it is a suitable monitor for characterising free-living posture and purposeful stepping activity in healthy adults and young people.
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Affiliation(s)
- Ceri Sellers
- Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK.
| | - Philippa Dall
- Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK.
| | - Margaret Grant
- Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK.
| | - Ben Stansfield
- Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK.
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Bania TA, Dodd KJ, Baker RJ, Graham HK, Taylor NF. The effects of progressive resistance training on daily physical activity in young people with cerebral palsy: a randomised controlled trial. Disabil Rehabil 2015; 38:620-6. [PMID: 26056856 DOI: 10.3109/09638288.2015.1055376] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine if individualised resistance training increases the daily physical activity of adolescents and young adults with bilateral spastic cerebral palsy (CP). METHOD Young people with bilateral spastic CP were randomly assigned to intervention or to usual care. The intervention group completed an individualised lower limb progressive resistance training programme twice a week for 12 weeks in community gymnasiums. The primary outcome was daily physical activity (number of steps, and time sitting and lying). Secondary outcomes included muscle strength measured with a one-repetition maximum (1RM) leg press and reverse leg press. Outcomes were measured at baseline, 12 weeks and 24 weeks. RESULTS From the 36 participants with complete data at 12 weeks, there were no between-group differences for any measure of daily physical activity. There was a likely increase in leg press strength in favour of the intervention group (mean difference 11.8 kg; 95% CI -1.4 to 25.0). No significant adverse events occurred during training. CONCLUSIONS A short-term resistance training programme that may increase leg muscle strength was not effective in increasing daily physical activity. Other strategies are needed to address the low-daily physical activity levels of young people with bilateral spastic CP. IMPLICATIONS FOR REHABILITATION Progressive resistance training may increase muscle strength but does not lead to increases in daily physical activity of young people with bilateral spastic cerebral palsy (CP) and mild to moderate walking disabilities. Other strategies apart from or in addition to resistance training are needed to address the low daily physical activity levels of young people with bilateral spastic CP and mild to moderate walking disabilities.
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Affiliation(s)
- Theofani A Bania
- a Faculty of Health Sciences , La Trobe University , Bundoora, Melbourne , VIC , Australia
| | - Karen J Dodd
- a Faculty of Health Sciences , La Trobe University , Bundoora, Melbourne , VIC , Australia
| | - Richard J Baker
- b Clinical Gait Analysis, University of Salford , Salford , UK , and
| | - H Kerr Graham
- c Department Orthopaedic Surgery , Royal Children's Hospital , Melbourne , VIC , Australia
| | - Nicholas F Taylor
- a Faculty of Health Sciences , La Trobe University , Bundoora, Melbourne , VIC , Australia
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14
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Bania TA, Taylor NF, Baker RJ, Graham HK, Karimi L, Dodd KJ. Gross motor function is an important predictor of daily physical activity in young people with bilateral spastic cerebral palsy. Dev Med Child Neurol 2014; 56:1163-1171. [PMID: 25052563 DOI: 10.1111/dmcn.12548] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2014] [Indexed: 01/23/2023]
Abstract
AIM The aim of the study was to describe daily physical activity levels of adolescents and young adults with bilateral spastic cerebral palsy (CP) and to identify factors that help predict these levels. METHOD Daily physical activity was measured using an accelerometer-based activity monitor in 45 young people with bilateral spastic CP (23 males, 22 females; mean age 18y 6mo [SD 2y 5mo] range 16y 1mo-20y 11mo); classified as Gross Motor Function Classification System (GMFCS) level II or III and with contractures of <20° at hip and knee. Predictor variables included demographic characteristics (age, sex, weight) and physical characteristics (gross motor function, lower limb muscle strength, 6min walk distance). Data were analyzed using the information-theoretic approach, using the Akaike information criterion (AIC) and linear regression. RESULTS Daily activity levels were low compared with published norms. Gross Motor Function Measure Dimension-E (GMFM-E; walking, running, and jumping) was the only common predictor variable in models that best predicted energy expenditure, number of steps, and time spent sitting/lying. GMFM Dimension-D (standing) and bilateral reverse leg press strength contributed to the models that predicted daily physical activity. INTERPRETATION Adolescents and young adults with bilateral spastic CP and mild to moderate walking disabilities have low levels of daily activity. The GMFM-E was an important predictor of daily physical activity.
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Affiliation(s)
- Theofani A Bania
- Faculty of Health Sciences, La Trobe University, Bundoora, Melbourne, Vic., Australia
| | - Nicholas F Taylor
- Faculty of Health Sciences, La Trobe University, Bundoora, Melbourne, Vic., Australia
| | | | - H Kerr Graham
- Royal Children's Hospital, Parkville, Vic., Australia
| | - Leila Karimi
- Faculty of Health Sciences, La Trobe University, Bundoora, Melbourne, Vic., Australia
| | - Karen J Dodd
- Faculty of Health Sciences, La Trobe University, Bundoora, Melbourne, Vic., Australia
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