Application of a wearable switch to perform a mouse left click for a child with mix type of cerebral palsy: a single case study

The switch access measure: development and evaluation of the reliability and clinical utility of a switching assessment for children with severe and multiple disabilities

PURPOSE

Children with severe, multiple disabilities often need to use switches to control their assistive technology. We developed the Switch Access Measure (SAM) to address the lack of validated functional activity-based measures to evaluate children's success using their prescribed switch(es). This goal-based performance measure evaluates switching ability on 16 skills items (6 motor, 2 visual, and 8 process). This study investigated SAM's reliability and confidence in scoring.

METHODS

Two occupational therapists with switch access intervention experience were trained as SAM study assessors. They independently scored SAM (inter-rater reliability) while viewing 20 study assessment videos where each child undertook at least one goal-based switching activity with their technology, and rated confidence in scoring for each SAM item. The SAM's two developers independently scored these videos as an inter-rater reliability benchmark. Each study assessor re-scored a subset of 10 videos 2-3 weeks later (intra-rater reliability).

RESULTS

SAM Total score inter-rater reliability was excellent for the two study assessors (ICC =0.82) and the two SAM developers (ICC = 0.95). Inter-rater reliability was lowest (moderate) for Motor Subsection for the assessors, but still excellent for the developers. Intra-reliability for both groups of raters was excellent for Total and Subsection scores. Assessors' confidence in scoring was high (mean of 84.7% and 86.8% respectively) across items/participants.

CONCLUSIONS

SAM is sufficiently reliable for clinical use, permitting clinicians, after SAM training and certification, to include it in their assessments and in development of switch access intervention plans for children with severe, multiple disabilities.IMPLICATIONS FOR REHABILITATIONFor practitioners new to the field of switching technology, the SAM will provide a comprehensive understanding of all the components of successful switch use that need consideration when working with those needing switch access technologies.For all practitioners in this area, the SAM offers a consistent language to support clear communication among professionals, families, clients and their support networks. The SAM also gives quantifiable and reliable data to back clinical decision making, particularly important to support the case for funding of these technologies.Use of the SAM will prompt discussions with clients, families and carers and lead to better understanding of strengths and challenges, thus enhancing collaborative working relationships in the pursuit of achieving the best possible outcomes for those needing to use switch access technologies.

Instrumented assessment of motor function in dyskinetic cerebral palsy: a systematic review

BACKGROUND

In this systematic review we investigate which instrumented measurements are available to assess motor impairments, related activity limitations and participation restrictions in children and young adults with dyskinetic cerebral palsy. We aim to classify these instrumented measurements using the categories of the international classification of functioning, disability and health for children and youth (ICF-CY) and provide an overview of the outcome parameters.

METHODS

A systematic literature search was performed in November 2019. We electronically searched Pubmed, Embase and Scopus databases. Search blocks included (a) cerebral palsy, (b) athetosis, dystonia and/or dyskinesia, (c) age 2-24 years and (d) instrumented measurements (using keywords such as biomechanics, sensors, smartphone, and robot).

RESULTS

Our search yielded 4537 articles. After inspection of titles and abstracts, a full text of 245 of those articles were included and assessed for further eligibility. A total of 49 articles met our inclusion criteria. A broad spectrum of instruments and technologies are used to assess motor function in dyskinetic cerebral palsy, with the majority using 3D motion capture and surface electromyography. Only for a small number of instruments methodological quality was assessed, with only one study showing an adequate assessment of test-retest reliability. The majority of studies was at ICF-CY function and structure level and assessed control of voluntary movement (29 of 49) mainly in the upper extremity, followed by assessment of involuntary movements (15 of 49), muscle tone/motor reflex (6 of 49), gait pattern (5 of 49) and muscle power (2 of 49). At ICF-CY level of activities and participation hand and arm use (9 of 49), fine hand use (5 of 49), lifting and carrying objects (3 of 49), maintaining a body position (2 of 49), walking (1 of 49) and moving around using equipment (1 of 49) was assessed. Only a few methods are potentially suitable outside the clinical environment (e.g. inertial sensors, accelerometers).

CONCLUSION

Although the current review shows the potential of several instrumented methods to be used as objective outcome measures in dyskinetic cerebral palsy, their methodological quality is still unknown. Future development should focus on evaluating clinimetrics, including validating against clinical meaningfulness. New technological developments should aim for measurements that can be applied outside the laboratory.