Actigraph assessment for measuring upper limb activity in unilateral cerebral palsy

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

Abstract

Background: Detecting differences in upper limb use in children with unilateral cerebral palsy (UCP) is challenging and highly dependent on examiner experience. The recent introduction of technologies in the clinical environment, and in particular the use of wearable sensors, can provide quantitative measurement to overcome this issue. This study aims to evaluate ActiGraph GT3X+ as a tool for measuring asymmetry in the use of the two upper limbs (ULs) during the assessment with a standardized clinical tool, the Assisting Hand Assessment (AHA) in UCP patients aged 3-25 years compared to age-matched typically developing (TD) subjects.

Methods: Fifty children with UCP and 50 TD subjects were assessed with AHA while wearing ActiGraphs GT3X+ on both wrists. The mean activity of each hand (dominant and non-dominant, MADH and MANDH, respectively) and the asymmetry index (AI) were calculated. Two linear mixed model analyses were carried out to evaluate how dependent actigraphic variables (i.e. MANDH and AI) varied by group (TD vs UCP) and among levels of manual ability based on Manual Ability Classification System (MACS). In both models age, sex, side of hemiplegia, presence/absence of mirror movements were specified as random effects.

Results: The MANDH was significantly lower in UCP compared to TD, while the AI was significantly higher in UCP compared to TD. Moreover, in UCP group there were significant differences related to MACS levels, both for MANDH and AI. None of the random variables (i.e. age, sex, side, presence/absence of mirror movements) showed significant interaction with MANDH and AI.

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

Trial registration: ClincalTrials.gov, NCT03054441 . Registered 15 February 2017.

Keywords: Actigraphy; Arm movements; Assisting hand assessment; Congenital hemiplegia; Information and communications technology (ICT).

Conflict of interest statement

Ethics approval and consent to participate

The study has been approved by Tuscan Region Paediatric Ethics Committee (Italy) (no. 78/2016).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Counts per age of participants
Fig. 2
Fig. 2
Mean activity of Dominant Hand (DH, upper-left quarter), Asymmetry Index (AI, upper-right quarter) in TD and UCP groups; Mean activity of Non Dominant Hand (NDH, lower-left quarter), Asymmetry Index (AI, lower-right quarter) of children with UCP grouped by MACS levels

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