Actigraph assessment for measuring upper limb activity in unilateral cerebral palsy
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(2019) 16:30
RESEARCH
Open Access
Actigraph assessment for measuring upper limb activity in unilateral cerebral palsy Elena Beani1,4, Martina Maselli2, Elisa Sicola1,4, Silvia Perazza1,4, Francesca Cecchi2, Paolo Dario2, Irene Braito1,4, Roslyn Boyd3, Giovanni Cioni1,4 and Giuseppina Sgandurra1,4*
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: Congenital hemiplegia, Arm movements, Actigraphy, Assisting hand assessment, Information and communications technology (ICT)
Background Cerebral palsy (CP), the most common cause of chronic childhood physical disability in industrialised societies, interests 2–3/1000 live births, up to 40–100/1000 among very premature and very low birth-weight infants [1]. Unilateral Cerebral Palsy (UCP, motor impairment on one side), constitutes the most frequent form of CP, * Correspondence: [email protected] 1 Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy 4 Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 56125 Pisa, Italy Full list of author information is available at the end of the article
comprising 30–40% of CP children [2, 3]. In children with UCP, presence of
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