Measuring Upper Extremity Activity of Children With Unilateral Cerebral Palsy Using Wrist-Worn Accelerometers: A Pilot Study

Abstract

Abstract Importance: Children with unilateral cerebral palsy (UCP) have poor strength and movement control on one side of their body, leading to impaired bimanual coordination skills. Objective: To compare duration and intensity of all-day habitual movement of the dominant and nondominant upper extremities (UEs) in typically developing (TD) children and children with UCP. Design: Two-group observational study. Setting: Children’s naturalistic settings. Participants: Convenience sample of 9 TD children and 9 children with UCP. Intervention: Children wore accelerometers on both wrists all day and night for 1 wk. Outcomes and Measures: We compared the extent of asymmetry in bilateral arm use (intensity and duration) between the 2 groups. Results: Compared with TD children who use both UEs equally, children with UCP were more likely to use their dominant or unaffected UE than their nondominant or affected UE during daily activities. There were no differences between groups in dominant UE activity. However, children with UCP engaged in lower levels of moderate to vigorous activity and greater levels of light activity with their nondominant or affected UE than their TD peers. Conclusions and Relevance: Wrist-worn accelerometry can provide objective information on real-world habitual activity with both arms in children. Accelerometers are nonintrusive, easy to use, and well tolerated by children, and they allow prolonged monitoring of UE activity outside therapeutic contexts. Occupational therapists can use wrist-worn accelerometers as sensitive tools to assess asymmetries in UE use at baseline and as an outcome measure to assess the efficacy of behavioral interventions and carryover into real-world settings among children with UCP. Plain-Language Summary: This pilot study provides promising evidence that supports the use of wrist-worn accelerometry as an accurate, easy-to-use, and objective assessment tool for children with unilateral cerebral palsy (UCP) to detect asymmetries in bilateral real-world arm activity at baseline and after intensive occupational therapy interventions to improve arm function. The authors used wrist-worn accelerometry for one week with 9 typically developing (TD) children and 9 children with UCP to compare dominant or unaffected versus nondominant or affected upper extremity (UE) use for intensity and duration of activity. Compared with TD children, children with UCP had lower relative intensity of activity in the nondominant UE than the dominant UE. Wrist-worn accelerometers seem to be a sensitive measure to detect asymmetries in bilateral all-day UE use in children with UCP. The findings have implications for the use of wrist-worn accelerometers as an outcome measure to assess the efficacy of intensive therapies to improve real-world affected UE activity and bimanual function among children with UCP.