Does accelerometry reflect hand function in infants at risk of unilateral cerebral palsy? A secondary analysis of BB-Bim results

Wearable sensors for measuring spontaneous upper limb use in children with unilateral cerebral palsy and typical development

BACKGROUND

Unilateral Cerebral Palsy (UCP) is a clinical condition which mainly involves the movement and muscle tone of one side of the body, often impacting the general manual function. While there are some clinical assessment tools aimed to quantify the Upper Limbs (UpLs) use and the manual abilities, acquiring information regarding the motor abilities outside the clinical environment, such as the UpLs use and their asymmetry during daily life, could provide a more complete evaluation of the child and open a new clinical reasoning. For this purpose, wearable sensors are one of the newest approaches for continuously monitoring UpLs functions without being invasive. The aim of this study was to use wearable sensors to compare spontaneous/daily UpLs usage and asymmetry with the Assisting Hand Assessment (AHA) test, as well as comparing the daily UpLs usage behavior of children with UCP with respect to Typical Developing (TD) peers.

METHODS

Eighty children (54 with UCP and 26 TD) wore an Actigraph sensor on each wrist during the AHA test and then at least for the following week of daily life. The amount of use of each hand and the asymmetry were analyzed during both the AHA and the following week of daily life using linear regression analysis and ANOVA models.

RESULTS

Significant relationships were found between the asymmetry detected during the week and both the AHA scores and the asymmetry detected during the test. UCP and TD children week asymmetry distributions were significantly different; moreover, some differences were found when grouping them by MACS levels.

CONCLUSION

This paper proposes a new and easy technological methodology for monitoring UpLs behavior in daily life. Through wearable sensor data analysis, we demonstrate a linear correlation between asymmetry measured during smi-structured assessments and daily life. Additionally, we provide evidence of distinct patterns of UpLs usage between typically developing children and children with UCP in daily life.

TRIAL REGISTRATION

Clinical Trials.gov (NCT03054441).

Movement Disorders and Smart Wrist Devices: A Comprehensive Study

In the medical field, there are several very different movement disorders, such as tremors, Parkinson's disease, or Huntington's disease. A wide range of motor and non-motor symptoms characterizes them. It is evident that in the modern era, the use of smart wrist devices, such as smartwatches, wristbands, and smart bracelets is spreading among all categories of people. This diffusion is justified by the limited costs, ease of use, and less invasiveness (and consequently greater acceptability) than other types of sensors used for health status monitoring. This systematic review aims to synthesize research studies using smart wrist devices for a specific class of movement disorders. Following PRISMA-S guidelines, 130 studies were selected and analyzed. For each selected study, information is provided relating to the smartwatch/wristband/bracelet model used (whether it is commercial or not), the number of end-users involved in the experimentation stage, and finally the characteristics of the benchmark dataset possibly used for testing. Moreover, some articles also reported the type of raw data extracted from the smart wrist device, the implemented designed algorithmic pipeline, and the data classification methodology. It turned out that most of the studies have been published in the last ten years, showing a growing interest in the scientific community. The selected articles mainly investigate the relationship between smart wrist devices and Parkinson's disease. Epilepsy and seizure detection are also research topics of interest, while there are few papers analyzing gait disorders, Huntington's Disease, ataxia, or Tourette Syndrome. However, the results of this review highlight the difficulties still present in the use of the smartwatch/wristband/bracelet for the identified categories of movement disorders, despite the advantages these technologies could bring in the dissemination of low-cost solutions usable directly within living environments and without the need for caregivers or medical personnel.

Acceptability, validity and responsiveness of inertial measurement units for assessing motor recovery after gene therapy in infants with early onset spinal muscular atrophy: a prospective cohort study

BACKGROUND

Onasemnogene abeparvovec gene replacement therapy (GT) has changed the prognosis of patients with spinal muscular atrophy (SMA) with variable outcome regarding motor development in symptomatic patients. This pilot study evaluates acceptability, validity and clinical relevance of Inertial Measurement Units (IMU) to monitor spontaneous movement recovery in early onset SMA patients after GT.

METHODS

Clinical assessments including CHOPINTEND score (the gold standard motor score for infants with SMA) and IMU measurements were performed before (M0) and repeatedly after GT. Inertial data was recorded during a 25-min spontaneous movement task, the child lying on the back, without (10 min) and with a playset (15 min) wearing IMUs. Two commonly used parameters, norm acceleration 95th centile (||A||_95) and counts per minute (||A||_CPM) were computed for each wrist, elbow and foot sensors.

RESULTS

23 SMA-patients were included (mean age at diagnosis 8 months [min 2, max 20], 19 SMA type 1, three type 2 and one presymptomatic) and 104 IMU-measurements were performed, all well accepted by families and 84/104 with a good child participation (evaluated with Brazelton scale). ||A||_95 and ||A||_CPM showed high internal consistency (without versus with a playset) with interclass correlation coefficient for the wrist sensors of 0.88 and 0.85 respectively and for the foot sensors of 0.93 and 0.91 respectively. ||A||_95 and ||A||_CPM were strongly correlated with CHOPINTEND (r for wrist sensors 0.74 and 0.67 respectively and for foot sensors 0.61 and 0.68 respectively, p-values < 0.001). ||A||_95 for the foot, the wrist, the elbow sensors and ||A||_CPM for the foot, the wrist, the elbow sensors increased significantly between baseline and the 12 months follow-up visit (respective p-values: 0.004, < 0.001, < 0.001, 0.006, < 0.001, < 0.001).

CONCLUSION

IMUs were well accepted, consistent, concurrently valid, responsive and associated with unaided sitting acquisition especially for the elbow sensors. This study is the first reporting a large set of inertial sensor derived data after GT in SMA patients and paves the way for IMU-based follow-up of SMA patients after treatment.

A systematic review of instrumented assessments for upper limb function in cerebral palsy: current limitations and future directions

INTRODUCTION

Recently, interest in quantifying upper limb function in cerebral palsy has grown. However, the lack of reference tasks and protocols, have hindered the development of quantified movement analysis in clinical practice. This study aimed to evaluate existing instrumented assessments of upper limb function in cerebral palsy, with a focus on their clinical applicability, to identify reasons for the lack of adoption and provide recommendations for improving clinical relevance and utility.

METHODS

A systematic review was conducted by a multidisciplinary team of researchers and clinicians (Prospero CRD42023402382). PubMed and Web of Science databases were searched using relevant keywords and inclusion/exclusion criteria.

RESULTS

A total of 657 articles were initially identified, and after the selection process, 76 records were included for analysis comprising a total of 1293 patients with cerebral palsy. The quality assessment of the reviewed studies revealed a moderate overall quality, with deficiencies in sample size justification and participant information. Optoelectronic motion capture systems were predominantly used in the studies (N = 57/76). The population mainly consisted of individuals with spastic cerebral palsy (834/1293) with unilateral impairment (N = 1092/1293). Patients with severe functional impairment (MACS IV and V) were underrepresented with 3.4% of the 754 patients for whom the information was provided. Thirty-nine tasks were used across the articles. Most articles focused on unimanual activities (N = 66/76) and reach or reach and grasp (N = 51/76). Bimanual cooperative tasks only represented 3 tasks present in 4 articles. A total of 140 different parameters were identified across articles. Task duration was the most frequently used parameter and 23% of the parameters were used in only one article.

CONCLUSION

Further research is necessary before incorporating quantified motion analysis into clinical practice. Existing protocols focus on extensively studied populations and rely on costly equipment, limiting their practicality. Standardized unimanual tasks provide limited insights into everyday arm use. Balancing methodological requirements and performance evaluation flexibility is a challenge. Exploring the correlation between outcome parameters and therapeutic guidance could facilitate the integration of quantified movement assessment into treatment pathways.