Rehabilitation Sciences Institute, University of Toronto; and Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
Department of Physical Therapy, Faculty of Rehabilitation Medicine; and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada.
Phys Ther. 2019 Jun 1;99(6):721-729. doi: 10.1093/ptj/pzz022.
For children with hemiplegic cerebral palsy (HCP), rehabilitation aims to increase movement of the affected arm. However, no validated measure objectively examines this construct in pediatric practice or daily life.
The objective of this study was to evaluate the criterion and known-groups validity of accelerometry as a measure of arm movement in children and adolescents with HCP.
This was a prospective cross-sectional study.
Twenty-seven children and adolescents with typical development (3.4-13.9 years old) and 11 children and adolescents with HCP (4.7-14.7 years old; Manual Ability Classification System rating I or II) wore accelerometers on their wrists while engaged in 20 minutes of play, which included intermittent intervals of stillness and vigorous movement of the arms. Vector magnitude (VM) values identified the presence (VM > 2.0 counts per epoch) and absence (VM ≤ 2.0 counts per epoch) of arm movement for every 2-second epoch. Video was simultaneously recorded; each 2-second interval of footage was scored as "movement" or "no movement" for each arm.
Agreement between accelerometry and video observation was greater than or equal to 81%, and the prevalence-adjusted and bias-adjusted κ value was greater than or equal to 0.69 for both groups of participants; these results supported the criterion validity of accelerometry. The ratio of nondominant arm movement to dominant arm movement measured by accelerometry was significantly greater in participants with typical development (mean [SD] = 0.87 [0.09]) than in participants with HCP (mean = 0.78 [0.07]) on the basis of 10 age- and sex-matched pairs; these results supported known-groups validity.
The small sample size of the group with HCP prevented the stratification of data by age. Participants with HCP had high or moderately high function of the affected arm; hence, the findings do not apply to children and adolescents with more significant hemiparesis.
Accelerometry is a valid measure of arm movement in children with HCP and children without HCP. These findings contribute to the development of innovative upper limb assessments for children with hemiparesis.
对于偏瘫脑瘫（HCP）患儿，康复的目的是增加患侧手臂的运动。然而，目前还没有经过验证的方法可以客观地评估儿科实践或日常生活中的这一结构。
本研究旨在评估加速度计作为一种测量 HCP 患儿手臂运动的方法的标准和已知群体的有效性。
这是一项前瞻性的横断面研究。
27 名发育正常的儿童和青少年（3.4-13.9 岁）和 11 名 HCP 患儿（4.7-14.7 岁；手动能力分类系统分级 I 或 II）在手腕上佩戴加速度计，进行 20 分钟的游戏，其中包括间歇性的静止和手臂剧烈运动。向量幅度（VM）值确定每个 2 秒时窗内手臂运动的存在（VM>2.0 个计数/时窗）和不存在（VM≤2.0 个计数/时窗）。同时记录视频；对于每个手臂，每 2 秒的视频片段都被评为“运动”或“无运动”。
加速度计与视频观察的一致性大于或等于 81%，且参与者组的调整后流行率和调整后偏倚 κ 值均大于或等于 0.69；这些结果支持了加速度计的标准效度。通过加速度计测量，发育正常组非优势手臂运动与优势手臂运动的比值（平均值[标准差] = 0.87 [0.09]）明显大于 HCP 组（平均值 = 0.78 [0.07]），基于 10 对年龄和性别匹配的参与者；这些结果支持了已知群体的有效性。
HCP 组的样本量较小，无法按年龄对数据进行分层。HCP 组患儿患侧手臂功能较高或中度高；因此，这些发现不适用于更严重偏瘫的儿童和青少年。
加速度计是测量 HCP 患儿和无 HCP 患儿手臂运动的有效方法。这些发现为偏瘫患儿的创新性上肢评估方法的发展提供了依据。
