Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri.
Program in Occupational Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri.
JAMA Netw Open. 2019 Apr 5;2(4):e192970. doi: 10.1001/jamanetworkopen.2019.2970.
Affordable, quantitative methods to screen children for developmental delays are needed. Motor milestones can be an indicator of developmental delay and may be used to track developmental progress. Accelerometry offers a way to gather real-world information about pediatric motor behavior.
To develop a referent cohort of pediatric accelerometry from bilateral upper extremities (UEs) and determine whether movement can accurately distinguish those with and without motor deficits.
DESIGN, SETTING, AND PARTICIPANTS: Children aged 0 to 17 years participated in a prospective cohort from December 8, 2014, to December 29, 2017. Children were recruited from Ranken Jordan Pediatric Bridge Hospital, Maryland Heights, Missouri, and Washington University School of Medicine in St Louis, St Louis, Missouri. Typically developing children were included as a referent cohort if they had no history of motor or neurological deficit; consecutive sampling and matching ensured equal representation of sex and age. Children with diagnosed asymmetric motor deficits were included in the motor impaired cohort.
Bilateral UE motor activity was measured using wrist-worn accelerometers for a total of 100 hours in 25-hour increments.
To characterize bilateral UE motor activity in a referent cohort for the purpose of detecting irregularities in the future, total activity and the use ratio between UEs were used to describe typically developing children. Asymmetric impairment was classified using the mono-arm use index (MAUI) and bilateral-arm use index (BAUI) to quantify the acceleration of unilateral movements.
A total of 216 children enrolled, and 185 children were included in analysis. Of these, 156 were typically developing, with mean (SD) age 9.1 (5.1) years and 81 boys (52.0%). There were 29 children in the motor impaired cohort, with mean (SD) age 7.4 (4.4) years and 16 boys (55.2%). The combined MAUI and BAUI (mean [SD], 0.86 [0.005] and use ratio (mean [SD], 0.90 [0.008]) had similar F1 values. The area under the curve was also similar between the combined MAUI and BAUI (mean [SD], 0.98 [0.004]) and the use ratio (mean [SD], 0.98 [0.004]).
Bilateral UE movement as measured with accelerometry may provide a meaningful metric of real-world motor behavior across childhood. Screening in early childhood remains a challenge; MAUI may provide an effective method for clinicians to measure and visualize real-world motor behavior in children at risk for asymmetrical deficits.
需要一种负担得起的、定量的方法来筛查儿童发育迟缓。运动发育里程碑可以作为发育迟缓的一个指标，并可用于跟踪发育进展。加速度计提供了一种收集儿科运动行为的真实世界信息的方法。
从双侧上肢（UE）建立儿科加速度计参考队列，并确定运动是否能准确区分有和无运动缺陷的儿童。
设计、地点和参与者：2014 年 12 月 8 日至 2017 年 12 月 29 日期间，0 至 17 岁的儿童参与了一项前瞻性队列研究。儿童来自密苏里州马里恩高地的 Ranken Jordan 儿科桥医院和密苏里州圣路易斯的华盛顿大学医学院。如果没有运动或神经缺陷史，则将发育正常的儿童纳入参考队列；连续采样和匹配确保了性别和年龄的平等代表性。有诊断为不对称运动缺陷的儿童被纳入运动障碍组。
使用腕戴式加速度计测量双侧 UE 运动活动，共进行 100 小时，每 25 小时递增一次。
为了描述未来的双侧 UE 运动活动，我们使用总活动量和 UE 使用比率来描述发育正常的儿童。使用单臂使用指数（MAUI）和双臂使用指数（BAUI）来量化单侧运动的加速度，对不对称损伤进行分类。
共有 216 名儿童入组，185 名儿童纳入分析。其中 156 名是发育正常的，平均年龄为 9.1（5.1）岁，81 名男孩（52.0%）。运动障碍组有 29 名儿童，平均年龄为 7.4（4.4）岁，16 名男孩（55.2%）。综合 MAUI 和 BAUI（平均值[标准差]，0.86[0.005]和使用比率（平均值[标准差]，0.90[0.008]）具有相似的 F1 值。综合 MAUI 和 BAUI（平均值[标准差]，0.98[0.004]）和使用比率（平均值[标准差]，0.98[0.004]）的曲线下面积也相似。
加速度计测量的双侧 UE 运动可能提供一个有意义的指标，衡量整个儿童期的真实世界运动行为。早期筛查仍然是一个挑战；MAUI 可能为临床医生提供一种有效的方法，用于测量和可视化有不对称缺陷风险的儿童的真实世界运动行为。
