脑瘫儿童四肢和腰部的时间匹配加速度计在肉毒毒素治疗后对真实生活活动提供了新的见解：概念验证研究。
Time-matched accelerometers on limbs and waist in children with CP give new insights into real-life activities after botulinum toxin treatment: A proof of concept study.
机构信息
Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Department of Pediatric Orthopaedic Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
出版信息
J Pediatr Rehabil Med. 2023;16(1):125-137. doi: 10.3233/PRM-210112.
PURPOSE
This study aimed to explore the feasibility of using time-matched uniaxial accelerometers for measuring movement in daily life in children with cerebral palsy (CP) before and after botulinum toxin injections.
METHODS
This observational study of clinical care with a pre-post design was set in the home and school environment. Participants included eleven children (4-13 years of age) with CP (GMFCS I-III). The children wore uniaxial accelerometers (ActiGraph, model GT1M) for 4 days on both wrists, the right ankle and around the waist before, 3 weeks and 3 months after BoNT-A injections in the legs. Five children also got BoNT-A in the most affected arm. All injections were given according to clinical indications and routine. The accelerometers were all time-matched to define ambulation, arm swing, voluntary activity of arms, and bimanual activity. The feasibility of wearing accelerometers with this setup was evaluated. A linear mixed model was used for analysis of the percentage time and at which intensity the different activities were performed. The confidence interval demonstrated any difference between the dominant and non-dominant arm.
RESULTS
Time-matching of accelerometers placed on both wrists, the waist, and one ankle is a feasible method of registering ambulation, arm swing during gait, and arm movements while not ambulating. Before injections, the children spent 5.6% of their time ambulating. This value declined to 3.9% at 3 months. Contrary to clinical goals, arm movement did not increase after injecting the most affected arm with BoNT-A, however, injections may have decreased mirror movements, which are often bothersome for the child.
CONCLUSION
A time-matched 4-accelerometer set-up is feasible in children with cerebral palsy. A future study including time-matched multi-axial accelerometers on all four limbs, could provide important information on the effect of BoNT-A in daily life.
目的
本研究旨在探索在脑性瘫痪（CP）儿童接受肉毒毒素注射前后，使用时间匹配的单轴加速度计测量日常生活中运动的可行性。
方法
这是一项具有前后设计的临床护理观察性研究，在家庭和学校环境中进行。参与者包括 11 名年龄在 4-13 岁之间的 CP（GMFCS I-III）儿童。在腿部接受肉毒毒素 A 注射前、3 周和 3 个月后，儿童在两个手腕、右踝关节和腰部佩戴单轴加速度计（ActiGraph，型号 GT1M），共佩戴 4 天。其中 5 名儿童还在受影响最严重的手臂接受了肉毒毒素 A 注射。所有注射均根据临床指征和常规进行。加速度计均进行时间匹配，以定义步行、手臂摆动、手臂主动活动和双手活动。评估了使用这种设置佩戴加速度计的可行性。使用线性混合模型分析不同活动的时间百分比和强度。置信区间显示了优势臂和非优势臂之间的任何差异。
结果
将两个手腕、腰部和一个脚踝上的加速度计进行时间匹配，是一种可行的方法，可以记录步行、步态时的手臂摆动和不步行时的手臂运动。在注射前，儿童有 5.6%的时间在步行。这一数值在 3 个月时下降到 3.9%。与临床目标相反，在对受影响最严重的手臂注射肉毒毒素 A 后，手臂运动并没有增加，但是，注射可能减少了镜像运动，这些运动常常让孩子感到困扰。
结论
在脑性瘫痪儿童中，使用时间匹配的 4 加速度计设置是可行的。未来的研究包括在所有四肢上使用时间匹配的多轴加速度计，可以提供关于肉毒毒素 A 在日常生活中影响的重要信息。
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