Sudha Srinivasan, PT, PhD, is Assistant Professor, Physical Therapy Program, Department of Kinesiology; Affiliate, Institute for Collaboration on Health, Intervention, and Policy; and Affiliate, Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs;
Nidhi Amonkar, PT, is Graduate Student, Department of Kinesiology; Affiliate, Institute for Collaboration on Health, Intervention, and Policy; and Affiliate, Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs.
Am J Occup Ther. 2024 Mar 1;78(2). doi: 10.5014/ajot.2024.050443.
Children with unilateral cerebral palsy (UCP) have poor strength and movement control on one side of their body, leading to impaired bimanual coordination skills.
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.
Two-group observational study.
Children's naturalistic settings.
Convenience sample of 9 TD children and 9 children with UCP.
Children wore accelerometers on both wrists all day and night for 1 wk.
We compared the extent of asymmetry in bilateral arm use (intensity and duration) between the 2 groups.
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.
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.
患有单侧脑瘫 (UCP) 的儿童身体一侧的力量和运动控制能力较差，导致双手协调技能受损。
比较正常发育 (TD) 儿童和患有 UCP 的儿童优势和非优势上肢 (UE) 的全天习惯性运动的持续时间和强度。
两组观察性研究。
儿童自然环境。
方便抽取的 9 名 TD 儿童和 9 名患有 UCP 的儿童。
儿童在手腕上全天佩戴加速度计一整周。
我们比较了两组之间双侧手臂使用（强度和持续时间）的不对称程度。
与同等使用两只 UE 的 TD 儿童相比，患有 UCP 的儿童在日常活动中更倾向于使用其优势或未受影响的 UE，而不是其非优势或受影响的 UE。两组之间在优势 UE 活动方面没有差异。然而，患有 UCP 的儿童在非优势或受影响的 UE 上进行的中等到剧烈活动水平较低，而进行的轻度活动水平较高。
腕戴加速度计可以为儿童使用双臂进行真实世界习惯性活动提供客观信息。加速度计是非侵入性的，易于使用，并且儿童易于耐受，并且允许在治疗环境之外长时间监测 UE 活动。职业治疗师可以将腕戴加速度计用作敏感工具，以在基线评估 UE 使用的不对称性，并作为评估疗效的结果测量指标以及在患有 UCP 的儿童中转移到真实世界环境中。
这项初步研究提供了有希望的证据，支持使用腕戴加速度计作为一种准确、易于使用且客观的评估工具，用于检测患有单侧脑瘫 (UCP) 的儿童在基线时和在进行旨在改善手臂功能的强化职业治疗干预后双侧真实世界手臂活动的不对称性。作者使用腕戴加速度计对 9 名典型发育 (TD) 儿童和 9 名患有 UCP 的儿童进行了为期一周的研究，以比较优势或未受影响的上肢 (UE) 与非优势或受影响的 UE 活动的强度和持续时间。与 TD 儿童相比，患有 UCP 的儿童在非优势 UE 上的活动相对强度低于优势 UE。腕戴加速度计似乎是一种敏感的测量方法，可用于检测 UCP 儿童全天双侧 UE 使用的不对称性。研究结果对使用腕戴加速度计作为评估强化疗法改善 UCP 儿童现实世界受影响 UE 活动和双手功能疗效的结果测量指标具有重要意义。
