Measuring Upper Extremity Activity of Children With Unilateral Cerebral Palsy Using Wrist-Worn Accelerometers: A Pilot Study.

IMPORTANCE: Children with unilateral cerebral palsy (UCP) have poor strength and movement control on one side of their body, leading to impaired bimanual coordination skills. OBJECTIVE: 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. DESIGN: Two-group observational study. SETTING: Children's naturalistic settings. PARTICIPANTS: Convenience sample of 9 TD children and 9 children with UCP. INTERVENTION: Children wore accelerometers on both wrists all day and night for 1 wk. OUTCOMES AND MEASURES: We compared the extent of asymmetry in bilateral arm use (intensity and duration) between the 2 groups. RESULTS: 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. CONCLUSIONS AND RELEVANCE: 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.

Joystick-Operated Ride-On Toy Navigation Training for Children With Hemiplegic Cerebral Palsy: A Pilot Study.

IMPORTANCE: Children with hemiplegic cerebral palsy (HCP) require intensive task-oriented training to make meaningful gains in affected upper extremity (UE) motor function. OBJECTIVE: To evaluate the acceptability and utility of single joystick-operated ride-on toy (ROT) navigation training incorporated into a modified constraint-induced movement therapy (CIMT) camp for children with HCP. DESIGN: Single group pretest-posttest design. SETTING: Three-wk structured CIMT camp. PARTICIPANTS: Eleven children with HCP between ages 3 and 14 yr. INTERVENTION: Children received group-based CIMT for 6 hr/day, 5 days/wk, for 3 wk. As part of camp activities, children also received ROT navigation training for 20 to 30 min/day, 5 days/wk, for 3 wk. OUTCOMES AND MEASURES: We assessed children's acceptance of ROT training by monitoring adherence and evaluating child engagement (affect and attention) during training sessions. The effects of ROT training combined with other camp activities on children's affected UE motor function were also assessed with the standardized Quality of Upper Extremity Skills Test (QUEST) and training-specific measures of ROT maneuvering accuracy. RESULTS: Children demonstrated high levels of training adherence, positive affect, and task-appropriate attention across weeks. Positive engagement during ROT sessions was correlated with independent navigation. We also found medium- to large-sized improvements in QUEST scores and toy-maneuvering capabilities after the combined program. CONCLUSIONS AND RELEVANCE: Our pilot data support the use of joystick-operated ROTs as child-friendly therapy adjuncts that can be incorporated into intensive UE training programs to improve adherence and motivation in therapy programs, boost treatment dosing, and promote affected UE motor function in children with HCP. Plain-Language Summary: This pilot study offers promising evidence that supports the use of modified single joystick-operated ride-on toys (ROTs) for children with hemiplegic cerebral palsy (HCP). The study used ROTs as one of several interventions that were part of a constraint-induced movement therapy (CIMT) camp program for children with HCP. The ROTs boosted children's motivation, their engagement with and adherence to training, and their practice in using their affected upper extremity (UE) for goal-directed activities in their natural settings. ROTs are accessible, age-appropriate, and easy-to-use devices for both occupational therapy clinicians and families to encourage children to use their affected UEs by challenging their perceptual, motor-planning, problem-solving, and movement-control skills in an enjoyable and engaging way. ROTs can be used within and outside conventional rehabilitation settings.