A systematic review of instrumented assessments for upper limb function in cerebral palsy: current limitations and future directions.

INTRODUCTION: Recently, interest in quantifying upper limb function in cerebral palsy has grown. However, the lack of reference tasks and protocols, have hindered the development of quantified movement analysis in clinical practice. This study aimed to evaluate existing instrumented assessments of upper limb function in cerebral palsy, with a focus on their clinical applicability, to identify reasons for the lack of adoption and provide recommendations for improving clinical relevance and utility. METHODS: A systematic review was conducted by a multidisciplinary team of researchers and clinicians (Prospero CRD42023402382). PubMed and Web of Science databases were searched using relevant keywords and inclusion/exclusion criteria. RESULTS: A total of 657 articles were initially identified, and after the selection process, 76 records were included for analysis comprising a total of 1293 patients with cerebral palsy. The quality assessment of the reviewed studies revealed a moderate overall quality, with deficiencies in sample size justification and participant information. Optoelectronic motion capture systems were predominantly used in the studies (N = 57/76). The population mainly consisted of individuals with spastic cerebral palsy (834/1293) with unilateral impairment (N = 1092/1293). Patients with severe functional impairment (MACS IV and V) were underrepresented with 3.4% of the 754 patients for whom the information was provided. Thirty-nine tasks were used across the articles. Most articles focused on unimanual activities (N = 66/76) and reach or reach and grasp (N = 51/76). Bimanual cooperative tasks only represented 3 tasks present in 4 articles. A total of 140 different parameters were identified across articles. Task duration was the most frequently used parameter and 23% of the parameters were used in only one article. CONCLUSION: Further research is necessary before incorporating quantified motion analysis into clinical practice. Existing protocols focus on extensively studied populations and rely on costly equipment, limiting their practicality. Standardized unimanual tasks provide limited insights into everyday arm use. Balancing methodological requirements and performance evaluation flexibility is a challenge. Exploring the correlation between outcome parameters and therapeutic guidance could facilitate the integration of quantified movement assessment into treatment pathways.

The Validity and Reliability of an iPhone App for Measuring Running Mechanics.

The purpose of this investigation was to analyze the validity of an iPhone application (Runmatic) for measuring running mechanics. To do this, 96 steps from 12 different runs at speeds ranging from 2.77-5.55 m·s-1 were recorded simultaneously with Runmatic, as well as with an opto-electronic device installed on a motorized treadmill to measure the contact and aerial time of each step. Additionally, several running mechanics variables were calculated using the contact and aerial times measured, and previously validated equations. Several statistics were computed to test the validity and reliability of Runmatic in comparison with the opto-electronic device for the measurement of contact time, aerial time, vertical oscillation, leg stiffness, maximum relative force, and step frequency. The running mechanics values obtained with both the app and the opto-electronic device showed a high degree of correlation (r = .94-.99, p < .001). Moreover, there was very close agreement between instruments as revealed by the ICC (2,1) (ICC = 0.965-0.991). Finally, both Runmatic and the opto-electronic device showed almost identical reliability levels when measuring each set of 8 steps for every run recorded. In conclusion, Runmatic has been proven to be a highly reliable tool for measuring the running mechanics studied in this work.

Does accelerometry reflect hand function in infants at risk of unilateral cerebral palsy? A secondary analysis of BB-Bim results.

BACKGROUND: Infants at high-risk of unilateral Cerebral Palsy (UCP) may have asymmetry in upper extremity movement and function, which should be identified as soon as possible for management. AIMS: To explore the feasibility of using two AX3 Axivity monitors in wrist-worn bracelets to quantify movements, and to identify whether accelerometry parameters are consistent with hand function. METHODS AND PROCEDURES: 6 infants at high risk of UCP (aged 3 to -12 months) were included in a Single-Case Experimental Design to explore the impact of an 8-week bimanual stimulation home program. OUTCOMES: Each week of the baseline (randomized duration 4-7 weeks) and 8-week program, the Hand Assessment for Infants (HAI) was performed and accelerometry parameters were collected during HAI and also during spontaneous activity, several times a week. RESULTS: Actimetry was analyzed during HAI and 238 spontaneous activity sessions (mean 42 ± 21 min). Actimetry ratios distribution and evolution show a high variability, especially for spontaneous activity. No strong correlation was found between HAI scores and accelerometry parameters, either collected during HAI, or during spontaneous activity times. CONCLUSION AND IMPLICATIONS: Despite its feasibility, using accelerometry bracelets looks unreliable for detecting and monitoring hand function in infants under one year.

Recommendations for the Use of Serious Games in Neurodegenerative Disorders: 2016 Delphi Panel.

The use of Serious Games (SG) in the health domain is expanding. In the field of neurodegenerative disorders (ND) such as Alzheimer's disease, SG are currently employed both to support and improve the assessment of different functional and cognitive abilities, and to provide alternative solutions for patients' treatment, stimulation, and rehabilitation. As the field is quite young, recommendations on the use of SG in people with ND are still rare. In 2014 we proposed some initial recommendations (Robert et al., 2014). The aim of the present work was to update them, thanks to opinions gathered by experts in the field during an expert Delphi panel. Results confirmed that SG are adapted to elderly people with mild cognitive impairment (MCI) and dementia, and can be employed for several purposes, including assessment, stimulation, and improving wellbeing, with some differences depending on the population (e.g., physical stimulation may be better suited for people with MCI). SG are more adapted for use with trained caregivers (both at home and in clinical settings), with a frequency ranging from 2 to 4 times a week. Importantly, the target of SG, their frequency of use and the context in which they are played depend on the SG typology (e.g., Exergame, cognitive game), and should be personalized with the help of a clinician.