Association between upper limb clinical tests and accelerometry metrics for arm use in daily life in children with unilateral cerebral palsy

To evaluate the association between upper-limb (UL) clinical tests and UL accelerometry-derived metrics in children with unilateral Cerebral Palsy (CP). In this cross-sectional study, twenty children with unilateral CP and Manual Ability Classification System level I-III were included. Outcomes of the Assisting Hand Assessment, Box and Block-Test and accelerometry metrics were collected in the clinical setting and in daily life. UL asymmetry index (i.e., the ratio between the well-functioning UL and the affected UL use) was evaluated in different physical activity levels and relative use of UL was evaluated during daily living. Spearman’s correlation was used to determine the association between UL clinical tests and accelerometry metrics in a clinical setting and in daily life. The strongest negative association was between the Assisting Hand Assessment units and accelerometry metrics during the sedentary time in daily life (r_s = −0.64). The asymmetries between ULs were highest during the child’s sedentary time (asymmetry index: 45.15) compared to when the child was in light (asymmetry index: 23.97) or higher intensity physical activity (asymmetry index: 13.39). The children used both ULs simultaneously for 44% of the time during daily life. Accelerometry metrics may provide additional objective information to clinical tests by quantifying the amount of UL movements and the amount of asymmetry between the upper limbs in daily life. Accelerometer-based metrics of the upper limbs offer additional information about the quantity of upper limb asymmetry and relative use in children and adolescents with unilateral Cerebral Palsy.Accelerometer-based metrics of upper limb asymmetry in sedentary time and different physical activity intensities in daily life can be a complement to clinical tests among children and adolescents with unilateral Cerebral Palsy. Accelerometer-based metrics of the upper limbs offer additional information about the quantity of upper limb asymmetry and relative use in children and adolescents with unilateral Cerebral Palsy. Accelerometer-based metrics of upper limb asymmetry in sedentary time and different physical activity intensities in daily life can be a complement to clinical tests among children and adolescents with unilateral Cerebral Palsy.

本研究旨在探讨单侧脑瘫（unilateral Cerebral Palsy, CP）儿童的上肢（upper-limb, UL）临床评估与加速度计衍生上肢指标之间的关联。本项横断面研究共纳入20名单侧脑瘫患儿，其手功能分级系统（Manual Ability Classification System, MACS）分级为I~III级。研究分别在临床环境与日常活动中采集了协助手评估（Assisting Hand Assessment, AHA）、方块与积木测试（Box and Block Test）以及加速度计指标数据。我们评估了不同体力活动强度下的上肢不对称指数（即健侧上肢与患侧上肢使用量的比值），并在日常生活中评估了上肢的相对使用情况。采用斯皮尔曼相关性分析，探究临床环境与日常活动中上肢临床评估与加速度计指标之间的关联。相关性最强的负相关出现在日常久坐时间内的协助手评估得分与加速度计指标之间（r_s = -0.64）。与轻度体力活动（不对称指数：23.97）或高强度体力活动（不对称指数：13.39）相比，患儿在久坐期间的上肢不对称程度最高（不对称指数：45.15）。患儿在日常生活中有44%的时间同时使用双侧上肢。加速度计指标可通过量化日常生活中的上肢活动量与双侧上肢不对称程度，为临床评估提供额外的客观信息。基于加速度计的上肢指标可为单侧脑瘫儿童与青少年提供更多关于上肢不对称程度与相对使用情况的客观信息。针对日常久坐时间与不同体力活动强度下的上肢不对称指数的加速度计测量结果，可作为单侧脑瘫儿童与青少年临床评估的补充手段。基于加速度计的上肢指标可为单侧脑瘫儿童与青少年提供更多关于上肢不对称程度与相对使用情况的客观信息。针对日常久坐时间与不同体力活动强度下的上肢不对称指数的加速度计测量结果，可作为单侧脑瘫儿童与青少年临床评估的补充手段。