Translation, reliability, and clinical utility of the Melbourne Assessment 2

Objective: The aims were to (i) provide a German translation of the Melbourne Assessment 2 (MA2), a quantitative test to measure unilateral upper limb function in children with neurological disabilities and (ii) to evaluate its reliability and aspects of clinical utility. Methods: After its translation into German and approval of the back translation by the original authors, the MA2 was performed and videotaped twice with 30 children with neuromotor disorders. For each participant, two raters scored the video of the first test for inter-rater reliability. To determine test–retest reliability, one rater additionally scored the video of the second test while the other rater repeated the scoring of the first video to evaluate intra-rater reliability. Time needed for rater training, test administration, and scoring was recorded. Results: The four subscale scores showed excellent intra-, inter-rater, and test–retest reliability with intraclass correlation coefficients of 0.90–1.00 (95%-confidence intervals 0.78–1.00). Score items revealed substantial to almost perfect intra-rater reliability (weighted kappa kw¼0.66–1.00) for the more affected side. Score item inter-rater and test–retest reliability of the same extremity were, with one exception, moderate to almost perfect (kw¼0.42–0.97; kw¼0.40–0.89). Furthermore, the MA2 was feasible and acceptable for patients and clinicians. Conclusions: The MA2 showed excellent subscale and moderate to almost perfect score item reliability

Monitoring motor capacity changes of children during rehabilitation using body-worn sensors

BACKGROUND: Rehabilitation services use outcome measures to track motor performance of their patients over time. State-of-the-art approaches use mainly patients' feedback and experts' observations for this purpose. We aim at continuously monitoring children in daily life and assessing normal activities to close the gap between movements done as instructed by caregivers and natural movements during daily life. To investigate the applicability of body-worn sensors for motor assessment in children, we investigated changes in movement capacity during defined motor tasks longitudinally. METHODS: We performed a longitudinal study over four weeks with 4 children (2 girls; 2 diagnosed with Cerebral Palsy and 2 with stroke, on average 10.5 years old) undergoing rehabilitation. Every week, the children performed 10 predefined motor tasks. Capacity in terms of quality and quantity was assessed by experts and movement was monitored using 10 ETH Orientation Sensors (ETHOS), a small and unobtrusive inertial measurement unit. Features such as smoothness of movement were calculated from the sensor data and a regression was used to estimate the capacity from the features and their relation to clinical data. Therefore, the target and features were normalized to range from 0 to 1. RESULTS: We achieved a mean RMS-error of 0.15 and a mean correlation value of 0.86 (p < 0.05 for all tasks) between our regression estimate of motor task capacity and experts' ratings across all tasks. We identified the most important features and were able to reduce the sensor setup from 10 to 3 sensors. We investigated features that provided a good estimate of the motor capacity independently of the task performed, e.g. smoothness of the movement. CONCLUSIONS: We found that children's task capacity can be assessed from wearable sensors and that some of the calculated features provide a good estimate of movement capacity over different tasks. This indicates the potential of using the sensors in daily life, when little or no information on the task performed is available. For the assessment, the use of three sensors on both wrists and the hip suffices. With the developed algorithms, we plan to assess children's motor performance in daily life with a follow-up study

Quantifying selective elbow movements during an exergame in children with neurological disorders: A pilot study

Background It is difficult to distinguish between restorative and compensatory mechanisms underlying (pediatric) neurorehabilitation, as objective measures assessing selective voluntary motor control (SVMC) are scarce. Methods We aimed to quantify SVMC of elbow movements in children with brain lesions. Children played an airplane game with the glove-based YouGrabber system. Participants were instructed to steer an airplane on a screen through a cloud-free path by correctly applying bilateral elbow flexion and extension movements. Game performance measures were (i) % time on the correct path and (ii) similarity between the ideal flight path and the actually flown path. SVMC was quantified by calculating a correlation coefficient between the derivative of the ideal path and elbow movements. A therapist scored whether the child had used compensatory movements. Results Thirty-three children with brain lesions (11 girls; 12.6 ± 3.6 years) participated. Clinical motor and cognitive scores correlated moderately with SVMC (0.50–0.74). Receiver Operating Characteristics analyses showed that SVMC could differentiate well and better than clinical and game performance measures between compensatory and physiological movements. Conclusions We conclude that a simple measure assessed while playing a game appears promising in quantifying SVMC. We propose how to improve the methodology, and how this approach can be easily extended to other joints.ISSN:1743-000

Reliability and responsiveness of upper limb motor assessments for children with central neuromotor disorders: a systematic review

BACKGROUND: To investigate the effectiveness of upper limb rehabilitation, sound measures of upper limb function, capacity, and performance are paramount. OBJECTIVES: This systematic review investigates reliability and responsiveness of upper limb measurement tools used in pediatric neurorehabilitation. METHODS: A 2-tiered search was conducted up to July 2014. The first search identified upper limb motor assessments for 1- to 18-year-old children with neuromotor disorders. The second search examined the psychometric properties of the tools. Methodological quality was rated according to COSMIN guidelines, and results for each tool were assembled in a "best evidence synthesis." Furthermore, we delineated whether tools were unimanual or bimanual tests and if they measured recovery or did not distinguish between physiological and compensatory movements. RESULTS: The first search delivered 2546 hits. Of these, 110 articles on 51 upper limb assessment tools were included. The second search resulted in 58 studies on reliability, 11 on measurement error, and 10 on responsiveness. Best evidence synthesis revealed only 2 assessments with moderate positive evidence for reliability, whereas no evidence on measurement error and responsiveness was found. The Melbourne Assessment showed moderate positive evidence for interrater and a fair positive level of evidence for intrarater reliability. The Pediatric Motor Activity Log Revised revealed moderate positive evidence for test-retest reliability. CONCLUSIONS: There is a lack of high-quality studies about psychometric properties of upper limb measurement tools in children with neuromotor disorders. To date, upper limb rehabilitation trials in children and adolescents risk being biased by insensitive measurement tools lacking reliability

Preparing a neuropediatric upper limb exergame rehabilitation system for home-use: a feasibility study

BACKGROUND: Home-based, computer-enhanced therapy of hand and arm function can complement conventional interventions and increase the amount and intensity of training, without interfering too much with family routines. The objective of the present study was to investigate the feasibility and usability of the new portable version of the YouGrabber® system (YouRehab AG, Zurich, Switzerland) in the home setting. METHODS: Fifteen families of children (7 girls, mean age: 11.3y) with neuromotor disorders and affected upper limbs participated. They received instructions and took the system home to train for 2 weeks. After returning it, they answered questions about usability, motivation, and their general opinion of the system (Visual Analogue Scale; 0 indicating worst score, 100 indicating best score; ≤30 not satisfied, 31-69 average, ≥70 satisfied). Furthermore, total pure playtime and number of training sessions were quantified. To prove the usability of the system, number and sort of support requests were logged. RESULTS: The usability of the system was considered average to satisfying (mean 60.1-93.1). The lowest score was given for the occurrence of technical errors. Parents had to motivate their children to start (mean 66.5) and continue (mean 68.5) with the training. But in general, parents estimated the therapeutic benefit as high (mean 73.1) and the whole system as very good (mean 87.4). Children played on average 7 times during the 2 weeks; total pure playtime was 185 ± 45 min. Especially at the beginning of the trial, systems were very error-prone. Fortunately, we, or the company, solved most problems before the patients took the systems home. Nevertheless, 10 of 15 families contacted us at least once because of technical problems. CONCLUSIONS: Despite that the YouGrabber® is a promising and highly accepted training tool for home-use, currently, it is still error-prone, and the requested support exceeds the support that can be provided by clinical therapists. A technically more robust system, combined with additional attractive games, likely results in higher patient motivation and better compliance. This would reduce the need for parents to motivate their children extrinsically and allow for clinical trials to investigate the effectiveness of the system. TRIAL REGISTRATION: ClinicalTrials.gov NCT02368223

Reliability of single-day walking performance and physical activity measures using inertial sensors in children with cerebral palsy

There is a lack of objective and reliable tools to measure walking performance in children with cerebral palsy (CP)

What is the Best Configuration of Wearable Sensors to Measure Spatiotemporal Gait Parameters in Children with Cerebral Palsy?

Wearable inertial devices have recently been used to evaluate spatiotemporal parameters of gait in daily life situations. Given the heterogeneity of gait patterns in children with cerebral palsy (CP), the sensor placement and analysis algorithm may influence the validity of the results. This study aimed at comparing the spatiotemporal measurement performances of three wearable configurations defined by different sensor positioning on the lower limbs: (1) shanks and thighs, (2) shanks, and (3) feet. The three configurations were selected based on their potential to be used in daily life for children with CP and typically developing (TD) controls. For each configuration, dedicated gait analysis algorithms were used to detect gait events and compute spatiotemporal parameters. Fifteen children with CP and 11 TD controls were included. Accuracy, precision, and agreement of the three configurations were determined in comparison with an optoelectronic system as a reference. The three configurations were comparable for the evaluation of TD children and children with a low level of disability (CP-GMFCS I) whereas the shank-and-thigh-based configuration was more robust regarding children with a higher level of disability (CP-GMFCS II-III)