Date Presented 3/30/2017
Identifying subtle motor delays in early childhood is challenging. Accelerometry is a novel way to characterize upper-extremity motor patterns in typically developing children. Differences were identified between typically developing children and children with hemiparesis ages 0–5 yr.
Primary Author and Speaker: Catherine Hoyt Drazen
Contributing Authors: Annie Nguyen, Elyse Everet, Melanie Berner, Jonathan Koller, Dustin K. Ragan, Nico U. F. Dosenbach
PURPOSE: The purpose of this study was to provide easily obtainable measurements of upper-extremity (UE) movements in very young children. Given the high prevalence of developmental delay (Boyle et al., 2011) and the difficulty of detecting motor disorders at a young age, frontline providers are in need of easy, affordable, and objective methods to capture true motor performance in young children. Currently therapists must evaluate a child’s motor capacity, supplemented by parent reports about a child’s motor abilities. Given the known limitations of parent report, it is critical that a method be identified to measure real-world activity.
General movements have been described as a means for identifying motor delays in the first few months of life (Einspieler & Prechtl, 2005). Given the consistent pattern of motor development, understanding UE activity patterns among typically developing children will enable children with functional motor delays to be identified. Unfortunately, diagnosis is not typically until the 2nd year of life, and in mild cases may not be until the child is several years old (National Institute of Neurological Disorders and Stroke, 2015). Accurately and efficiently identifying motor deficits early on would enable timely intervention to diminish the long-term effects of disability (American Academy of Pediatrics, 2001).
METHOD: This study was a cross-sectional baseline analysis of a prospective cohort. Approval was obtained from the institutional review board at Washington University School of Medicine. Participants were children ages 0–5 yr who (1) did not have a history of neurological or motor impairment or (2) had diagnoses of hemiparesis. Everyday movement was captured using ActiGraph wGT3X-BT activity monitors (ActiGraph Corp., Pensacola, FL). The ActiGraph uses a three-axis accelerometer and ambient light sensor to gauge activity by converting and summing voltage proportional to acceleration in three directions. Participants wore ActiGraphs on both wrists for four 25-hr epochs within a 1-mo period. Parents completed a medical history, satisfaction survey, and the motor subscales (12 items) of the Ages and Stages Questionnaire–3 (ASQ; Squires & Bricker, 2009) online using REDcap (Nashville, TN). Activity counts and use ratio were used to classify bilateral activity.
RESULTS: A total of 52 typically developing children and six children with hemiparesis participated in this study. Children with hemiparesis had an average use ratio of .803, indicating asymmetric UE movement patterns. This reflected an average activity count of 34,130 on the dominant hand and 27,431 on the affected hand. The average use ratio among typically developing children was 1.002. Children younger than age 4 had an average use ratio of 1.005, while 5-yr-olds had an average use ratio of .974, approaching the adult average of around .950. This reflected an average activity count of 35,209 on the left and 35,048 on the right. Children with hemiparesis had use ratios significantly different from typically developing children (p = .000000006, t = –16.85). There was no significant difference between children age 4 and under and 5-yr-olds (p = .11, t = 1.74).
CONCLUSION: Our findings document objectively that typically developing children use both UEs throughout the day equally, indicating no hand dominance, whereas children with hemiparesis demonstrated hand use significantly different from typical handedness. This difference indicates that accelerometry successfully identified a deficit that may indicate disability. Children with hemiparesis had lower activity than their typically developing peers and used their affected hand less frequently throughout the day.
IMPACT STATEMENT: Asymmetric UE patterns can be identified at very young ages using accelerometry. Early, objective identification will enable earlier intervention to ameliorate future deficits.
References
American Academy of Pediatrics. (2001). Role of the pediatrician in family-centered early intervention services. Pediatrics, 107, 1155–1157.
Boyle, C. A., Boulet, S., Schieve, L. A., Cohen, R. A., Blumberg, S. J., Yeargin-Allsopp, M., . . . Kogan, M. D. (2011). Trends in the prevalence of developmental disabilities in US children, 1997–2008. Pediatrics, 127, 1034–1042. https://doi.org/10.1542/peds.2010-2989
Einspieler, C., & Prechtl, H. F. (2005). Prechtl’s assessment of general movements: A diagnostic tool for the functional assessment of the young nervous system. Mental Retardation and Developmental Disabilities Research Reviews, 11, 61–67. https://doi.org/10.1002/mrdd.20051
National Institute of Neurological Disorders and Stroke. (2015). Cerebral palsy: Hope through research. Retrieved from http://www.ninds.nih.gov/disorders/cerebral_palsy/cerebral_palsy.htm
Squires, J., & Bricker, D. (2009). Ages and Stages Questionnaires–3. Baltimore: Brookes.
