Poster #64 - Changes in bilateral arm activity assessing using wrist-worn accelerometers and video coding following a 3-week dual joystick-operated ride-on-car (ROC) navigation training program in children with Hemiplegic Cerebral Palsy (HCP: Results of a pilot study.

• In Event: Poster Session 03

Abstract

Introduction: In contrast to standardized clinician-administered tests of upper extremity (UE) motor function that are typically limited to observation of children’s motor performance in standard settings, wrist-worn accelerometry allows collection of data on the duration and intensity of arm use over longer periods of time in naturalistic settings. Recently, wrist-worn accelerometers have been used as outcome measures to assess changes in affected arm activity in children and adults with unilateral weakness. In the current study, we will assess changes in duration and intensity of bilateral arm activity during a 3-week, joystick-operated, ride-on-car (ROC) navigation intervention that aims to promote bilateral coordination skills in children with hemiplegic cerebral palsy (HCP).
Study Design: Quasi-experimental, single group study
Study Participants: We recruited 11 children with HCP between 4-10 years (4M, 7F, 6 right hemiparesis and 5 left hemiparesis) with clear asymmetry in UE strength/control, using convenience sampling. The ROC navigation training was provided as part of a 3-week summer camp. Children were excluded if they couldn’t sustain supported sitting (<20 minutes), use their arm/body to briefly activate a joystick, exceeded weight limits of the toy, or had other additional comorbidities.
Methods: Children received dual joystick-operated ROC navigation training for 20-30 minutes/day over 15 days. Training involved active use of both UE to control dual joysticks to maneuver the ROC through incrementally challenging paths during different navigation games and obstacle courses. The training also involved practice of UE reach, grasp, and manipulation tasks such as picking, throwing, pulling, and catching playful props. Children wore 2 ActiGraph activity monitors on both wrists during the ROC navigation across the first and last weeks of training. In addition, videos of all ROC training sessions in the early and late training weeks were coded for the amount of independent (child using both arms independently to drive the ROC) vs. assisted mobility (adult helped child to drive the car). We will report changes in duration and intensity of use of dominant versus non-dominant hands during ROC navigation across early and late training weeks. We will correlate changes in accelerometer-based measures with changes in independent control of joysticks across training sessions as assessed using video data.
Expected Results: From early to late training sessions, we hypothesize that children will increase use of their non-dominant (i.e. affected) UE during ROC navigation as indicated by both accelerometer-based and video-based measures. From early to late sessions, increases in duration and intensity metrics for UE use using accelerometers will be positively correlated with increase in independent mobility and a decrease in assisted mobility as assessed using video data.
Conclusion: If the above-mentioned hypotheses hold true, wrist-worn accelerometery can serve as a sensitive and objective outcome measure to detect changes in affected UE use following behavioral interventions in children with HCP. Our findings also have implications for the utility of joystick-operated ROCs as motivating toys that can help promote goal-oriented use of the affected UE and bimanual function in children with HCP.

Authors

• Vaishnavi Sandeep Shahane, University of Connecticut
  Presenting Author

• Nidhi Amonkar

• Patrick Kumavor

• Kristin Morgan

• Sudha M Srinivasan, University of Connecticut