Validity and reliability of an accelerometer-based assessgame to quantify upper limb selective voluntary motor control.
Jeffrey W Keller, Annina Fahr, Julia Balzer and 2 others
PMID 32660569WHAT IT FOUND
An accelerometer game separated children with upper motor neuron lesions from healthy peers and agreed with therapist notes, but it is not yet reliable enough to track small changes after therapy.
Key findings
01The game separated patients from healthy peers at most ages, but not at younger ages on the less affected side.
02The involuntary movement score agreed most strongly with therapist notes, more than with the MACS or SCUES.
03Averaged scores were repeatable, but the smallest real differences for mean scores were 42 to 122% of the median patient score.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The patient group had different diagnoses, including cerebral palsy, stroke, traumatic brain injury, and encephalitis, so results may not apply to any one condition. The MACS and SCUES were used for comparison, but they have not been validated in patients with upper motor neuron lesions other than cerebral palsy. Only 23 of 33 patients returned for the repeat assessment, and the repeat interval differed for inpatients and outpatients. The groups were recruited by convenience or quota sampling, not random sampling, and patient and healthy child gender proportions were dissimilar. Absolute reliability was poor for tracking change: the smallest real differences for mean scores were 42 to 122% of the median patient score. Patients had to follow simple instructions and sit upright for 1 h with backrest support, so children who could not do this were not represented. Time of day was not standardized, and motivation or fatigue may have affected repeat scores. Some movements, especially pronation and supination, were unintuitive and may have added cognitive demand.
Declared interests
The assessgame was created in collaboration with Reha-Stim Medtech AG, previously YouRehab. The funder named is Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung.
The easy way to misread this
Do not use this game to decide whether therapy has improved a child's motor control. The smallest real differences for mean scores were 42 to 122% of the median patient score, which means small gains may not be reliable.