Background: A discrepancy between the level of impairment at the upper extremity (UE) and its use in activities of daily life is frequently observed in individuals who have experienced a stroke. Wrist-worn accelerometers allow an objective and valid measure of UE use in everyday life. Accelerometer studies have shown that a wide range of factors beyond UE impairment can influence UE use. This scoping review aims to identify factors associated with UE use and to investigate the influence of different types of accelerometry metrics on these associations. Method: A search using CINHAL, Embase, MEDLINE, Compendex, and Web of Science Core Collection databases was performed. Studies that assessed the association between UE use quantified with accelerometers and factors related to the person or their environment in individuals with stroke were included. Data related to study design, participants characteristics, accelerometry methodology (absolute vs. relative UE use metrics), and associations with personal and environmental factors were extracted. Results: Fifty-four studies were included. Multiple studies consistently reported associations between relative UE use and stroke severity, UE motor impairment, unimanual capacity, bimanual capacity, and mobility. In contrast, there were inconsistent associations with factors such as neglect and concordance between dominance and side of paresis and a consistent lack of association between relative UE use and time since stroke, sex, and age. Metrics of absolute paretic UE use yielded different results regarding their association with personal and environmental factors, as they were more influenced by factors related to physical activity and less associated with factors related to UE capacity. Conclusion: Healthcare providers should recognize the complexity of the relationship between UE use and impairment and consider additional factors when selecting assessments during rehabilitation to identify patients at risk of underutilizing their paretic arm in daily life. Future research in this domain should preconize relative UE use metrics or multi-sensors method to control for the effect of physical activity.

Various accelerometry protocols have been used to quantify upper extremity (UE) activity, encompassing diverse epoch lengths and thresholding methods. However, there is no consensus on the most effective approach. The aim of this study was to delineate the optimal parameters for analyzing accelerometry data to quantify UE use in individuals with unilateral cerebral palsy (CP). Methods: A group of adults with CP (n = 15) participated in six activities of daily living, while a group of children with CP (n = 14) underwent the Assisting Hand Assessment. Both groups performed the activities while wearing ActiGraph GT9X-BT devices on each wrist, with concurrent video recording. Use ratio (UR) derived from accelerometry and video analysis and accelerometer data were compared for different epoch lengths (1, 1.5, and 2 s) and activity count (AC) thresholds (between 2 and 150). Results: In adults, results are comparable across epoch lengths, with the best AC thresholds being ≥ 100. In children, results are similar across epoch lengths of 1 and 1.5 (optimal AC threshold = 50), while the optimal threshold is higher with an epoch length of 2 (AC = 75). Conclusions: The combination of epoch length and AC thresholds should be chosen carefully as both influence the validity of the quantification of UE use.

Most activities of daily living (ADLs) require the use of both upper extremities. However, few assessments exist to assess bimanual performance, especially among adults living with cerebral palsy (CP). The aim of this preliminary study is to assess the interrater reliability and convergent validity of the Assisting Hand Assessment (AHA) scoring grid applied to unstandardized ADLs. For this validation study, nineteen adults living with spastic unilateral CP were videotaped performing seven bimanual ADLs. Three raters assessed the videos independently using the 20-item grid of the AHA. Gwet's AC2 was used to assess interrater reliability. Kendall's Tau-b correlation was used between the observation-based scoring grid and Jebsen-Taylor Hand Function Test (JTHFT) scores to assess convergent validity. Interrater reliability was good (0.84, SD = 0.02). The correlation with the JTHFT was high (τb = -0.74; p < 0.001). The results show the potential of using an observation-based scoring grid with unstandardized ADLs to assess bimanual performance in adults living with CP, but further research on psychometric properties is needed. This method allows for an assessment that is occupation-oriented, ecological, and meaningful.

The purpose of this scoping review was to examine the literature on the use of anti-gravity treadmills and its effects on lower-limb motor functions in children and adolescents with locomotor impairments. Method: Four databases (MEDLINE, CINAHL, Embase, Web of Science) were searched for articles from inception to August 2021. Inclusion criteria were: (1) experimental or quasi-experimental studies using anti-gravity training as the primary intervention; (2) studies conducted in pediatric participants; (3) articles reporting outcomes related to lower-limb functions; and (4) studies published in French or English. Results: Fifteen articles were included in the review. Studies included children and adolescents aged 4–18 years with locomotor impairments. Intervention duration ranged from 2 to 12 weeks, with 2–5 sessions per week. Included studies reported that anti-gravity training induces improvements in muscle strength, balance, spatiotemporal gait parameters, and walking endurance in children with locomotor impairments. Conclusion: This review provides relevant information about interventions, outcomes and limits associated with anti-gravity training in pediatrics. Overall, anti-gravity treadmill training could be viewed as a valuable training modality, specifically for children with cerebral palsy. However, a more precise and comprehensive description of anti-gravity training protocols would be useful.

Children with unilateral cerebral palsy (uCP) experience pronounced sensorimotor impairments on one side of the body, impacting upper limb (UL) use and leisure participation. This study compares UL performance in children with uCP and typically developing (TD) children and examines, within the uCP group, the association between UL capacity, UL performance, and leisure participation. Twenty-one children with uCP (age: 11.2 ± 1.8 years) and 30 TD children (age: 10.6 ± 2.1 years) were recruited. UL performance was measured using accelerometry and expressed in activity counts per minute, UL capacity with the Jebsen–Taylor Hand Function Test, and leisure participation with the Children’s Assessment of Participation and Enjoyment questionnaire. The uCP group showed markedly lower performance in their non-dominant side compared to the TD group (p < 0.001, ηp² = 0.57), while dominant-side performance showed no significant difference between groups. UL capacity, UL performance, and leisure participation were not correlated (r range: −0.06–0.20). Children with uCP remained active despite UL asymmetry. The lack of significant association between UL capacity, performance, and participation may reflect contextual factors. These findings highlight the importance of complementing accelerometry with measures capturing other dimensions of motor function (e.g., fine motor skills) for a more comprehensive assessment of real-world UL performance.

Background: The subacute phase post-stroke is a critical period for recovery, yet it remains unclear how spontaneous use of the paretic upper extremity (UE) increases during this period. Objective: This longitudinal study aimed to characterize changes in patterns of UE use during the subacute phase, focusing on unimanual and bimanual use, and to examine the influence of different clinical contexts on UE use. Methods: Participants (n = 41; 28.4 [8.0] days since stroke) were assessed at admission to inpatient rehabilitation, prior to discharge, and at 6 months post-stroke. UE use was measured with wrist-worn accelerometers over 7 consecutive days in 3 contexts: daily life, therapy sessions, and functional assessments. Metrics included the use ratio (UR; paretic/non-paretic) and the percentage of unimanual and bimanual use. Results: UR improved from admission to discharge ( P < .001), reflecting a more symmetrical UE use, but no further change was observed after discharge ( P = .09). Percentage of unimanual non-paretic use decreased while bimanual use increased across all time points ( P ≤ .03). Percentage of unimanual paretic use remained low, with no change over time ( P = .28). An effect of context was observed for all variables ( P ≤ .003), showing more asymmetric UE use outside of supervised clinical contexts (therapies and assessments). Conclusions: The subacute phase is characterized by substantial improvements in bimanual UE use during rehabilitation, followed by subtler changes in UE use patterns during the late subacute phase. The discrepancy between UE use during supervised clinical contexts and spontaneous use in daily life highlights the need for accelerometry-based monitoring in clinical practice.