Developing technology-based hand and arm activity tracking

• Research type

  Research Study

• Full title

  Developing technology-based hand and arm activity tracking for children with hemiplegia:The TwoCan Project

• IRAS ID

  254853

• Contact name

  Anna Basu

• Contact email

  anna.basu@newcastle.ac.uk

• Sponsor organisation

  Newcastle upon Tyne Hospitals NHS Foundation Trust

• Duration of Study in the UK

  0 years, 11 months, 31 days

• Research summary

  Summary of Research

  Developing technology-based hand and arm rehabilitation for children and young people with hemiplegia: the TwoCan Study

  What’s the study about?
  Hemiplegic cerebral palsy (HCP) causes lifelong weakness and stiffness on one side of the body, impacting everyday functioning including hand use. We want to see whether young people with HCP can be encouraged to use their affected arm and hand more during everyday activities. We will use wrist worn devices (one on each wrist) and software including a smartphone “app”.

  Who will take part?
  We will include around 20 participants with HCP, aged 8-18 years. Each participant will invite a “buddy” of around the same age to participate, so we have data from children with and without HCP. Recruitment will be from two sites (Newcastle and London).

  What will happen?
  Children with HCP will have assessments of hand function at the start. We will provide all children and young people in the study with wrist-worn devices and access to the app (lending a smartphone if necessary). They will wear the devices during the day for 10 weeks in total. During 6 of these weeks, the devices will provide visual and/or vibratory feedback up to every hour regarding amount of use of the affected arm. (For those without HCP, the feedback will be on amount of use of the “non-dominant” arm). The app will be accessed at the end of the day for more detailed information including trends in progress.

  We will interview participants and their families to understand their views, and we will analyse the movement data, to see if this approach can in principle lead to changes in the amount of hand and arm use. If so, we will aim to undertake a larger future study to find out whether the approach is effective, and if so, how effective.

  Summary of Results

  Aim: To determine whether a wrist-worn triaxial accelerometer-based device and software (including smartphone application), incorporating feedback, is feasible, ac-ceptable, and can lead to increased affected upper limb use during everyday activi-ties in children with unilateral cerebral palsy (UCP).
  Methods: Study design: Mixed methods proof of concept study. Participants: Children aged 8–18 years with UCP; age-matched typically developing controls (“Buddies”), therapists. Intervention: Baseline (2 weeks): devices recorded arm activity. Active feedback (6 weeks): devices also gave vibratory prompts if affected arm activity fell below pre-set personalised thresholds (UCP group only; control group continued as per Baseline). Final 2 weeks: as base-line. Both groups accessed a smartphone application providing feedback on relative arm motion throughout the study. Assessment and analysis: ABILHAND-Kids questionnaires and MACS classifications captured baseline participant characteris-tics (UCP group). Accelerometer data was used to calculate relative arm activity (sig-nal vector magnitude) corrected for time worn/day, and trends in relative arm activi-ty examined using single case experimental design (both groups). In-depth inter-views with families, “Buddies” and therapists assessed feasibility and acceptability of implementation. A framework approach was used for qualitative data analysis.
  Results: We recruited 19 participants with UCP; 19 buddies; and 7 therapists. Five participants (two with UCP) did not complete the study. Baseline mean (stdev) ABILHAND-Kids score of children with UCP who completed the study was 65.7 (16.2); modal MACS score was II.
  Qualitative analysis demonstrated acceptability and feasibility of the approach. Ac-tive therapist input for this group was minimal. Therapists appreciated the potential for summary patient data to inform management. Arm activity in children with UCP increased in the hour following a prompt (mean effect size z = 0.261) for the non-dominant hand, and the dominant hand (z = 0.247). However, a significant increase in affected arm activity between baseline and intervention periods was not demon-strated.
  Discussion: Children with UCP were prepared to wear the wristband devices for prolonged periods. Whilst arm activity increased bilaterally in the hour following a prompt, increases were not sustained. Delivery of the study during the COVID-19 pandemic may have negatively influenced findings. Technological challenges oc-curred but could be overcome. Future testing should incorporate structured therapy input.

• REC name

  West Midlands - Edgbaston Research Ethics Committee

• REC reference

  19/WM/0257

• Date of REC Opinion

  17 Jan 2020

• REC opinion

  Further Information Favourable Opinion