Concurrent validity,test-retest reliability,and sensitivity of a PostureRite system measurement on dynamic postural sway and risk of fall in cerebral palsy

Abstract

BACKGROUND:

Accurately diagnosing dynamic postural sway (DPS) is essential for effective and sustainable intervention in children with cerebral palsy (CP). We developed an accurate, inexpensive, and wearable DPS measurement system to measure DPS accurately and consistently during walking and functional activities of daily living.

OBJECTIVE:

We investigated the validity and reliability of this PostureRite system in children with CP, and the link between PostureRite and clinical measures including gross motor function measure (GMFM), pediatric balance scale (PBS), and fall efficacy scale (FES).

METHODS:

Twenty-one participants were categorized as follows: 11 healthy adults (3 females, mean age, 25.00±1.00 years) and 10 children with CP (mean age, 11.10±6.28 years). We determined the concurrent validity of PostureRite by comparing DPS data to the gold standard accelerometer measurement results. We determined test-retest reliability by measuring DPS data on three occasions at 2-h intervals. We assessed PostureRite measurement sensitivity to ascertain differences between healthy children and children with CP DPS measurements.

RESULTS:

Random and mixed intraclass correlation coefficients (ICC_2,k and ICC_3,k) were obtained; an independent T-test was performed (P < 0.05). Concurrent validity analysis showed a good relationship between the gold standard accelerometer and PostureRite (ICC_2,k = 0.973, P < 0.05). Test-retest reliability demonstrated a good relationship across the three repeated measures of the DPS data (ICC_3,k = 0.816–0.924, P < 0.05). Independent T-test revealed a significant difference in DPS data between healthy adults and children with CP (P < 0.05).

CONCLUSIONS:

We developed a portable, wireless, and affordable PostureRite system to measure DPS during gross motor function associated with daily activity and participation, and established the concurrent validity, test-retest reliability as sensitivity, and clinical relevance by comparing the DPS obtained from the participants with and without CP.

Keywords

Validity reliability sensitivity dynamic postural sway cerebral palsy

Get full access to this article

View all access options for this article.

References

Abaid,

, Cappa,

, Palermo,

, Petrarca,

, & Porfiri,

(2013). Gait detection in children with and without hemiplegia using single-axis wearable gyroscopes. PloS One, 8(9) e73152.

Ahlrichs,

, Samà,

, Lawo,

, Cabestany,

, Rodríguez-Martín,

, Pérez-López,

, Sweeney,

, Quinlan,

L. R.

, Laighin,

G. Ò.

, & Counihan,

(2016). Detecting freezing of gait with a tri-axial accelerometer in Parkinson’s disease patients. Medical & Biological Engineering & Computing, 54(1), 223–233.

Alessandrini,

, Micarelli,

, Viziano,

, Pavone,

, Costantini,

, Casali,

, Paolizzo,

, & Saggio,

(2017). Body-worn triaxial accelerometer coherence and reliability related to static posturography in unilateral vestibular failure. Acta Otorhinolaryngologica Italica, 37(3), 231.

Alotaibi,

, Long,

, Kennedy,

, & Bavishi,

(2014). The efficacy of GMFM-88 and GMFM-66 to detect changes in gross motor function in children with cerebral palsy (CP): a literature review. Disability and Rehabilitation, 36(8), 617–627.

Chen,

C.L.

, Shen,

I.H.

, Chen,

C.Y.

, Wu,

C.Y.

, Liu,

W.Y.

, & Chung,

C.Y.

(2013). Validity, responsiveness, minimal detectable change, and minimal clinically important change of Pediatric Balance Scale in children with cerebral palsy. Research in Developmental Disabilities, 34(3), 916–922.

Cho,

C. Y.

, Kamen,

, & Holt,

(1995). Using accelerometry for assessing balance performance in normal elderly and frequent fallers. In Washington, DC: World Confederation of Physical Therapy Conference (Vol. 995).

Clifford,

A. M.

, & Holder-Powell,

(2010). Postural control in healthy individuals. Clinical Biomechanics, 25(6), 546–551.

Delbaere,

, Close,

J. C.

, Mikolaizak,

A. S.

, Sachdev,

P. S.

, Brodaty,

, & Lord,

S. R.

(2010). The falls efficacy scale international (FES-I). A comprehensive longitudinal validation study. Age and Ageing, 39(2), 210–216.

Franjoine,

M. R.

, Darr,

, Held,

S. L.

, Kott,

, & Young,

B. L.

(2010). The performance of children developing typically on the pediatric balance scale. Pediatric Physical Therapy, 22(4), 350–359.

10.

Girolami,

G. L.

, Shiratori,

, & Aruin,

A. S.

(2011). Anticipatory postural adjustments in children with hemiplegia and diplegia. Journal of Electromyography and Kinesiology, 21(6), 988–997.

11.

Jung,

, Shin,

H. H.

, Choi,

Y. W.

, & Kim,

K. M.

(2015). The relationship between fall efficacy and activity level in older adults. Physical & Occupational Therapy in Geriatrics, 33(1), 53–63.

12.

Ko,

, & Kim,

(2013). Reliability and responsiveness of the gross motor function measure-88 in children with cerebral palsy. Physical Therapy, 93(3), 393–400.

13.

Mancini,

, Salarian,

, Carlson-Kuhta,

, Zampieri,

, King,

, Chiari,

, & Horak,

F. B.

(2012). ISway: a sensitive, valid and reliable measure of postural control. Journal of Neuroengineering and Rehabilitation, 9(1), 1–8.

14.

McDougall,

, Wright,

, & Rosenbaum,

(2010). The ICF model of functioning and disability: incorporating quality of life and human development. Developmental Neurorehabilitation, 13(3), 204–211.

15.

Morgan,

, & McGinley,

(2013). Performance of adults with cerebral palsy related to falls, balance and function: a preliminary report. Developmental Neurorehabilitation, 16(2), 113–1203.

16.

Muir,

J. W.

, Kiel,

D. P.

, Hannan,

, Magaziner,

, & Rubin,

C. T.

(2013). Dynamic parameters of balance which correlate to elderly persons with a history of falls. PloS One, 8(8), e70566.

17.

O’Neil,

M. E.

, Fragala-Pinkham,

, Lennon,

, George,

, Forman,

, & Trost,

S. G.

(2016). Reliability and validity of objective measures of physical activity in youth with cerebral palsy who are ambulatory. Physical Therapy, 96(1), 37–45.

18.

Park,

E.Y.

, & Park,

S.Y.

(2010). Comparison of reliability and validity between GMFM-88 and GMFM-66 in children with cerebral palsy. Physical Therapy Korea, 17(3), 40–47.

19.

Prado,

J. M.

, Stoffregen,

T. A.

, & Duarte,

(2007). Postural sway during dual tasks in young and elderly adults. Gerontology, 53(5), 274–281.

20.

Saxena,

, Rao,

B. K.

, & Kumaran,

(2014). Analysis of postural stability in children with cerebral palsy and children with typical development: an observational study. PediatricPhysical Therapy, 26(3), 325–330.

21.

Senden,

, Savelberg,

, Grimm,

, Heyligers,

, & Meijer,

(2012). Accelerometry-based gait analysis, an additional objective approach to screen subjects at risk for falling. Gait & Posture, 36(2), 296–300.

22.

Shahzad,

, Ko,

, Lee,

J.A

, & Kim,

(2017). Quantitative assessment of balance impairment for fall-risk estimation using wearable triaxial accelerometer. IEEE Sensors Journal, 17(20), 6743–6751.

23.

Shany,

, Redmond,

S. J.

, Narayanan,

M. R.

, & Lovell,

N. H.

(2011). Sensors-based wearable systems for monitoring of human movement and falls. IEEE Sensors Journal, 12(3), 658–670.

24.

Tracy, James

, Drew Petersen,

, Jamie Pigman,

Benjamin Conner,

Henry Wright,

, Christopher Modlesky,

, Freeman Miller, , Curtis Johnson,

, & Jeremy Crenshaw,

(2019). Dynamic Stability During Walking in Children with and without Cerebral Palsy. Gait & Posture, 72, 182–187.

25.

Winter,

D. A.

(2009). Biomechanics and motor control of human movement. John Wiley & Sons.

26.

Yi,

S.H.

, Hwang,

J. H.

, Kim,

S. J.

, & Kwon,

J.Y.

(2012). Validity of pediatric balance scales in children with spastic cerebral palsy. Neuropediatrics, 43(06), 307–313.

27.

You,

S. H.

(2005). Joint position sense in elderly fallers: a preliminary investigation of the validity and reliability of the SENSERite measure. Archives of Physical Medicine and Rehabilitation, 86(2), 346–352.