L. Kent1, C. Kerr1, C. Saunders2, A. Ennis2, C. Nugent2, I. Cleland2
1Queen's University Belfast, School of Nursing and Midwifery, Belfast, United Kingdom, 2Ulster University, Connected Health Innovation Centre, Newtownabbey, United Kingdom
Background: Cerebral palsy (CP), a disorder of movement and posture, is the most common physical disability of childhood. Accurate assessment of movement is core to physiotherapy practice with children with CP but is often confined to a specialist laboratory setting. Wearable sensor technologies can provide detailed physiological and performance measurements outside the clinic or laboratory environment, thereby helping patients and clinicians evaluate therapies and monitor progress over time in ‘real-world’ settings.
Purpose: To develop a sensor-based Digital Toolkit for objective assessment of movement in children with CP. Aims were to identify outcome domains amenable to change when using mobility devices; understand what end users consider important to measure when assessing the effects of mobility devices; map important outcome domains to potential sensor-based solutions; and evaluate and select sensor technologies.
Methods: The Digital Toolkit was developed using a sequential process comprising four steps based on both healthcare and technology design frameworks (NIHR 2019; Caulfield et al 2019; Booth et al 2019). The multidisciplinary team of physiotherapists and computer scientists were involved at all stages.
Step 1: The ICF Core Sets for CP was used as framework to identify potential outcome domains of interest. This was supplemented via rapid reviews of the literature using the Medline and EMBASE databases.
Step 2: Three user engagement workshops were held with physiotherapists and children and families living with CP to prioritise outcome domains.
Step 3: Prioritised outcome domains were mapped to potential sensor technologies.
Step 4: Sensors were evaluated against predefined criteria.
Step 1: The ICF Core Sets for CP was used as framework to identify potential outcome domains of interest. This was supplemented via rapid reviews of the literature using the Medline and EMBASE databases.
Step 2: Three user engagement workshops were held with physiotherapists and children and families living with CP to prioritise outcome domains.
Step 3: Prioritised outcome domains were mapped to potential sensor technologies.
Step 4: Sensors were evaluated against predefined criteria.
Results: Step 1: Nineteen domains of potential relevance were shortlisted from the ICF core set and rapid reviews.
Step 2: Nine adults from seven families attended a family workshop. Eleven physiotherapists and three technical instructors attended a clinician workshop. Both user groups considered joint mobility and pain as important domains to measure when assessing the effects of mobility devices. Other impairment domains prioritised by families included muscle tone and muscle power, whereas physiotherapy staff included exercise tolerance and control of voluntary movement as top ranked domains. Differences were evident between physiotherapist and family rankings of importance of outcome domains in relation to impairment and activity and participation.
Step 3: Prioritised outcome domains were successfully mapped to potential sensor technologies, with the exception of pain.
Step 4: Evaluation of the potential sensors resulted in three sensor-based technology solutions being selected for inclusion in the Digital Toolkit.
Step 2: Nine adults from seven families attended a family workshop. Eleven physiotherapists and three technical instructors attended a clinician workshop. Both user groups considered joint mobility and pain as important domains to measure when assessing the effects of mobility devices. Other impairment domains prioritised by families included muscle tone and muscle power, whereas physiotherapy staff included exercise tolerance and control of voluntary movement as top ranked domains. Differences were evident between physiotherapist and family rankings of importance of outcome domains in relation to impairment and activity and participation.
Step 3: Prioritised outcome domains were successfully mapped to potential sensor technologies, with the exception of pain.
Step 4: Evaluation of the potential sensors resulted in three sensor-based technology solutions being selected for inclusion in the Digital Toolkit.
Conclusion(s): A systematic, multidisciplinary approach that engaged relevant stakeholders, facilitated the successful development of a novel sensor-based Digital Toolkit for measuring movement in children with CP. Collaborative working was critical in this process, firstly in understanding the priorities of families and clinicians when developing new assessment tools and secondly, the multidisciplinary approach involving physiotherapists and computer scientists was integral in development of a common vision for the Digital Toolkit and planning future research.
Implications: The results of this process have been used to design a feasibility study evaluating the Digital Toolkit as a means of assessing effectiveness of a mobility device in children with CP.
Funding, acknowledgements: Invest Northern Ireland is acknowledged for supporting this project under the Competence Centre Programme Grant - Connected Health Innovation Centre (RD1014267).
Keywords: cerebral palsy, assessment, technology
Topic: Paediatrics: cerebral palsy
Did this work require ethics approval? No
Institution: Queen's University Belfast
Committee: University Research Ethics and Governance Department
Reason: Systematic review and patient and public involvement (PPI) activity. Ethical review was not required for PPI activity to inform future research.
All authors, affiliations and abstracts have been published as submitted.
