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Updated: Jul 30, 2025
A Method for Quantifying Upper Limb Performance in Daily Life Using Accelerometers
Published on: April 21, 2017
Construct Validity of the Both Hands Assessment Using Wrist-Worn Accelerometers
Andrea Burgess1, Stina Oftedal1, Roslyn N Boyd1
1Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
Insights
This study validates the Both Hands Assessment (BoHA) for children with cerebral palsy (CP) using accelerometers to measure upper limb activity, confirming its effectiveness in assessing performance.
Area of Science:
- Biomedical Engineering
- Rehabilitation Medicine
- Pediatric Neurology
Background:
- Cerebral palsy (CP) significantly impacts upper limb function in children.
- Objective measurement of upper limb activity is crucial for assessing CP-related impairments.
- The Both Hands Assessment (BoHA) is a clinical tool, but its construct validity needs further evaluation.
Purpose of the Study:
- To evaluate the construct validity of the Both Hands Assessment (BoHA).
- To correlate BoHA scores with objective upper limb activity data from accelerometry in children with bilateral CP.
Main Methods:
- An observational study included 44 children with bilateral CP (27 boys, mean age 9.1 years).
- Participants underwent BoHA assessment while wearing triaxial accelerometers on each wrist.
- Linear regression analyses examined associations between BoHA metrics and accelerometer-derived activity measures.
Main Results:
- Significant positive associations were found between BoHA Units and total mean activity (B=0.86).
- BoHA Percentage difference between hands correlated with mean activity asymmetry index (B=0.95).
- BoHA Each-Hand sub-score linked to non-dominant hand activity (B=1.71) but not dominant hand activity.
Conclusions:
- The study supports the construct validity of the BoHA for assessing upper limb performance in children with CP.
- Accelerometers effectively quantify gross upper limb movements but do not capture fine motor skills assessed by BoHA.
Aim:
The aim of this study was to evaluate the construct validity of the Both Hands Assessment (BoHA) using activity of the upper limbs as detected by accelerometry in children with bilateral cerebral palsy (CP).
Methods:
Observational study of children with CP (n = 44, n = 27 boys, aged 9.1 ± 1.6 years; Manual Ability Classification Scale I: n = 15, II: n = 22, III: n = 7) completing a BoHA assessment while wearing a triaxial accelerometer on each wrist. BoHA Each-Hand sub-scores, BoHA percentage difference between hands, BoHA Units, mean activity for each hand, mean activity asymmetry index and total mean activity were calculated. Linear regressions were used to analyze associations between measures.
Results:
There were significant, positive associations between BoHA Units and total mean activity (B = 0.86, 95%CI: 0.32, 1.40), BoHA Percentage difference between hands and mean activity asymmetry index (B = 0.95, 95%CI: 0.75,1.15), and BoHA Each-Hand sub-score and mean activity for the non-dominant hand (B = 1.71, 95%CI: 1.16, 2.28), but not the dominant hand (B = 0.50, 95%CI: -0.45, 1.45).
Conclusions:
This study provides further evidence for the construct validity of the BoHA as a measure of upper limb performance. Wearable wrist sensors such as accelerometers capture and quantify gross upper limb movement in children with CP but cannot measure fine finger movements captured by the BoHA.
Clinical Trials Registration:
Australian New Zealand Clinical Trials Registry (ACTRN12616001488493 and ACTRN12618000164291).
