Bridging Clinical Capacity and Real-World Performance: Upper and Lower Limb Accelerometry in Pediatric Cerebral Palsy Rehabilitation

The rehabilitation of children with cerebral palsy (CP) has progressively evolved from therapist-centered, impairment-focused models to child- and family-centered approaches that emphasize real-world participation. This narrative review summarizes conceptual and practical shifts in CP rehabilitation, highlighting the distinction between motor capacity and real-world performance. Accelerometry is a critical objective tool for assessing lower and upper limb physical activity. Devices such as StepWatch and ActiGraph provide ecologically valid data on lower limb activity levels, step counts, and energy expenditure. Studies have shown reduced physical activity in children with CP compared to their typically developing peers, with variations in age and GMFCS levels. For the upper limbs, wrist-worn accelerometers quantify asymmetry and movement frequency using metrics such as the use ratio, magnitude ratio, asymmetry index, and bilateral-arm use index. These data correlate well with standardized assessments, including the Assisting Hand Assessment, enabling a more precise evaluation of functional use in daily life. However, many studies have reported that intervention-induced gains in activity levels often fail to generalize or persist after intervention. Aligning accelerometer-based monitoring with individualized and meaningful goals, such as those prioritized by children and families, may improve the ecological validity and long-term impacts. Future research should emphasize the integration of objective data with participatory goals to enhance real-world outcomes in children with CP.