Evaluation of a computer game-assisted rehabilitation program for manual dexterity of children with cerebral palsy: Feasibility randomized control trial.

INTRODUCTION: There is a need for innovation to improve the engagement and compliance of rehabilitation programs for children with upper extremity (UE) motor impairments due to Cerebral Palsy (CP); a computer games-based rehabilitation platform (GRP) was developed to address this need. The GRP provides engaging task-specific exercises targeting manual dexterity (object handling and manipulation).

OBJECTIVE: An exploratory randomized clinical trial was conducted to evaluate the therapeutic value and treatment effect size of an exercise program using the GRP in children with CP.

METHODS: A total of sixty-three children with CP, aged 4 to 10 years, were recruited. The Peabody Developmental Motor Scale-2 (PDMS-2) Grasp and Visual-Motor Integration subscores and Computer game-based Upper Extremity (CUE) assessment of manual dexterity was used to assess participants before and after a 16-week intervention program, delivered three times per week. The experimental group (XG) received a computer games-based exercise program targeting object manipulation tasks. The active control arm (CG) consisted of task-specific training similar to the tasks used in constrained induced movement therapy.

RESULTS: There were only a few dropouts during the 16-week program, and compliance was high. Both groups showed significant improvements with medium to large effect sizes. Improvements in the PDMS-2 Grasp and VMI subscores observed in the XG were significantly greater than that in the CG. There was a significant improvements (p<0.01) in PDMS-2 grasp and VMI subscores for XG with moderate to large effect sizes, (0.5-0.8). For CG, the Grasp and VMI subscores did improve but these changes were not statistically significant. There was a significant improvement observed in the majority of CUE object manipulation test scores for XG (p<0.01) with moderate to large effect sizes (0.50-1.2) Although CG did show improvements in all CUE object manipulation test scores the changes did not reach statistical significance (p<0.01).

CONCLUSION: This study demonstrates the utility of the GRP to practice a broad range of object manipulation tasks in children with CP. The present findings are positive and support further research and development. The long-term effects of the GRP program in children with CP will need to be confirmed in a future randomized controlled trial. In addition to measures of structure and function, future RCT should also include outcome measures such as health-related quality of life and level of participation to validate the findings.