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BMC Pediatrics

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Open Access 01-12-2021 | Study protocol

Game-based training of selective voluntary motor control in children and youth with upper motor neuron lesions: protocol for a multiple baseline design study

Authors: Annina Fahr, Andrina Kläy, Larissa S. Coka, Hubertus J. A. van Hedel

Published in: BMC Pediatrics | Issue 1/2021

Abstract

Background

Impairments of selective control of joint movements can have consequences for many activities of daily life, but there are only a few interventions to improve selective voluntary motor control (SVMC). We have developed a treatment option to specifically enhance SVMC exploiting the advantages of interactive computer play technology. It targets SVMC by training selective activation of a muscle or a selective joint movement while it provides immediate feedback about involuntary muscle activations/movements at an (unwanted) joint. This study aims to investigate the effectiveness of this game-based intervention to enhance SVMC in children and youth with upper motor neuron lesions.

Methods

We will conduct a randomized, non-concurrent, multiple baseline design study. Patients aged between 6 and 20 years with reduced SVMC due to an upper motor neuron lesion will be included. During the baseline phase of random length, participants will attend their regular intensive rehabilitation program, and in the intervention phase, they will additionally complete 10 therapy sessions (à 40 min) of the game-based SVMC training. The primary outcome will be a short SVMC assessment conducted repeatedly throughout both phases, which quantifies movement accuracy and involuntary movements. Changes in clinical SVMC measures, muscle strength, cortical excitability, motor control of the inhibited/unwanted movement, and functional independence will be assessed as secondary outcomes. We will use a mixed-effect model to determine the change in the course of the primary outcome when the intervention is introduced, and we will compare changes between phases for secondary outcomes with paired tests.

Discussion

This study will provide first evidence whether SVMC can be improved with our game-based training. The single-case design takes into account the individualization required for this intervention, and it can help to address the challenges of intervention trials in our setting.

Trial registration

German Clinical Trials Register: DRKS00025184, registered on 28.04.2021.

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Cahill-Rowley K, Rose J. Etiology of impaired selective motor control: emerging evidence and its implications for research and treatment in cerebral palsy. Dev Med Child Neurol. 2014;56(6):522–8.PubMedCrossRef

Sanger TD, Chen D, Delgado MR, Gaebler-Spira D, Hallett M, Mink JW. Definition and classification of negative motor signs in childhood. Pediatrics. 2006;118(5):2159–67.PubMedCrossRef

Addamo PK, Farrow M, Hoy KE, Bradshaw JL, Georgiou-Karistianis N. The effects of age and attention on motor overflow production - a review. Brain Res Rev. 2007;54(1):189–204.PubMedCrossRef

Perry J. Determinants of muscle function in the spastic lower extremity. Clin Orthop Relat Res. 1993;288:10–26.CrossRef

Adler C, Berweck S, Lidzba K, Becher T, Staudt M. Mirror movements in unilateral spastic cerebral palsy: specific negative impact on bimanual activities of daily living. Eur J Paediatr Neurol. 2015;19(5):504–9.PubMedCrossRef

Kuo H-C, Friel KM, Gordon AM. Neurophysiological mechanisms and functional impact of mirror movements in children with unilateral spastic cerebral palsy. Dev Med Child Neurol. 2018;60(2):155–61.PubMedCrossRef

Schiariti V, Mâsse LC. Relevant areas of functioning in children with cerebral palsy based on the international classification of functioning, disability and health coding system: a clinical perspective. J Child Neurol. 2015;30(2):216–22.PubMedCrossRef

Østensjø S, Carlberg EB, Vøllestad NK. Motor impairments in young children with cerebral palsy: relationship to gross motor function and everyday activities. Dev Med Child Neurol. 2004;46(9):580–9.PubMedCrossRef

Noble JJ, Gough M, Shortland AP. Selective motor control and gross motor function in bilateral spastic cerebral palsy. Dev Med Child Neurol. 2019;61(1):57–61.PubMedCrossRef

10.

Vos RC, Becher JG, Voorman JM, Gorter JW, van Eck M, van Meeteren J, et al. Longitudinal association between gross motor capacity and neuromusculoskeletal function in children and youth with cerebral palsy. Arch Phys Med Rehabil. 2016;97(8):1329–37.PubMedCrossRef

11.

Voorman JM, Dallmeijer AJ, Knol DL, Lankhorst GJ, Becher JG. Prospective longitudinal study of gross motor function in children with cerebral palsy. Arch Phys Med Rehabil. 2007;88(7):871–6.PubMedCrossRef

12.

Zhou JY, Lowe E, Cahill-Rowley K, Mahtani GB, Young JL, Rose J. Influence of impaired selective motor control on gait in children with cerebral palsy. J Child Orthop. 2019;13(1):73–81.PubMedPubMedCentralCrossRef

13.

Fahr A, Keller JW, van Hedel HJA. A systematic review of training methods that may improve selective voluntary motor control in children with spastic cerebral palsy. Front Neurol. 2020;11:1620.CrossRef

14.

Wu Y-N, Hwang M, Ren Y, Gaebler-Spira D, Zhang L-Q. Combined passive stretching and active movement rehabilitation of lower-limb impairments in children with cerebral palsy using a portable robot. Neurorehabil Neural Repair. 2011;25(4):378–85.PubMedCrossRef

15.

Rios DC, Gilbertson T, McCoy SW, Price R, Gutman K, Miller KEF, et al. NeuroGame therapy to improve wrist control in children with cerebral palsy: a case series. Dev Neurorehabil. 2013;16(6):398–409.PubMedCrossRef

16.

Holden MK. Virtual environments for motor rehabilitation. CyberPsychol Behav. 2005;8(3):187–211.PubMedCrossRef

17.

Fahr A, Kläy A, Keller JW, van Hedel HJA. An interactive computer game for improving selective voluntary motor control in children with upper motor neuron lesions: development and preliminary feasibility study. JMIR Serious Games. 2021;9(3):e26028.PubMedPubMedCentralCrossRef

18.

Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39(4):214–23.PubMedCrossRef

19.

Eliasson A-C, Krumlinde-Sundholm L, Rösblad B, Beckung E, Arner M, Öhrvall A-M, et al. The manual ability classification system (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Dev Med Child Neurol. 2006;48(7):549–54.PubMedCrossRef

20.

Hislop H, Avers D, Brown M. Daniels and Worthingham’s muscle testing: techniques of manual examination and performance testing. 9th ed: Elsevier Health Sciences; 2013.

21.

Bohannon R, Smith M. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67(2):206–7.PubMedCrossRef

22.

Jethwa A, Mink J, Macarthur C, Knights S, Fehlings T, Fehlings D. Development of the hypertonia assessment tool (HAT): a discriminative tool for hypertonia in children. Dev Med Child Neurol. 2010;52(5):e83–7.PubMedCrossRef

23.

Marsico P, Frontzek-Weps V, Balzer J, van Hedel HJA. Hypertonia assessment tool: reliability and validity in children with neuromotor disorders. J Child Neurol. 2017;32(1):132–8.PubMedCrossRef

24.

Wei LJ, Lachin JM. Properties of the urn randomization in clinical trials. Control Clin Trials. 1988;9(4):345–64.PubMedCrossRef

25.

Keller JW, Balzer J, Fahr A, Lieber J, Keller U, van Hedel HJA. First validation of a novel assessgame quantifying selective voluntary motor control in children with upper motor neuron lesions. Sci Rep. 2019;9(1):19972.PubMedPubMedCentralCrossRef

26.

Keller JW, Fahr A, Balzer J, Lieber J, van Hedel HJA. Validity and reliability of an accelerometer-based assessgame to quantify upper limb selective voluntary motor control. J Neuroeng Rehabil. 2020;17(1):89.PubMedPubMedCentralCrossRef

27.

Fowler EG, Staudt LA, Greenberg MB, Oppenheim WL. Selective control assessment of the lower extremity (SCALE): development, validation, and interrater reliability of a clinical tool for patients with cerebral palsy. Dev Med Child Neurol. 2009;51(8):607–14.PubMedCrossRef

28.

Wagner LV, Davids JR, Hardin JW. Selective Control of the Upper Extremity Scale: validation of a clinical assessment tool for children with hemiplegic cerebral palsy. Dev Med Child Neurol. 2016;58(6):612–7.PubMedCrossRef

29.

Balzer J, Marsico P, Mitteregger E, van der Linden ML, Mercer TH, van Hedel HJA. Construct validity and reliability of the selective control assessment of the lower extremity in children with cerebral palsy. Dev Med Child Neurol. 2016;58(2):167–72.PubMedCrossRef

30.

Lieber J, Gartmann T, Keller JW, van Hedel HJA. Validity and reliability of the selective control of the upper extremity scale in children with upper motor neuron lesions. Disabil Rehabil. 2021:1–7. https://doi.org/10.1080/09638288.2021.1881171.

31.

Balzer J, Marsico P, Mitteregger E, van der Linden MLML, Mercer THTH, van Hedel HJAHJA. Influence of trunk control and lower extremity impairments on gait capacity in children with cerebral palsy. Disabil Rehabil. 2018;40(26):3164–70.PubMedCrossRef

32.

van Hedel HJA, Murer C, Dietz V, Curt A. The amplitude of lower leg motor evoked potentials is a reliable measure when controlled for torque and motor task. J Neurol. 2007;254(8):1089–98.PubMedCrossRef

33.

Ribeiro AC, Araújo-Neto SA. Localizing the primary motor cortex of the hand by the 10-5 and 10-20 systems for neurostimulation: an MRI study. Clin EEG Neurosci. 2021;52(6):427–35. https://doi.org/10.1177/1550059420934590.

34.

Uniform Data System for Medical Rehabilitation. The WeeFIM II Clinical Guide, Version 6.0. Buffalo: UDSMR; 2006.

35.

Cohen J. Statistical power analysis for the behavioral sciences (revised ed). New York: Academic Press; 1977.

36.

Champely S, De Rosario H. pwr: Basic functions for power analysis [Internet]. 2020. Available from: https://github.com/heliosdrm/pwr

37.

Hsieh FY, Lavori PW, Cohen HJ, Feussner JR. An overview of variance inflation factors for sample-size calculation. Eval Health Prof. 2003;26(3):239–57.PubMedCrossRef

38.

R Core Team. R: A Language and Environment for Statistical Computing. Vienna: R Foundation for Statistical Computing; 2018. https://www.R-project.org/.

39.

Beckers LWME, Stal RA, Smeets RJE, Onghena P, Bastiaenen CHG. Single-case design studies in children with cerebral palsy: a scoping review. Dev Neurorehabil. 2020;23(2):73–105.PubMedCrossRef

40.

Ledford JR, Gast DL, editors. Single case research methodology: applications in special education and behavioral sciences. 3rd ed. New York: Routledge; 2014.

41.

Kratochwill TR, Hitchcock J, Horner RH, Levin JR, Odom SL, Rindskopf DM, Shadish WR. Single-case designs technical documentation. [Internet]. What Works Clearinghouse. 2010. Available from: https://ies.ed.gov/ncee/wwc/Docs/ReferenceResources/wwc_scd.pdf

42.

Krasny-Pacini A, Evans J. Single-case experimental designs to assess intervention effectiveness in rehabilitation: a practical guide. Ann Phys Rehabil Med. 2018;61(3):164–79.PubMedCrossRef

43.

Damiano DL, Leonard R. 2014 section on pediatrics knowledge translation lecture. Pediatr Phys Ther. 2015;27(2):105–12.PubMedPubMedCentralCrossRef

44.

Shamseer L, Sampson M, Bukutu C, Schmid CH, Nikles J, Tate R, et al. CONSORT extension for reporting N-of-1 trials (CENT) 2015: explanation and elaboration. BMJ. 2015;350:h1793.PubMedCrossRef

45.

Romeiser-Logan L, Slaughter R, Hickman R. Single-subject research designs in pediatric rehabilitation: a valuable step towards knowledge translation. Dev Med Child Neurol. 2017;59(6):574–80.PubMedCrossRef

46.

Rast FM, Labruyère R. ICF mobility and self-care goals of children in inpatient rehabilitation. Dev Med Child Neurol. 2020;62(4):483–8.PubMedCrossRef

47.

Sukal-Moulton T, Clancy T, Zhang L-Q, Gaebler-Spira D. Clinical application of a robotic ankle training program for cerebral palsy compared to the research laboratory application: does it translate to practice? Arch Phys Med Rehabil. 2014;95(8):1433–40.PubMedPubMedCentralCrossRef

48.

Chen K, Wu Y-N, Ren Y, Liu L, Gaebler-Spira D, Tankard K, et al. Home-based versus laboratory-based robotic ankle training for children with cerebral palsy: a pilot randomized comparative trial. Arch Phys Med Rehabil. 2016;97(8):1237–43.PubMedCrossRef

49.

Keller JW, Fahr A, Balzer J, Lieber J, van Hedel HJ. Validity and reliability of an electromyography-based upper limb assessment quantifying selective voluntary motor control in children with upper motor neuron lesions. Sci Prog. 2021;104(2):368504211008058. https://doi.org/10.1177/00368504211008058.

Title: Game-based training of selective voluntary motor control in children and youth with upper motor neuron lesions: protocol for a multiple baseline design study
Authors: Annina Fahr
Andrina Kläy
Larissa S. Coka
Hubertus J. A. van Hedel
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: BMC Pediatrics / Issue 1/2021
Electronic ISSN: 1471-2431
DOI: https://doi.org/10.1186/s12887-021-02983-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Game-based training of selective voluntary motor control in children and youth with upper motor neuron lesions: protocol for a multiple baseline design study

Abstract

Background

Methods

Discussion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Discussion

Trial registration

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