Efficacy of a home‐based platform for child‐to‐child interaction on hand motor function in unilateral cerebral palsy

Abstract

Aim To evaluate the feasibility and effectiveness of an action observation treatment (AOT) home‐based platform promoting child‐to‐child interaction to improve hand motor function in unilateral cerebral palsy (CP). Method Twenty children (14 males, six females; mean age 6y 7mo, standard deviation 1y 7mo; range 5y 1mo–10y 6mo) with unilateral CP underwent 20 sessions where they had to observe and then imitate a wizard performing dexterity‐demanding magic tricks; a child‐to‐child live video‐session to practise the same exercise then took place. We assessed hand‐motor skills with the Besta Scale, neurological motor impairment with Fugl‐Meyer Assessment for upper extremity, as well as spasticity, muscle strength, visual analogue scale, and global impression of change 1‐month before (T‐1), at baseline (T0), and at the end of treatment (T1). Results We observed a T0 to T1 improvement in global hand‐motor and bimanual skills, and a significant correlation between motor improvement and difference in hand motor skills relative to the peer (r=–0.519). Interpretation AOT associated with child‐to‐child interaction effectively improves hand motor function in unilateral CP. This improvement is linked to differences in hand motor ability among peers, suggesting that children should observe others with superior motor skills to their own. This study extends traditional AOT toward novel socially‐enriched scenarios, where children might simultaneously be recipients and leaders within a motor learning process. What this paper adds Home‐based action observation treatment (AOT) based on child‐to‐child interaction improves hand motor function in children with unilateral cerebral palsy. Interaction with a more capable peer increases the chances of positive outcome in child‐to‐child AOT.

Conventional and Virtual Reality Mirror Therapies in Upper Obstetric Brachial Palsy: A Randomized Pilot Study

“…This would allow the individual to identify the goal of the observed action relying mainly on her or his own motor processes and representations [ 32 ]. In line with this, in neurological diseases, action observation is thus able to access the motor system, favoring cortical reorganization and ultimately affecting motor abilities [ 33 , 34 , 35 ]. Such an approach, known as Action Observation Treatment (AOT), has proven effective in improving upper limb motor abilities in several neurological diseases, presenting the advantage of being applicable also at the patient’s own home [ 35 ].…”

Home‐based action observation treatment for children with unilateral cerebral palsy: strategies to promote intervention engagement

“…In the study by Nuara et al., the authors analyzed the feasibility of a home‐based AOT protocol with strategies to engage children with unilateral cerebral palsy (CP) in the proposed tasks. They included attractive magic‐themed activities, the use of a kinetic device to provide positive feedback when the child used the affected upper extremity in the training of magic tricks, and an interactive platform in which the child practiced the tasks with another child with CP of similar age.…”

“…There are currently many assessments available to measure hand function in children with unilateral CP. Nuara et al . opted for using the Besta Scale as the primary outcome measure, which measures hand function (capacity and performance) in three areas: grasp assessment, spontaneous use in bimanual tasks, and activities of daily living .…”

“…There are currently many assessments available to measure hand function in children with unilateral CP. Nuara et al 2 opted for using the Besta Scale as the primary outcome measure, which measures hand function (capacity and performance) in three areas: grasp assessment, spontaneous use in bimanual tasks, and activities of daily living. 5 Of special concern is the low number of daily living activities in the test, which raises the question of whether the instrument is able to capture the complexities involved in children's use of their hands in their daily routines.…”

“…In a home‐based program, the inclusion of a platform to promote child‐to‐child interaction when performing activities may have helped the children to find solutions when dealing with challenges to use their hands, based on the strategies used by another child with unilateral CP. The thorough description of the intervention procedures by Nuara et al . facilitates the use of these strategies in clinical practice and the replication of the proposed protocol in future studies.…”