Randomized controlled trial of web‐based multimodal therapy for unilateral cerebral palsy to improve occupational performance

Abstract

Aim The study aimed to investigate the effectiveness of a web‐based therapy programme, ‘Move it to improve it’ (Mitii™), in children with unilateral cerebral palsy (UCP) on occupational performance, upper limb function, and visual perception. Method Participants (n=102) were matched in pairs and randomized to intervention (Mitii for 20wks; 26 males, mean age 11y 8mo [2y 4mo], Manual Ability Classification System level I=11, II=39, III=1) or control (standard care; 25 males, mean age 11y 10mo [2y 5mo], Manual Ability Classification System level I=13, II=37). Outcomes were the Assessment of Motor and Process Skills (AMPS), Assisting Hand Assessment, Jebsen–Taylor Test of Hand Function (JTTHF), Melbourne Assessment of Unilateral Upper Limb Function (MUUL), Canadian Occupational Performance Measure (COPM), and Test of Visual Perceptual Skills (TVPS‐3). Results Participants completed on average 32.4 hours of Mitii (range 3.7–74.7h). The Mitii group demonstrated significantly greater post‐intervention scores than the comparison group on the AMPS, JTTHF dominant upper limb, COPM, and TVPS‐3. The differences between groups were not clinically significant. There were no differences between groups on measures of impaired upper limb function. Interpretation Mitii delivers individualized, web‐based therapy at home and has potential to increase therapy dose. Mitii can be considered as an option to enhance occupational performance and visual perception for children with UCP.

Randomized controlled trial of a web-based multi-modal therapy program for executive functioning in children and adolescents with unilateral cerebral palsy

“…Our hypotheses were not supported in that there were no significant differences at 20 weeks in EF capacity or performance for children who were allocated to the Mitii TM group as compared to children in the waitlist control group. This is in contrast to primary outcomes of the larger RCT, in which significant improvements in upper limb function, visual perception, and physical strength were found at 20 weeks following the Mitii TM intervention [25,26] .…”

“…The lack of effect on EF outcomes is consistent with the outcomes of this RCT broadly; in the sense that the improvements found were specific to the modules trained or specificity of the practice. For example, the significant outcomes of the Mitii TM group compared to the control group on upper limb functioning, visual perception, and manual dexterity were specific to the modules trained in Mitii TM [25] . Overall this is also consistent with findings from other studies, in which skills practiced improve with online or web-based training, however generalisation to other skills or everyday functioning is not always evident [15,16,21,33] .…”

“…This paper reports the EF results from an RCT of Mitii TM . The effectiveness of Mitii on improving motor planning and physical activity outcomes in this cohort has been reported [25,26] . The primary hypothesis for the present study was that Mitii™ would improve capacity on tests of EF.…”

Do we really know what they were testing? Incomplete reporting of interventions in randomised trials of upper limb therapies in unilateral cerebral palsy

“…Home programs were variously described as lists of activities, manual of exercises (Klingels et al, 2013), home program with neurodevelopmental activities (Law, Cadman, Rosenbaum, Walter, Russell, & Dematteo, 1991;Law, Russell, Pollock, Rosenbaum, Walter, & King, 1997) or written lists of training tasks (Taub, Griffin, Uswatte, Gammons, Nick, & Law, 2011). Four studies provided details of the content and structure of the home program (Aarts et al, 2012;Abd El-Kafy et al, 2014;Deppe et al, 2013;Eliasson, Shaw, Berg, & Krumlinde-Sundholm, 2011), three described commercially available video or web-based games (Chiu et al, 2014;James et al, 2015;Zoccolillo et al, 2015) and the remaining studies had inadequate details to replicate either the structure or content of the home program.…”

Interactive computer play – what happens when the game is over?

“…ICP can be defined as 'any kind of computer game or virtual-reality technique where the child can interact and play with virtual objects in a computer generated environment '. 3 With the advantage of being able to provide ample opportunities to individualize and create fun and engaging exercise environments, an online-based training concept 'Move it to improve it' (Mitii) was investigated by James et al 4 James et al's study is important and timely with interactive computer games being popular amongst children in general. The use of ICP in therapy is a relatively new research field.…”