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Efcacy of integrating a semi-immersive virtual device in the HABIT-ILE intervention for children with unilateral cerebral palsy: a non-inferiority randomized controlled trial

2024-10-02T13:48:04Z

Efcacy of integrating a semi-immersive virtual device in the HABIT-ILE intervention for children with unilateral cerebral palsy: a non-inferiority randomized controlled trial Saussez, Geoffroy; Bailly, R.; Araneda, Rodrigo; Paradis, Julie; Ebner-Karestinos, Daniela; Klöcker, Anne; Sogbossi, E. S.; Riquelme, I.; Bleyenheuft, Yannick Background The implementation of virtual devices can facilitate the role of therapists (e.g., patient motivation, intensity of practice) to improve the effectiveness of treatment for children with cerebral palsy. Among existing therapeutic devices, none has been specifically designed to promote the application of principles underlying evidence-based motor skill learning interventions. Consequently, evidence is lacking regarding the effectiveness of virtual-based sessions in motor function rehabilitation with respect to promoting the transfer of motor improvements into daily life activities. We tested the effectiveness of implementing a recently developed virtual device (REAtouch®), specifically designed to enable the application of therapeutic motor skill learning principles, during a Hand Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) intervention. Methods Forty children with unilateral cerebral palsy (5–18 years; MACS I-III; GMFCS I-II) were randomly assigned to a control group or a “REAtouch®” experimental group for a 90-h HABIT-ILE day-camp intervention (two weeks). Children in the REAtouch® group spent nearly half of their one-on-one therapeutic time using the REAtouch®. Participants underwent three testing sessions: the week before (T1), after intervention (T2), and at three months follow-up (T3). The primary outcome was the Assisting Hand Assessment (T3–T1; blinded). Secondary outcomes measured uni-bimanual hand function, stereognosis, gait endurance, daily life abilities, and functional goals. Accelerometers and a manual report of daily activities served to document therapeutic dosage and treatment characteristics. We used one-way RMANOVA to compare the efficacies of the two interventions, and non-inferiority analyses to contrast changes in the “REAtouch®” group versus the “HABIT-ILE” control group. Results We found significant improvements in both groups for most of the outcome measures (p < 0.05). There was significant non-inferiority of changes in the REAtouch® group for upper extremities motor function, functional goals attainment, and abilities in daily life activities (p < 0.05). Conclusions Use of the REAtouch® device during HABIT-ILE showed non-inferior efficacy compared to the conventional evidence-based HABIT-ILE intervention in children with unilateral cerebral palsy. This study demonstrates the feasibility of using this virtual device in a high dosage camp model, and establishes the possibility of applying the therapeutic principles of motor skill learning during specifically designed virtual-based sessions. Trial registration: Trial registration number: NCT03930836-Registration date on the International Clinical Trials Registry Platform (ICTRP): June 21th, 2018; Registration date on NIH Clinical Trials Registry: April 29th, 2019. First patient enrollment: July 3rd, 2018.

Brain activation changes following motor training in children with unilateral cerebral palsy: An fMRI study

2024-10-02T13:07:07Z

Brain activation changes following motor training in children with unilateral cerebral palsy: An fMRI study Araneda, Rodrigo; Dricot, Laurance; Ebner-Karestinos, Daniela; Paradis, Julie; Gordon, Andrew M.; Friel, Kathleen M.; Bleyenheuft, Yannick Background Intensive motor-learning-based interventions have demonstrated efficacy for improving motor function in children with unilateral spastic cerebral palsy (USCP). Although this improvement has been associated mainly with neuroplastic changes in the primary sensori-motor cortices, this plasticity may also involve a wider fronto-parietal network for motor learning. Objective To determine whether hand-arm bimanual intensive therapy including lower extremities (HABIT-ILE) induces brain activation changes in an extensive network for motor skill learning and whether these changes are related to functional changes observed after HABIT-ILE. Methods In total, 25 children with USCP were behaviourally assessed in manual dexterity and everyday activities before and after HABIT-ILE. Functional imagery monitored brain activity while participants manipulated objects using their less-affected, more-affected or both hands. Two random-effects-group analyses performed at the whole-brain level assessed the brain activity network before and after therapy. Three other random-effects-group analyses assessed brain activity changes after therapy. Spearman's correlations were used to evaluate the correlation between behavioural and brain activity changes. Results The same fronto-parietal network was identified before and after therapy. After the intervention, the more-affected hand manipulation elicited a decrease in activity on the motor cortex of the non-lesional hemisphere and an increase in activity on motor areas of the lesional hemisphere. The less-affected hand manipulation generated a decrease in activity of sensorimotor areas in the non-lesional hemisphere. Both-hands manipulation elicited an increase in activity of both hemispheres. Furthermore, we observed an association between brain activity changes and changes in everyday activity assessments. Conclusion Brain activation changes were observed in a fronto-parietal network underlying motor skill learning with HABIT-ILE in children with USCP. Two different patterns were observed, probably related to different phases of motor skill learning, representing an increased practice-dependent brain recruitment or a brain activation refinement by more efficient means.

La pratique de la guitare en rééducation favorise-t-elle la volition ainsi que la récupération sensorimotrice chez le patient atteint de Sclérose en Plaques ?

2024-10-02T12:33:00Z

La pratique de la guitare en rééducation favorise-t-elle la volition ainsi que la récupération sensorimotrice chez le patient atteint de Sclérose en Plaques ? Albert, Lisa; Brasset, Emilie; Descendre, Amélie; Paradis, Julie Contexte : La sclérose en plaques (SEP) engendre fréquemment des troubles sensorimoteurs au niveau des membres supérieurs. Elle perturbe la personne dans son répertoire occupationnel particulièrement au niveau de ses loisirs. Ces transitions occupationnelles peuvent altérer le processus volitionnel des personnes. L’objectif de ce travail est d’investiguer si la pratique de la guitare en rééducation permettrait de stimuler la volition des participants et de diminuer les troubles sensorimoteurs. Méthode : Dix participants atteints de SEP présentant des troubles sensorimoteurs au niveau des membres supérieurs ont reçu l’intervention individuellement 1 à 5 fois par semaine à raison de 30 à 60 minutes pendant 7 semaines. L’intervention consistait à apprendre graduellement aux patients à jouer de la guitare par le biais de tablatures. Les participants ont été évalués une semaine avant l’intervention (T1) et juste après la thérapie (T2). Huit évaluations (monofilaments de Semmes-Weinstein, dynamomètre de Jamar, cotation d’opposition du pouce de Kapandji, amplitudes articulaires passives des doigts et des poignets, Grooved Pegboard test, QuickDASH, ABILHAND, Volitional Questionnaire) ont été réalisées en T1 et T2. Un questionnaire de fin de pratique (satisfaction, engagement, ressenti) spécialement créé pour l’étude a été administré uniquement en T2. Résultats : Au terme de la thérapie, les participants ont montré une amélioration significative de leur volition (p<0,001). La plupart des amplitudes articulaires du pouce, de l’index et de l’annulaire des deux mains ont augmenté significativement entre T1 et T2 (p<0,05). Le questionnaire de satisfaction a montré que 90 % des participants voulaient continuer l’activité, 40 % percevaient des améliorations dans leurs activités quotidiennes et 70 % éprouvaient une satisfaction très élevée dans la réalisation de l’activité. Certaines améliorations étaient proches de la significativité (force de préhension, sensibilité tactile) alors que d’autres changements ne sont pas considérés comme significatifs (capacité fonctionnelle globale des membres supérieurs, dextérité digitale, habileté manuelle, opposition du pouce et amplitudes articulaires du poignet). Conclusion : La pratique de la guitare semble être un outil prometteur et favorable à la volition et à l’engagement du patient, ainsi qu’un vecteur d’amélioration sensorimotrice. Cependant, une étude réalisée sur un plus grand échantillon et incorporant un groupe contrôle est nécessaire pour confirmer ces résultats.

Protocol of changes induced by early Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (e-HABIT-ILE) in pre-school children with bilateral cerebral palsy: a multisite randomized controlled trial

2024-10-02T12:25:23Z

Protocol of changes induced by early Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (e-HABIT-ILE) in pre-school children with bilateral cerebral palsy: a multisite randomized controlled trial Araneda, Rodrigo; Sizonenko, Stephane V.; Newman, Christopher J.; Dinomais, Mickael; Le Gal, Gregoire; Ebner-Karestinos, Daniela; Paradis, Julie; Klöcker, Anne; Saussez, Geoffroy; Demas, Josselin; Bailly, Rodolphe; Bouvier, Sandra; Nowak, Emmanuel; Guzzetta, Andrea; Inmaculada, Riquelme; Brochard, Sylvain; Bleyenheuft, Yannick Background Cerebral palsy (CP), which is the leading cause of motor disability during childhood, can produce sensory and cognitive impairments at different degrees. Most recent therapeutic interventions for these patients have solely focused on upper extremities (UE), although more than 60% of these patients present lower extremities (LE) deficits. Recently, a new therapeutic concept, Hand-arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE), has been proposed, involving the constant stimulation of UE and LE. Based on motor skill learning principles, HABIT-ILE is delivered in a day-camp setting, promoting voluntary movements for several hours per day during 10 consecutive week days. Interestingly, the effects of this intervention in a large scale of youngsters are yet to be observed. This is of interest due to the lack of knowledge on functional, neuroplastic and biomechanical changes in infants with bilateral CP. The aim of this randomized controlled study is to assess the effects of HABIT-ILE adapted for pre-school children with bilateral CP regarding functional, neuroplastic and biomechanical factors. Methods This international, multicentric study will include 50 pre-school children with CP from 12 to 60 months of age, comparing the effect of 50 h (2 weeks) of HABIT-ILE versus regular motor activity and/or customary rehabilitation. HABIT-ILE presents structured activities and functional tasks with continuous increase in difficulty while the child evolves. Assessments will be performed at 3 period times: baseline, two weeks later and 3 months later. The primary outcome will be the Gross Motor Function Measure 66. Secondary outcomes will include Both Hands Assessment, Melbourne Assessment-2, Semmes-Weinstein Monofilament Test, algometry assessments, executive function tests, ACTIVLIM-CP questionnaire, Pediatric Evaluation of Disability Inventory (computer adaptative test), Young Children’s Participation and Environment Measure, Measure of the Process of Care, Canadian Occupational Performance Measure, neuroimaging and kinematics. Discussion The results of this study should highlight the impact of a motor, intensive, goal-directed therapy (HABIT-ILE) in pre-school children at a functional, neuroplastic and biomechanical level. In addition, this changes could demonstrated the impact of this intervention in the developmental curve of each child, improving functional ability, activity and participation in short-, mid- and long-term. Name of the registry Evaluation of Functional, Neuroplastic and Biomechanical Changes Induced by an Intensive, Playful Early-morning Treatment Including Lower Limbs (EARLY-HABIT-ILE) in Preschool Children With Uni and Bilateral Cerebral Palsy (HABIT-ILE).