Development and Feasibility of a Kinect-Based Constraint-Induced Therapy Program in the Home Setting for Children With Unilateral Cerebral Palsy

Hao-Ling Chen, Szu-Yu Lin, Chun-Fu Yeh, Ren-Yu Chen, Hsien-Hui Tang, Shanq-Jang Ruan, Tien-Ni Wang, Hao-Ling Chen, Szu-Yu Lin, Chun-Fu Yeh, Ren-Yu Chen, Hsien-Hui Tang, Shanq-Jang Ruan, Tien-Ni Wang

Abstract

Introduction: Cerebral palsy (CP) is the leading cause of childhood-onset physical disability. Children with CP often have impaired upper limb (UL) function. Constraint-induced therapy (CIT) is one of the most effective UL interventions for children with unilateral CP. However, concerns about CIT for children have been repeatedly raised due to frustration caused by restraint of the child's less-affected UL and lack of motivation for the intensive protocol. Virtual reality (VR), which can mitigate the disadvantages of CIT, potentially can be used as an alternative mediator for implementing CIT. Therefore, we developed a VR-based CIT program for children with CP using the Kinect system. Aims: The feasibility of the Kinect-based CIT program was evaluated for children with unilateral CP using a two-phase study design. Materials and Methods: In phase 1, ten children with unilateral CP were recruited. To confirm the achievement of the motor training goals, maximal UL joint angles were evaluated during gameplay. To evaluate children's perceptions of the game, a questionnaire was used. In phase 2, eight children with unilateral CP were recruited and received an 8 weeks Kinect-based CIT intervention. Performance scores of the game and outcomes of the box and block test (BBT) were recorded weekly. Results: In phase 1, results supported that the design of the program was CIT-specific and was motivational for children with unilateral CP. In phase 2, game performance and the BBT scores began showing stable improvements in the fifth week of intervention. Conclusion: It suggested the Kinect-based CIT program was beneficial to the motor function of the affected UL for children with unilateral CP. According to the results of this feasibility study, larger and controlled effectiveness studies of the Kinect-based CIT program can be conducted to further improve its clinical utility. Clinical Trial Registration: ClinicalTrials.gov, NCT02808195; Comparative effectiveness of a Kinect-based unilateral arm training system vs. CIT for children with CP.

Keywords: cerebral palsy; children; constraint-induced therapy; upper limb; virtual reality.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Chen, Lin, Yeh, Chen, Tang, Ruan and Wang.

Figures

FIGURE 1
FIGURE 1
The game screen and the feedback during the gameplay. (A) A participant playing our Kinect game with a Kinect skeleton tracker. (B) The visual feedback on the upper limb movements of the player (Knowledge of performance). (C) The performance score during gameplay as another form of feedback (Knowledge of results).
FIGURE 2
FIGURE 2
A Kinect-based CIT program was designed with three levels of task difficulty. In the preparation stage (A) and the first level (B), the movement training goals include reaching, grasping, and releasing. In the second level (C), the training goals include reaching, grasping, releasing, and aiming. In the third level (D), the goals consist of reaching, grasping, releasing, aiming, and holding.
FIGURE 3
FIGURE 3
(A) Eight weeks of performance scores of the Kinect game and (B) outcomes of the BBT among children with unilateral CP over training sessions. * statistical significance of p ≤ 0.05 compared to the baseline.

References

    1. Abd El-Kafy E. M., Elshemy S. A., Alghamdi M. S. (2014). Effect of Constraint-Induced Therapy on Upper Limb Functions: A Randomized Control Trial. Scand. J. Occup. Ther. 21 (1), 1–13. 10.3109/11038128.2013.837505
    1. Anton D., Berges I., Bermúdez J., Goñi A., Illarramendi A. (2018). A Telerehabilitation System for the Selection, Evaluation and Remote Management of Therapies. Sensors 18 (5), 1459. 10.3390/s18051459
    1. Araneda R., Ebner‐Karestinos D., Paradis J., Saussez G., Friel K. M., Gordon A. M., et al. (2019). Reliability and Responsiveness of the Jebsen‐Taylor Test of Hand Function and the Box and Block Test for Children with Cerebral Palsy. Dev. Med. Child. Neurol. 61 (10), 1182–1188. 10.1111/dmcn.14184
    1. Sabapathy S., Bhardwaj P. (2011). Assessment of the Hand in Cerebral Palsy. Indian J. Plast. Surg. 44 (2), 348–356. 10.4103/0970-0358.85356
    1. Case-Smith J., DeLuca S. C., Stevenson R., Ramey S. L. (2012). Multicenter Randomized Controlled Trial of Pediatric Constraint-Induced Movement Therapy: 6-month Follow-Up. Am. J. Occup. Ther. 66 (1), 15–23. 10.5014/ajot.2012.002386
    1. Chen C.-L., Kang L.-j., Hong W.-H., Chen F.-C., Chen H.-C., Wu C.-Y. (2013). Effect of Therapist-Based Constraint-Induced Therapy at home on Motor Control, Motor Performance and Daily Function in Children with Cerebral Palsy: A Randomized Controlled Study. Clin. Rehabil. 27 (3), 236–245. 10.1177/0269215512455652
    1. Chen Y.-P., Lee S.-Y., Howard A. M. (2014a). Effect of Virtual Reality on Upper Extremity Function in Children with Cerebral Palsy. Pediatr. Phys. Ther. 26 (3), 289–300. 10.1097/PEP.0000000000000046
    1. Chen Y.-P., Pope S., Tyler D., Warren G. L. (2014b). Effectiveness of Constraint-Induced Movement Therapy on Upper-Extremity Function in Children with Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Clin. Rehabil. 28 (10), 939–953. 10.1177/0269215514544982
    1. Chen J. L., Fujii S., Schlaug G. (2016). The Use of Augmented Auditory Feedback to Improve Arm Reaching in Stroke: A Case Series. Disabil. Rehabil. 38 (11), 1115–1124. 10.3109/09638288.2015.1076530
    1. Choi J. Y., Yi S. H., Ao L., Tang X., Xu X., Shim D., et al. (2021). Virtual Reality Rehabilitation in Children with Brain Injury: A Randomized Controlled Trial. Dev. Med. Child. Neurol. 63 (4), 480–487. 10.1111/dmcn.14762
    1. Cope S. M., Liu X.-C., Verber M. D., Cayo C., Rao S., Tassone J. C. (2010). Upper Limb Function and Brain Reorganization after Constraint-Induced Movement Therapy in Children with Hemiplegia. Dev. Neurorehabil. 13 (1), 19–30. 10.3109/17518420903236247
    1. Silva T. D. d., Silva P. L. d., Valenzuela E. d. J., Dias E. D., Simcsik A. O., de Carvalho M. G., et al. (2021). Serious Game Platform as a Possibility for Home-Based Telerehabilitation for Individuals with Cerebral Palsy during COVID-19 Quarantine - A Cross-Sectional Pilot Study. Front. Psychol. 12, 1–15. 10.3389/fpsyg.2021.622678
    1. Deluca S. C., Echols K., Law C. R., Ramey S. L. (2006). Intensive Pediatric Constraint-Induced Therapy for Children with Cerebral Palsy: Randomized, Controlled, Crossover Trial. J. Child. Neurol. 21 (11), 931–938. 10.1177/08830738060210110401
    1. Eliasson A. C., Krumlinde-Sundholm L., Gordon A. M., Feys H., Klingels K., Aarts P. B. M., et al. (2014). Guidelines for Future Research in Constraint-Induced Movement Therapy for Children with Unilateral Cerebral Palsy: An Expert Consensus. Dev. Med. Child. Neurol. 56 (2), 125–137. 10.1111/dmcn.12273
    1. Fluet G. G., Qiu Q., Kelly D., Parikh H. D., Ramirez D., Saleh S., et al. (2010). Interfacing a Haptic Robotic System with Complex Virtual Environments to Treat Impaired Upper Extremity Motor Function in Children with Cerebral Palsy. Dev. Neurorehabil. 13 (5), 335–345. 10.3109/17518423.2010.501362
    1. Fonseca Junior P. R., Filoni E., Setter C. M., Berbel A. M., Fernandes A. O., Moura R. C. d. F. (2017). Constraint-induced Movement Therapy of Upper Limb of Children with Cerebral Palsy in Clinical Practice: Systematic Review of the Literature. Fisioter. Pesqui. 24 (3), 334–346. 10.1590/1809-2950/17425124032017
    1. Geerdink Y., Aarts P., van der Burg J., Steenbergen B., Geurts A. (2015). Intensive Upper Limb Intervention with Self-Management Training Is Feasible and Promising for Older Children and Adolescents with Unilateral Cerebral Palsy. Res. Dev. Disabil. 43-44, 97–105. 10.1016/j.ridd.2015.06.013
    1. Gilmore R., Ziviani J., Sakzewski L., Shields N., Boyd R. (2010). A Balancing Act: Children's Experience of Modified Constraint-Induced Movement Therapy. Dev. Neurorehabil. 13 (2), 88–94. 10.3109/17518420903386161
    1. Golomb M. R., McDonald B. C., Warden S. J., Yonkman J., Saykin A. J., Shirley B., et al. (2010). In-home Virtual Reality Videogame Telerehabilitation in Adolescents with Hemiplegic Cerebral Palsy. Arch. Phys. Med. Rehabil. 91 (1), 1–8.e1. 10.1016/j.apmr.2009.08.153
    1. Gordon A. M., Charles J., Wolf S. L. (2005). Methods of Constraint-Induced Movement Therapy for Children with Hemiplegic Cerebral Palsy: Development of a Child-Friendly Intervention for Improving Upper-Extremity Function. Arch. Phys. Med. Rehabil. 86 (4), 837–844. 10.1016/j.apmr.2004.10.008
    1. Gordon A. M., Okita S. Y. (2010). Augmenting Pediatric Constraint-Induced Movement Therapy and Bimanual Training with Video Gaming Technology. Tad 22 (4), 179–191. 10.3233/TAD-2010-0302
    1. Hanley J. A., Negassa A., Edwardes M. D. d., Forrester J. E. (2003). Statistical Analysis of Correlated Data Using Generalized Estimating Equations: an Orientation. Am. J. Epidemiol. 157 (4), 364–375. 10.1093/aje/kwf215
    1. Hanna L., Neapolitan D., Risden K. (2004). “Evaluating Computer Game Concepts with Children,” in Proceedings of the 2004 conference on Interaction design and children: building a community: Association for Computing Machinery, Maryland, United States, June 1-3, 2004 49–56.
    1. Harris K., Reid D. (2005). The Influence of Virtual Reality Play on Children's Motivation. Can. J. Occup. Ther. 72 (1), 21–29. 10.1177/000841740507200107
    1. Hart H. (2005). Can Constraint Therapy Be Developmentally Appropriate and Child-Friendly. Dev. Med. Child. Neurol. 47 (6), 363. 10.1017/S0012162205000708
    1. Hemayattalab R., Rostami L. R. (2010). Effects of Frequency of Feedback on the Learning of Motor Skill in Individuals with Cerebral Palsy. Res. Dev. Disabil. 31 (1), 212–217. 10.1016/j.ridd.2009.09.002
    1. Holden M. K. (2005). Virtual Environments for Motor Rehabilitation: Review. CyberPsychology Behav. 8 (3), 187–211. 10.1089/cpb.2005.8.187
    1. Jaspers E., Desloovere K., Bruyninckx H., Klingels K., Molenaers G., Aertbeliën E., et al. (2011). Three-dimensional Upper Limb Movement Characteristics in Children with Hemiplegic Cerebral Palsy and Typically Developing Children. Res. Dev. Disabil. 32 (6), 2283–2294. 10.1016/j.ridd.2011.07.038
    1. Johnson A. (2002). Prevalence and Characteristics of Children with Cerebral Palsy in Europe. Dev. Med. Child. Neurol. 44 (9), 633–640. 10.1017/S0012162201002675
    1. Jongbloed-Pereboom M., Nijhuis-van der Sanden M. W. G., Steenbergen B. (2013a). Norm Scores of the Box and Block Test for Children Ages 3-10 Years. Am. J. Occup. Ther. 67 (3), 312–318. 10.5014/ajot.2013.006643
    1. Jongbloed-Pereboom M., Nijhuis-van der Sanden M. W. G., Saraber-Schiphorst N., Crajé C., Steenbergen B. (2013b). Anticipatory Action Planning Increases from 3 to 10years of Age in Typically Developing Children. J. Exp. Child Psychol. 114 (2), 295–305. 10.1016/j.jecp.2012.08.008
    1. Klingels K., Feys H., Molenaers G., Verbeke G., Van Daele S., Hoskens J., et al. (2013). Randomized Trial of Modified Constraint-Induced Movement Therapy with and without an Intensive Therapy Program in Children with Unilateral Cerebral Palsy. Neurorehabil. Neural Repair 27 (9), 799–807. 10.1177/1545968313496322
    1. Levac D., Rivard L., Missiuna C. (2012). Defining the Active Ingredients of Interactive Computer Play Interventions for Children with Neuromotor Impairments: A Scoping Review. Res. Dev. Disabil. 33 (1), 214–223. 10.1016/j.ridd.2011.09.007
    1. Lin K.-C., Wang T.-N., Wu C.-Y., Chen C.-L., Chang K.-C., Lin Y.-C., et al. (2011). Effects of home-based Constraint-Induced Therapy versus Dose-Matched Control Intervention on Functional Outcomes and Caregiver Well-Being in Children with Cerebral Palsy. Res. Dev. Disabil. 32 (5), 1483–1491. 10.1016/j.ridd.2011.01.023
    1. Mancini M. C., Brandão M. B., Dupin A., Drummond A. F., Chagas P. S. C., Assis M. G. (2013). How Do Children and Caregivers Perceive Their Experience of Undergoing the CIMT Protocol. Scand. J. Occup. Ther. 20 (5), 343–348. 10.3109/11038128.2013.799227
    1. Meulenbroek R. G. J., van Galen G. P. (1988). “The Acquisition of Skilled Handwriting: Discontinuous Trends in Kinematic Variables,” in Advances in Psychology (Elsevier; ), 273–281. 10.1016/s0166-4115(08)60627-5
    1. Mintal F. A., Szucs V., Sik-Lanyi C. (2015). “Developing Movement Therapy Application with Microsoft Kinect Control for Supporting Stroke Rehabilitation,” in Assistive Technology (IOS Press; ), 773–781.
    1. Molinaro A., Micheletti S., Pagani F., Garofalo G., Galli J., Rossi A., et al. (2020). Action Observation Treatment in a Tele-Rehabilitation Setting: A Pilot Study in Children with Cerebral Palsy. Disabil. Rehabil., 1–6. 10.1080/09638288.2020.1793009
    1. Palacios-Navarro G., García-Magariño I., Ramos-Lorente P. (2015). A Kinect-Based System for Lower Limb Rehabilitation in Parkinson's Disease Patients: A Pilot Study. J. Med. Syst. 39 (9), 1–10. 10.1007/s10916-015-0289-0
    1. Pastor I., Hayes H. A., Bamberg S. J. M. (2012). “A Feasibility Study of an Upper Limb Rehabilitation System Using Kinect and Computer Games,” in 2012 Annual International Conference of the IEEE Engineering in Medicine and Biology Society, San Diego, CA, August-September 28-1, 2012 (USA: IEEE; ). 2013/02/01. 10.1109/embc.2012.6346173
    1. Monge Pereira E., Molina Rueda F., Alguacil Diego I. M., Cano De La Cuerda R., De Mauro A., Miangolarra Page J. C. (2014). Use of Virtual Reality Systems as Proprioception Method in Cerebral Palsy: Clinical Practice Guideline. Neurología (English Edition) 29 (9), 550–559. 10.1016/j.nrl.2011.12.00410.1016/j.nrleng.2011.12.011
    1. Peretti A., Amenta F., Tayebati S. K., Nittari G., Mahdi S. S. (2017). Telerehabilitation: Review of the State-Of-The-Art and Areas of Application. JMIR Rehabil. Assist. Technol. 4 (2), e7. 10.2196/rehab.7511
    1. Psychouli P., Burridge J., Kennedy C. (2010). Forced Use as a home-based Intervention in Children with Congenital Hemiplegic Cerebral Palsy: Choosing the Appropriate Constraint. Disabil. Rehabil. Assistive Technol. 5 (1), 25–33. 10.3109/17483100903121489
    1. Rostami H. R., Arastoo A. A., Nejad S. J., Mahany M. K., Malamiri R. A., Goharpey S. (2012). Effects of Modified Constraint-Induced Movement Therapy in Virtual Environment on Upper-Limb Function in Children with Spastic Hemiparetic Cerebral Palsy: A Randomised Controlled Trial. NeuroRehabilitation 31 (4), 357–365. 10.3233/NRE-2012-00804
    1. Sakzewski L., Ziviani J., Boyd R. (2009). Systematic Review and Meta-Analysis of Therapeutic Management of Upper-Limb Dysfunction in Children with Congenital Hemiplegia. Pediatrics 123 (6), e1111–e1122. 10.1542/peds.2008-3335
    1. Sakzewski L., Gordon A., Eliasson A.-C. (2014a). The State of the Evidence for Intensive Upper Limb Therapy Approaches for Children with Unilateral Cerebral Palsy. J. Child. Neurol. 29 (8), 1077–1090. 10.1177/0883073814533150
    1. Sakzewski L., Ziviani J., Boyd R. N. (2014b). Efficacy of Upper Limb Therapies for Unilateral Cerebral Palsy: A Meta-Analysis. Pediatrics 133 (1), e175–e204. 10.1542/peds.2013-0675
    1. Sakzewski L. (2012). Bimanual Therapy and Constraint-Induced Movement Therapy Are Equally Effective in Improving Hand Function in Children with Congenital Hemiplegia. J. Physiother. 58 (1), 59. 10.1016/s1836-9553(12)70075-9
    1. Scholtes V. A., Becher J. G., Beelen A., Lankhorst G. J. (2006). Clinical Assessment of Spasticity in Children with Cerebral Palsy: A Critical Review of Available Instruments. Dev. Med. Child. Neurol. 48 (1), 64–73. 10.1017/S0012162206000132
    1. Shih W. J. (1997). Sample Size and Power Calculations for Periodontal and Other Studies with Clustered Samples Using the Method of Generalized Estimating Equations. Biom. J. 39 (8), 899–908. 10.1002/bimj.4710390803
    1. Sim G., Cassidy B. (2013). “Investigating the Fidelity Effect when Evaluating Game Prototypes with Children,” in 27th International BCS Human Computer Interaction Conference, London, United Kingdom, September 9-13, 2013 (British Computer Society; ), 1–6.
    1. Smania N., Aglioti S. M., Cosentino A., Camin M., Gandolfi M., Tinazzi M., et al. (2009). A Modified Constraint-Induced Movement Therapy (CIT) Program Improves Paretic Arm Use and Function in Children with Cerebral Palsy. Eur. J. Phys. Rehabil. Med. 45 (4), 493–500.
    1. Snider L., Majnemer A., Darsaklis V. (2010). Virtual Reality as a Therapeutic Modality for Children with Cerebral Palsy. Dev. Neurorehabil. 13 (2), 120–128. 10.3109/17518420903357753
    1. Tatla S. K., Sauve K., Virji-Babul N., Holsti L., Butler C., Van Der Loos H. F. M. (2013). Evidence for Outcomes of Motivational Rehabilitation Interventions for Children and Adolescents with Cerebral Palsy: An American Academy for Cerebral Palsy and Developmental Medicine Systematic Review. Dev. Med. Child. Neurol. 55 (7), 593–601. 10.1111/dmcn.12147
    1. Taub E., Crago J. E., Uswatte G. (1998). Constraint-induced Movement Therapy: A New Approach to Treatment in Physical Rehabilitation. Rehabil. Psychol. 43 (2), 152–170. 10.1037/0090-5550.43.2.152
    1. Thibaut J.-P., Toussaint L. (2010). Developing Motor Planning over Ages. J. Exp. Child Psychol. 105 (1-2), 116–129. 10.1016/j.jecp.2009.10.003
    1. Thompson A. M. E., Chow S., Vey C., Lloyd M. (2015). Constraint-Induced Movement Therapy in Children Aged 5 to 9 Years with Cerebral Palsy. Pediatr. Phys. Ther. 27 (1), 72–80. 10.1097/PEP.0000000000000111
    1. Tickle-Degnen L. (2013). Nuts and Bolts of Conducting Feasibility Studies. Am. J. Occup. Ther. 67 (2), 171–176. 10.5014/ajot.2013.006270
    1. Wang T.-N., Chen Y.-L., Shieh J.-Y., Chen H.-L. (2021). Commercial Exergaming in home-based Pediatric Constraint-Induced Therapy: A Randomized Trial. OTJR: Occup. Participation Health 41 (2), 90–100. 10.1177/1539449220984110
    1. Zoccolillo L., Morelli D., Cincotti F., Muzzioli L., Gobbetti T., Paolucci S., et al. (2015). Video-game Based Therapy Performed by Children with Cerebral Palsy: A Cross-Over Randomized Controlled Trial and a Cross-Sectional Quantitative Measure of Physical Activity. Eur. J. Phys. Rehabil. Med. 51 (6), 669–676.
    1. Zorn C. J. W. (2001). Generalized Estimating Equation Models for Correlated Data: A Review with Applications. Am. J. Polit. Sci. 45, 470–490. 10.2307/2669353

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner