Rehabilitation for Children With Dystonic Cerebral Palsy Using Haptic Feedback in Virtual Reality: Protocol for a Randomized Controlled Trial

Abstract

Background: Cerebral palsy (CP) is the most common developmental motor disorder in children. Individuals with CP demonstrate abnormal muscle tone and motor control. Within the population of children with CP, between 4% and 17% present dystonic symptoms that may manifest as large errors in movement tasks, high variability in movement trajectories, and undesired movements at rest. These symptoms of dystonia typically worsen with physical intervention exercises.

Objective: The aim of this study is to establish the effect of haptic feedback in a virtual reality (VR) game intervention on movement outcomes of children with dystonic CP.

Methods: The protocol describes a randomized controlled trial that uses a VR game-based intervention incorporating fully automated robotic haptic feedback. The study consists of face-to-face assessments of movement before, after, and 1 month following the completion of the 6-session game-based intervention. Children with dystonic CP, aged between 7 and 17 years, will be recruited for this study through posted fliers and laboratory websites along with a group of typically developing (TD) children in the same age range. We anticipate to recruit a total of 68 participants, 34 each with CP and TD. Both groups of children will be randomly allocated into an intervention or control group using a blocked randomization method. The primary outcome measure will be the smoothness index of the interaction force with the robot and of the accelerometry signals of sensors placed on the upper limb segments. Secondary outcomes include a battery of clinical tests and a quantitative measure of spasticity. Assessors administering clinical measures will be blinded. All sessions will be administered on-site by research personnel.

Results: The trial has not started and is pending local institutional review board approval.

Conclusions: Movement outcomes will be examined for changes in muscle activation and clinical measures in children with dystonic CP and TD children. Paired t tests will be conducted on movement outcomes for both groups of children independently. Positive and negative results will be reported and addressed.

Trial registration: ClinicalTrials.gov NCT03744884; https://ichgcp.net/clinical-trials-registry/NCT03744884 (Archived by WebCite at http://www.webcitation.org/74RSvmbZP).

International registered report identifier (irrid): PRR1-10.2196/11470.

Keywords: cerebral palsy; child; dystonia; motor skills; muscle spasticity; randomized controlled trial; rehabilitation; robotics; sensory feedback; virtual reality.

Conflict of interest statement

Conflicts of Interest: None declared.

©Reika Nicole McNish, Pramod Chembrammel, Nathaniel Christopher Speidel, Julian Jwchun Lin, Citlali López-Ortiz. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 14.01.2019.

Figures

Figure 1

Projection into virtual reality (VR) space. The vector x in VR space is the projection of the signal vector b of n=6 force and torque signals, by the principal components matrix A.

Figure 2

Royal Academy of Dance first port de bras. From left to right: en bas, first position, second position, and en bas. Participants will be asked to move through these positions during assessment 7 to measure muscle activity patterns and smoothness of movement.

Figure 3

Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) flow diagram of participants. CP: cerebral palsy; DIS: Dyskinesia Impairment Scale; MSRT: Montreal Spasticity Rating Test; PT: physical therapy; QUEST: Quality of Upper Extremity Skills Test; sEMG: surface electromyography; SCUES: Selective Control of the Upper Extremity Scale; WHODAS 2-CY:World Health Organization Disability Assessment Schedule II-Children and Youth.