Contextual interference in children with brain lesions: a pilot study investigating blocked vs. random practice order of an upper limb robotic exergame

Judith V Graser, Caroline H G Bastiaenen, Anja Gut, Urs Keller, Hubertus J A van Hedel, Judith V Graser, Caroline H G Bastiaenen, Anja Gut, Urs Keller, Hubertus J A van Hedel

Abstract

Introduction: Evidence about contextual interference in children with brain lesions when practising motor tasks is lacking. Our main objective was to evaluate the feasibility of a randomised controlled trial (RCT) comparing blocked with random practice order of an upper limb robotic exergame to improve reaching in children with neuromotor disorders with a pilot trial.

Methods: We recruited children with brain lesions and impaired upper limb functions who underwent a 3-week schedule that consisted of baseline assessments, intervention period (participants were randomised to a blocked or random order group), and follow-up assessment. We evaluated ten feasibility criteria, including the practicability of the inclusion/exclusion criteria, recruitment rate, feasibility of randomisation, scheduling procedure, and the participants' programme adherence.

Results: The inclusion/exclusion criteria were not completely feasible as patients who were not able to perform the exergames were included. Twelve participants were recruited, and six datasets were used for analysis. The scheduling and randomisation procedures were generally feasible, but the procedure was only partially feasible for the participants, as some sessions were aborted due to lack of motivation and fatigue.

Conclusion: An RCT following this study protocol is not feasible. We formulated suggestions for future studies that aim to investigate contextual interference as in this pilot study.

Trial registration: ClinicalTrials.gov Identifier: NCT02443857 , registered on May 14, 2015.

Keywords: Blocked versus random order; Feasibility; Paediatric rehabilitation; Robotic exergames; Vanguard trial; Variable practice.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
ChARMin with two distal modules and different movement planes. A1 Small distal module (dark blue), movements restricted to the transversal plane. A2 Large distal module (purple), movement direction restricted to the transversal plane. B1 Small distal module (dark blue), movements restricted to the frontal plane. B2 Large distal module (purple), movements restricted to the frontal plane
Fig. 2
Fig. 2
Exergame scenarios displayed on the computer screen. Each exergame version provided two different scenarios. A1 exergame version transversal plane, scenario ‘Unicorn’; A2 exergame version transversal plane, scenario ‘Snail’; B1 exergame version frontal plane, scenario ‘UFO’; B2 exergame version frontal plane, scenario ‘Submarine’
Fig. 3
Fig. 3
The Standard Protocol Items for Clinical Trials (SPIRIT)-figure: schedule of enrolment, interventions, and assessments. Abbreviations: t = time point
Fig. 4
Fig. 4
Adherence to the study protocol. *The Test of Nonverbal Intelligence – Fourth edition (TONI-4) was performed at any day between familiarisation (appointment 1) and randomisation. Hence, the TONI-4 appointment was either the second or the third appointment, and the same applies to the second assessment block on t3. **Participant who dropped out after appointment 7 due to illness was included in the analysis with incomplete dataset. Abbreviations: t = time point
Fig. 5
Fig. 5
Immediate, 1-day, and 1-week transfer. Displayed are the sum scores of the Melbourne Assessment 2, subscale ‘fluency’ (MA2fluency) for each participant at the time points before, immediately after, 1 day and 1 week after practice. Participants are represented with different shades of colours: reddish colours represent blocked practice order, and blueish colours represent random practice order
Fig 6.
Fig 6.
Additional therapies during week 1 and week 2. A The mean numbers of the different therapies are displayed for both practice groups and both weeks. B Boxplots of the total number of therapies that have taken place during week 1 and week 2 for both practice groups. Abbreviations: OT occupational therapy, RUEX Robotics Upper Extremities, PT Physiotherapy, and RLEX Robotics Lower Extremities

References

    1. Krakauer JW. Motor learning: its relevance to stroke recovery and neurorehabilitation. Curr Opin Neurol. 2006;19(1):84–90. doi: 10.1097/.
    1. Muratori LM, Lamberg EM, Quinn L, Duff SV. Applying principles of motor learning and control to upper extremity rehabilitation. J Hand Ther. 2013;26(2):94–103. doi: 10.1016/j.jht.2012.12.007.
    1. Schmidt RA, Lee TD. Motor learning and performance. From principles to application. 5th ed. Champaign: Human Kinetics Publishers; 2014.
    1. Bernstein NA. The co-ordination and regulation of movements. Oxford: Pergamon Press; 1967.
    1. Magill RA, Hall KG. A review of the contextual interference effect in motor skill acquisition. Hum Mov Sci. 1990;9(3–5):241–289. doi: 10.1016/0167-9457(90)90005-X.
    1. Shea JB, Morgan RL. Contextual interference effects on the acquisition, retention, and transfer of a motor skill. J Exp Psychol Hum Learn Mem. 1979;5(2):179–187. doi: 10.1037/0278-7393.5.2.179.
    1. Shea JB, Zimny S. Context effects in memory and learning movement information. In: Magill RA, editor. Memory and control of action. Amsterdam: North-Holland; 1983. pp. 345–366.
    1. Lee TD, Magill RA. Can forgetting facilitate skill acquisition? In: Goodman D, Wilberg R, Franks I, editors. Differing perspectives in motor learning, memory, and control. New York: Elsevier Science; 1985. pp. 3–21.
    1. Poto CC. How forgetting facilitates remembering: an analysis of the contextual interference effect in motor learning. 1988.
    1. Thürer B, Gedemer S, Focke A, Stein T. Contextual interference effect is independent of retroactive inhibition but variable practice is not always beneficial. Front Hum Neurosci. 2019;13. 10.3389/fnhum.2019.00165.
    1. Shewokis PA, Del Rey P, Simpson KJ. A test of retroactive inhibition as an explanation of contextual interference. Res Q Exerc Sport. 1998;69(1):70–74. doi: 10.1080/02701367.1998.10607669.
    1. Brady F. Contextual interference: a meta-analytic study. Percept Mot Skills. 2004;99(1):116–126. doi: 10.2466/pms.99.1.116-126.
    1. Graser JV, Bastiaenen C, van Hedel H. The role of the practice order: a systematic review about contextual interference in children. PLoS One. 2019;14(1):e0209979. 10.1371/journal.pone.0209979.
    1. Aurich-Schuler T, van Hedel HJA, Labruyère R. Roboterunterstützte Lokomotionstherapie bei Kindern in der Neuroreha. Neuroreha. 2018;10(03):119–126. doi: 10.1055/a-0641-0397.
    1. van Hedel HJA, Lieber J, Ricklin S, Meyer-Heim A. Die praktische Anwendung von Exergames und virtueller Realität in der pädiatrischen Rehabilitation. Neuroreha. 2017;09(01):35–40. doi: 10.1055/s-0043-101150.
    1. Gerber CN, Kunz B, van Hedel HJA. Preparing a neuropediatric upper limb exergame rehabilitation system for home-use: a feasibility study. J Neuroeng Rehabil. 2016;13(33):1–12.
    1. Duret C, Grosmaire A-G, Krebs HI. Robot-assisted therapy in upper extremity hemiparesis: overview of an evidence-based approach. Front Neurol. 2019;10:1–8. doi: 10.3389/fneur.2019.00412.
    1. Prado MTA, Gonçalves Luiz Fernani DC, Dias da Silva T, Smorenburg ARP, de Abreu LC, Bandeira de Mello Monteiro C. Motor learning paradigm and contextual interference in manual computer tasks in indivisuals with cerebral palsy. Res Dev Disabil. 2017;64:56–63. doi: 10.1016/j.ridd.2017.03.006.
    1. Thabane L, Ma J, Chu R, Cheng J, Ismaila A, Rios LP, Robson R, Thabane M, Giangregorio L, Goldsmith CH. A tutorial on pilot studies: the what, why and how. BMC Med Res Methodol. 2010;10(1). 10.1186/1471-2288-10-1.
    1. Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, Lancaster GA, PAFS consensus group. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. BMJ (Clinical research ed.). 2016;355(i5239). 10.1136/bmj.i5239.
    1. Chan A-W, Tetzlaff JM, Altman DG. SPIRIT 2013 Statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013;158(3):200–207. doi: 10.7326/0003-4819-158-3-201302050-00583.
    1. Graser JV, Bastiaenen C, Keller U, van Hedel H. Contextual interference in children with brain lesions: protocol of a pilot study investigating blocked vs. random practice order of an upper limb robotic exergame. Pilot and feasibility studies. 2020;6:156. 10.1186/s40814-020-00694-y.
    1. Eliasson A-C, Krumlinde-Sundholm L, Rösblad B, Beckung E, Arner M, Ohrvall A-M, et al. The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Dev Med Child Neurol. 2006;48(7):549–554. doi: 10.1017/S0012162206001162.
    1. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67(2):206–207. doi: 10.1093/ptj/67.2.206.
    1. Altman DG, Bland JM. Treatment allocation by minimisation. Br Med J. 2005;330(April):843. doi: 10.1136/bmj.330.7495.843.
    1. Ritter N, Kilinc E, Navruz B, Bae Y. Test Review: L. Brown, R. J. Sherbenou, & S. K. Johnsen ‘Test of Nonverbal Intelligence-4’ (Toni-4). Austin, TX--PRO-ED, 2010. J Psychoeduc Assess. 2011;29(5):484–488. doi: 10.1177/0734282911400400.
    1. Keller U, Van Hedel HJA, Klamroth-Marganska V, Riener R. ChARMin: the first actuated exoskeleton robot for pediatric arm rehabilitation. IEEE/ASME Trans Mechatronics. 2016;21(5):2201–2213. doi: 10.1109/TMECH.2016.2559799.
    1. Randall M, Johnson L, Reddihough D. The Melbourne Assessment 2. Available from: . Cited 2019 Mar 29
    1. Wang T-N, Liang K-J, Liu Y-C, Shieh J-Y, Chen H-L. Psychometric and clinimetric properties of the Melbourne Assessment 2 in children with cerebral palsy. Arch Phys Med Rehabil. 2017;98(9):1836–1841. doi: 10.1016/j.apmr.2017.01.024.
    1. Husted JA, Cook RJ, Farewell VT, Gladman DD. Methods for assessing responsiveness: a critical review and recommendations. J Clin Epidemiol. 2000;53(5):459–468. doi: 10.1016/S0895-4356(99)00206-1.
    1. Hickey GL, Grant SW, Dunning J, Siepe M. Statistical primer: sample size and power calculations — why, when and how? Eur J Cardio-Thoracic Surg. 2018;54(1):4–9. doi: 10.1093/ejcts/ezy169.
    1. Middel B, van Sonderen E. Statistical significant change versus relevant or important change in (quasi) experimental design: some conceptual and methodological problems in estimating magnitude of intervention-related change in health services research. Int J Integr Care. 2002;2(4). 10.5334/ijic.65.
    1. Cohen J. Statistical power analysis for the behavioral sciences. 2nd editio. Hillsdale: Lawrence Erlbaum Associates; 1988.
    1. Kendall McCreary E, Peterson Kendall F, Geise PP. Muscles: testing and function. Philadelphia: Lippincott Williams and Wilkins; 1993.
    1. Landesman Ramey S, DeLuca S, Stevenson RD, Case-Smith J, Darragh A, Conaway M. Children with Hemiparesis Arm and Movement Project (CHAMP): protocol for a multisite comparative efficacy trial of paediatric constraint-induced movement therapy (CIMT) testing effects of dosage and type of constraint for children with hemiparetic cerebra. BMJ Open. 2019;9(1).
    1. Ramey SL, DeLuca S, Stevenson RD, Case-Smith J, Darragh A, Conaway M. Children with Hemiparesis Arm and Movement Project (CHAMP): protocol for a multisite comparative efficacy trial of paediatric constraint-induced movement therapy (CIMT) testing effects of dosage and type of constraint for children with hemiparetic cerebral palsy. BMJ open. 2019;9(1):e023285. 10.1136/bmjopen-2018-023285.
    1. Treweek S, Mitchell E, Pitkethly M, Cook J, Kjeldstrøm M, Johansen M, et al. Strategies to improve recruitment to randomised controlled trials (Review). Cochrane Database Syst Rev. 2010;1(MR000013).
    1. Treweek S, Pitkethly M, Cook J, Fraser C, Mitchell E, Sullivan F, Gardner H. Strategies to improve recruitment to randomised trials. Cochrane Database of Systematic Reviews. John Wiley and Sons Ltd. 2018. 10.1002/14651858.MR000013.pub6.
    1. Kravitz R, Naihua D, Sunita V, Jiang L. The DEcIDE Methods Center N-0f-1 Guidance Panel. Introduction to N-of-1 trials: indications and barriers. In: RL K, Duan N, editors. Design and implementation of N-of-1 trials: a user’s guide. Rockville: Agency for Healthcare Research and Quality; 2014. pp. 1–11.
    1. Carter R, Lubinsky J, Domholdt E. Rehabilitation research: principles and applications. 4. St. Louis: Elsevier Saunders; 2005.
    1. Gilliaux M, Lejeune TM, Detrembleur C, Sapin J, Dehez B, Selves C, Stoquart G. Using the robotic device REAplan as a valid, reliable, and sensitive tool to quantify upper limb impairments in stroke patients. J Rehabil Med. 2014;46(2):117–125. doi: 10.2340/16501977-1245.
    1. Latorre Román PÁ, García Pinillos F, Navarro Martínez AV, Izquierdo RT. Validity and reliability of Physical Activity Enjoyment Scale questionnaire (PACES) in children with asthma. J Asthma. 2014;51(6):633–638. doi: 10.3109/02770903.2014.898773.
    1. Boffoli N, Foley JT, Gasperetti B, Yang SP, Lieberman L. Enjoyment levels of youth with visual impairments playing different exergames. Insight Res Pract Vis Impair Blind. 2011;4(4):171–176.
    1. Granda Vera J, Montilla MM. Practice schedule and acquisition, retention, and transfer of a throwing task in 6-yr.-old children. Percept Mot Skills. 2003;96(3 Pt 1):1015–1024. doi: 10.2466/pms.2003.96.3.1015.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する