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

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

Abstract

Background: If adults practice several motor tasks together, random practice leads to better transfer and retention compared to blocked practice. Knowledge about this contextual interference (CI) effect could be valuable to improve neurorehabilitation of children. We present the protocol of a randomised controlled pilot study investigating the feasibility of blocked practice vs. random practice of robot-assisted upper limb reaching in children with brain lesions undergoing neurorehabilitation.

Methods: Children with affected upper limb function due to congenital or acquired brain lesions undergoing neurorehabilitation will be recruited for a randomised controlled pilot study with a 3-week procedure. In the control week (1), two assessment blocks (robot-assisted reaching tasks, Melbourne assessment 2, subscale fluency), 2 days apart, take place. In the practice week (2), participants are randomly allocated to blocked practice or random practice and perform 480 reaching and backward movements in the horizontal and vertical plane using exergaming with an exoskeleton robot per day during three consecutive days. Assessments are performed before, directly after and 1 day after the practice sessions. In the follow-up week (3), participants perform the assessments 1 week after the final practice session. The primary outcome is the immediate transfer of the Melbourne Assessment 2, subscale fluency. Secondary outcomes are the immediate retention, 1-day and 1-week delayed transfer and retention and acquisition during the practice sessions. We will evaluate the feasibility of the inclusion criteria, the recruitment rate, the scheduling procedure, the randomisation procedure, the procedure for the participants, the handling of the robot, the handling of the amount of data, the choice of the outcome measures and the influence of other therapies. Furthermore, we will perform a power calculation using the data to estimate the sample size for the main trial.

Discussion: The protocol of the pilot study is a first step towards a future main randomised controlled trial. This low risk pilot study might induce some benefits for the participants. However, we need to place its results into perspective, especially concerning the generalisability, as it remains questionable whether improving reaching constrained within a robotic device will ameliorate daily life reaching tasks.

Trial registration: ClinicalTrials.gov Identifier: NCT02443857.

Keywords: Contextual interference; Motor learning; Paediatric neurorehabilitation; Practice order.

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

© The Author(s) 2020.

Figures

Fig. 1
Fig. 1
Standard Protocol Items Recommendation for Interventional Trials (SPIRIT) figure. Actions and appointments throughout the whole study. *The test of nonverbal intelligence is conducted before the first practice session (outcome needed for randomisation by minimisation). **Allocation is done when all the parameters for minimisation are obtained; at latest on the day before the first practice session
Fig. 2
Fig. 2
The ChARMin robot. The ChARMin exoskeleton: a young boy practicing with ChARMin’s small distal module
Fig. 3
Fig. 3
Restrictions of movement inside a haptic wall on the horizontal (A) and the vertical plane (B). The movement area during the horizontal plane exergame with the small distal module (A1) and the large distal module (A2). The haptic wall is located 10 cm below the shoulder joint. The movement area on the vertical plane is located 30 cm in front of the shoulder joint for the small distal module (B1) and 35 cm in front of the shoulder joint for the large distal module (B2)
Fig. 4
Fig. 4
ChARMin exergames. Upper row: transversal version of the ChARMin exergames (A1: avatar unicorn, target cupcake; A2: avatar snail, target apple). Lower row: frontal version of the ChARMin exergames (B1: avatar UFO, target planet; B2: avatar submarine, target fish, in this picture the gold target is displayed)
Fig. 5
Fig. 5
Study procedure. The study duration for each participant is 3 weeks. Week 1 contains the familiarisation of the two versions of the exergame, two assessment blocks (Melbourne Assessment 2 and exergame tests) and the Test of Nonverbal Intelligence, Fourth edition (TONI-4). The TONI-4 will be planned before the first practice session day (i.e. on appointment 2 or 3). Week 2 contains three practice sessions with an assessment block proceeding the first practice session and another assessment block after the last practice session to evaluate immediate transfer and retention. One day after the last practice session, the assessment block is repeated to assess the delayed one-day transfer and retention). During week 3, the last assessment block is scheduled one week after the last practice session to assess the delayed 1-week transfer and retention. TONI-4 Test of Nonverbal Intelligence, Fourth edition
Fig. 6
Fig. 6
The Consolidated Standards of Reporting Trials (CONSORT) extension to randomised pilot and feasibility trials flow diagram [27]

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