Accepted for/Published in: JMIR Rehabilitation and Assistive Technologies
Date Submitted: Aug 13, 2024
Date Accepted: Jan 16, 2025
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Evaluation of a Game-Based Mechatronic Device for Rehabilitation of Hand-Arm Function in Children With Cerebral Palsy: A Feasibility Randomized Control Trial
ABSTRACT
Background:
A computer game-based system was developed to enhance the engagement and compliance of rehabilitation programs for children with upper extremity (UE) motor impairments due to neurodevelopmental disorders. The system includes a low-cost, easy-to-use Rehabilitation Manipulandum Device (RMD), equipped with monitoring technologies to facilitate game-based exercise and repetitive task practices. The RMD is designed to practice a broad range of manual dexterity skills involving the thumb, fingers, and wrist. Finger-hand function is specifically targeted to extend utility beyond gross reaching or transport movements.
Objective:
The objective of this mixed-methods exploratory randomized controlled trial (RCT) was to provide evidence for the feasibility and therapeutic value of the game-based RMD exercise programs in children with Cerebral Palsy (CP).
Methods:
A total of 34 children with CP, aged 4 to 10 years, were recruited and randomly assigned to either the experimental group or the control group. The experimental group (XG) received a computer game-based exercise program using the RMD, focusing on object manipulation tasks. The control group (CG) consisted of task-specific training similar to the tasks used in constraint-induced movement therapy. Both groups received their respective therapy programs for 10 weeks, three times per week. Semi-structured interviews with parents and children, along with qualitative analysis, were conducted to evaluate the children’s experiences with the game-based exercise program. The following outcome measures were used to assess changes before and after the 10-week intervention program: a) Peabody Developmental Motor Scale-2 (PDMS-2) Grasping and Visual-Motor Integration subtests, and b) a computerized assessment of manual dexterity.
Results:
There were no dropouts during the 10-week exercise program. Both groups showed significant improvements with medium to large effect sizes. Improvements in the PDMS-2 subtests and the computerized tests of manual dexterity observed in the XG were significantly greater than those in the CG. Parents reported a change in the children’s level of independence in daily tasks at home, school, and leisure activities.
Conclusions:
The results of this study demonstrate the feasibility, acceptability, and positive outcomes of the RMD game-based exercise program for the rehabilitation of hand function in children with CP. The findings support further research and development related to the effects of computer game-assisted rehabilitation technology. Clinical Trial: Clinical Trials Registry - India CTRI/2021/07/034903; https://ctri.nic.in/Clinicaltrials/login.php
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