A web-based therapy program enhances occupational performance and visual perception in children with unilateral cerebral palsy [commentary]

摘要

Summary of: James S, Ziviani J, Ware R, Boyd R. Randomized controlled trial of web-based multimodal therapy for unilateral cerebral palsy to improve occupational performance. Dev Med Child Neuro. 2015; doi:10.1111/dmcn.12705. Question: Does a web-based therapy program improve occupational performance, upper limb function and visual perception in children with unilateral cerebral palsy? Design: Randomised controlled trial with concealed allocation and blinded outcome assessment for some, but not all, outcome measures. Setting: Home environment in Australia. Participants: Children with spastic-type unilateral cerebral palsy, Manual Ability Classification System levels I to III and Gross Motor Function Classification System levels I or II. Children were aged 8 to 18 years, had sufficient understanding and co-operation to perform the program, and [2F_DT]DI$Finternet access at home. Exclusion criteria were: upper or lower limb surgery in the previous 6 months and unstable epilepsy. Randomisation of 102 participants allocated 51 to the web-based therapy group and 51 to a waitlist control group. Interventions: The intervention group participated in a web-based therapy program comprising upper limb, cognitive and visual perceptual training (60%) and gross motor activities (40%). The dose was 20 to 30 minutes, 6 days per week for 20 weeks (maximum 60 hours). For each child, therapists devised an individual program selected from 14 modules and adjusted it weekly. The control group received usual care. Outcome measures: The primary outcomes at baseline and after the intervention were: the Assessment of Motor and Process Skills, Assisting Hand Assessment, the Jebsen-Taylor Test of Hand Function and the1836-9553/ 2015 Australian Physiotherapy Association. Published by Elsevier B.V. AlMelbourne Assessment of Unilateral Upper Limb Function. Secondary outcome measures were: the Canadian Occupational Performance Measure and the Test of Visual Perceptual Skill. Results: Ninety-two participants completed the study. The intervention group completed 32 hours (95% CI 4 to 75 hours) of the program. At the end of the intervention, the Assessment of Motor and Process Skills motor scores were significantly greater in the treatment group by 0.28 logits (95% CI 0.17 to 0.39). The Jebsen-Taylor Test of Hand Function for the dominant limb improved significantly more in the intervention than the control group (C]3F_DT$DI[F4.7 seconds, 95% CI C4[_TD$DFIF]7.4 to C[5F_DT$DIF2] .0), but not for the impaired limb (C6[_FTIDD$F]22.0 seconds, 95% CI C[7_TDI$DF]F44.8 to $T[_8DDIF0F] .7). The intervention group had higher scores on the Canadian Occupational Performance Measure performance[I1$_DTDF]F ( D[D9T_$IFF]1.3 points, 95% CI [10_DT$DIFF] .7 to [D1D1T_$IFF] .9) and satisfaction ( [1I2$_DTDF]F .5 points, 95% CI T13[_D$DFIF]0.4 to [1I4$_DTDF]F0.8) 1[5_TD$FDIFs] cales, and the Test of Visual Perceptual Skill ( T16[_D$DFIF] .8 points, 95% CI [71_FTIDD$F]2.8 to 1[8_TD$FDIF] 0.8). The groups did not differ for other outcomes. Conclusion: A web-based therapy program at home has the potential to enhance occupa- tional performance and visual perception for children with cerebral palsy and to increase therapy dose1[9_TD$FDIF.] Provenance: Invited. Not peer-reviewed. Nora Shields School of Allied Health, La Trobe University, Australia http://dx.doi.org/10.1016/j.jphys.2015.05.005.