A biofeedback-enhanced therapeutic exercise video game intervention for young people with cerebral palsy: A randomized single-case experimental design feasibility study

Abstract

Importance/Background Movement-controlled video games have potential to promote home-based practice of therapy activities. The success of therapy gaming interventions depends on the quality of the technology used and the presence of effective support structures. Aim This study assesses the feasibility of a novel intervention that combines a co-created gaming technology integrating evidence-based biofeedback and solution-focused coaching (SFC) strategies to support therapy engagement and efficacy at home. Methods Following feasibility and single-case reporting standards (CONSORT and SCRIBE), this was a non-blind, randomized, multiple-baseline, AB, design. Nineteen (19) young people with cerebral palsy (8-18 years old) completed the 4-week home-based intervention in France and Canada. Participant motivations, personalized practice goals, and relevance of the intervention to daily activities were discussed in a Solution Focused Coaching-style conversation pre-, post-intervention and during weekly check-ins. Participants controlled a video game by completing therapeutic gestures (wrist extension, pinching) detected via electromyography and inertial sensors on the forearm (Myo Armband and custom software). Process feasibility success criteria for recruitment response, completion and adherence rates, and frequency of technical issues were established a priori. Scientific feasibility, effect

A Classification and Calibration Procedure for Gesture Specific Home-Based Therapy Exercise in Young People With Cerebral Palsy

“…The most important individual features and the variability of feature use across participants is also reported. As an exploratory objective, we evaluated linear correlation coefficients between the feature group importance and two clinical measures: a) wrist extension amplitude, and b) grip strength as related to the amount of practice and number of repetitions [12], [27]. Table I shows participant information and the available data set size.…”

“…Table I shows participant information and the available data set size. Detailed demographics can be found in the complementary clinical publication [27]. Briefly, there were 19 participants (ten females, average age: 11.7 ± 2.5 years).…”

“…Inclusion criteria were: mild-moderately impaired use of one hand (Manual abilities classification system (MACS) levels I-II [26]), able to follow simple instructions and no history of unmanaged epilepsy, no botulinum toxin treatment within 3 months or constraint-based movement therapy within 6 months. As the objective of this article is to detail the calibration and classification procedure, complete study methodology and clinical findings are presented in an associated publication [27]. A detailed description of the game design and an evaluation of the biofeedback provided can also be found in a complementary article [12].…”

“…Most (17/19) participants practiced wrist extension (open or closed) for the entire activity. In all cases, participants aimed to keep the wrist in an extended or neutral position while performing the gesture [27].…”

“…Table V shows correlations between the relative importance of each feature group and two clinical measures wrist extension amplitude and grip strength with respect to the average number of repetitions/session and the total practice time. In the accompanying clinical paper [27], outcomes for all measures of manual capacity are detailed. activities (RA) group and high movement variability (MV) group with greater importance than traditional, channel-independent (CI) feature group.…”