Single-case Design Studies in Children with Cerebral Palsy: A Scoping Review

Abstract

Aim: To critically evaluate single-case design (SCD) studies performed within the population of children/ adolescents with cerebral palsy (CP). Methods: A scoping review of SCD studies of children/adolescents with CP. Demographic, methodological, and statistical data were extracted. Articles were evaluated using the Risk of Bias in N-of-1 Trials (RoBiNT) Scale and the Consolidated Standards of Reporting Trials (CONSORT) extension for N-of-1 trials (CENT 2015). Comments regarding strengths and limitations were analyzed. Results: Studies investigated the effects of a wide range of interventions on various outcomes. Most SCD types were adopted in multiple studies. All studies used visual inspection rather than visual analysis, often complemented with basic statistical descriptives. Risk of bias was high, particularly concerning internal validity. Many CENT items were insufficiently reported. Several benefits and limitations of SCD were identified. Conclusions: The quality of evidence from results of SCD studies needs to be increased through risk of bias reduction. ARTICLE HISTORY

Contextual interference

“…Therefore, for all the children participating in this study, a direct benefit can be expected. Especially for such a vulnerable population as children with neurological impairments, the risks of participating in a study should be minimal or, if greater, should be outweighed by the anticipated benefit [55]. Our study provides a safe setting, and we expect no severe adverse events.…”

“…This effect was firstly observed in the field of verbal learning and described by Battig in the 1960ies and 70ies [13,56,57]. Several years later, it was verified in the area of motor learning [55]. The contextual interference effect has mainly been assessed in fields of sports in healthy adults.…”

“…High contextual interference which occurs when practicing in random order, leads to better performance at retention and transfer but worse performance during acquisition compared to practicing under low contextual interference (blocked order) [55]. Figure 1.9 shows a schematic summary of the contextual interference effect.…”

“…However, as this issue is under debate, there is still no definite agreement which brain regions and processes are involved in learning and how the learning processes are executed (e.g. [55][56][57]. Furthermore, the individual lesion areas in combination with many other factors make every patient and their learning abilities and strategies unique.…”

“…We experienced this during the recruitment phase of our pilot study. Also, randomised controlled trials mostly only include a small number of all the different characteristics of children, limiting the sample size and therewith the generalisability even more [55].…”