Zoccolillo L, Morelli D, Cincotti F, Muzzioli L, Gobbetti T, Paolucci S, Iosa M
Department of Child Neurorehabilitation, I.R.C.C.S. Fondazione Santa Lucia, Rome, Italy -
Eur J Phys Rehabil Med. 2015 Dec;51(6):669-76. Epub 2015 Feb 5.
Previous studies reported controversial results about the efficacy of video-game based therapy (VGT) in improving neurorehabilitation outcomes in children with cerebral palsy (CP).
Primary aim was to investigate the effectiveness of VGT with respect to conventional therapy (CT) in improving upper limb motor outcomes in a group of children with CP. Secondary aim was to quantify if VGT leads children to perform a higher number of movements.
A cross-over randomized controlled trial (RCT) for investigating the primary aim and a cross-sectional study for investigating the secondary aim of this study.
Outpatients.
clinical diagnosis of CP, age between 4 and 14 years, level of GMFC between I and IV.
QI<35, severe comorbidities, incapacity to stand even with an external support.
Twenty-two children with CP (6.89±1.91-year old) were enrolled in a cross-over RCT with 16 sessions of VGT (using Xbox with Kinect device) and then 16 of CT or vice versa. Upper limb functioning was assessed using the Quality of Upper Extremities Skills Test (QUEST) and hand abilities using Abilhand-kids score. According to the secondary aim of this study a secondary cross-sectional study has been performed. Eight children with CP (6.50±1.60-year old) were enrolled into a trial in which five wireless triaxial accelerometers were positioned on their forearms, legs and trunk for quantifying the physical activity during VGT vs. CT.
QUEST scores significantly improved only after VGT (P=0.003), and not after CT (P=0.056). The reverse occurred for Abilhand-kids scores (P=0.165 vs. P=0.013, respectively). Quantity of performed movements was three times higher in VGT than in CT (+198%, P=0.027).
VGT resulted effective in improving the motor functions of upper limb extremities in children with CP, conceivably for the increased quantity of limb movements, but failed in improving the manual abilities for performing activities of daily living which benefited more from CT.
VGT performed using the X-Box with Kinect device could enhance the number of upper limb movements in children with CP during rehabilitation and in turn improving upper limb motor skills, but CT remained superior for improving performances in manual activities of daily living.
先前的研究报告了基于视频游戏的疗法（VGT）在改善脑瘫（CP）儿童神经康复结果方面的疗效存在争议。
主要目的是研究VGT相对于传统疗法（CT）在改善一组CP儿童上肢运动结果方面的有效性。次要目的是量化VGT是否能使儿童进行更多的动作。
一项用于研究主要目的的交叉随机对照试验（RCT）和一项用于研究本研究次要目的的横断面研究。
门诊患者。
CP的临床诊断，年龄在4至14岁之间，GMFC水平在I至IV级之间。
智商<35，严重合并症，即使在外部支持下也无法站立。
22名CP儿童（6.89±1.91岁）参加了一项交叉RCT，接受16节VGT治疗（使用配备Kinect设备的Xbox），然后接受16节CT治疗，反之亦然。使用上肢技能质量测试（QUEST）评估上肢功能，使用Abilhand-kids评分评估手部能力。根据本研究的次要目的进行了一项次要横断面研究。8名CP儿童（6.50±1.60岁）参加了一项试验，在他们的前臂、腿部和躯干上放置了五个无线三轴加速度计，以量化VGT与CT期间的身体活动。
仅在VGT后QUEST评分显著改善（P = 0.003），而在CT后未改善（P = 0.056）。Abilhand-kids评分则相反（分别为P = 0.165和P = 0.013）。VGT中执行的动作数量比CT中高出三倍（+198%，P = 0.027）。
VGT在改善CP儿童上肢运动功能方面有效，可能是因为肢体动作数量增加，但在改善日常生活活动的手部能力方面失败，而CT在这方面更有优势。
使用配备Kinect设备的Xbox进行VGT可以增加CP儿童康复期间上肢运动的数量，进而提高上肢运动技能，但CT在改善日常生活手动活动表现方面仍然更优。
