Keller Jeffrey W, van Hedel Hubertus J A
Rehabilitation Center Affoltern am Albis, University Children's Hospital Zurich, Mühlebergstrasse 104, -8910, Affoltern am Albis, Switzerland.
Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
J Neuroeng Rehabil. 2017 Aug 30;14(1):87. doi: 10.1186/s12984-017-0293-3.
Novel neurorehabilitation technologies build upon treatment principles derived from motor learning studies. However, few studies have investigated motor learning with assistive devices in children and adolescents with Cerebral Palsy (CP). The aim of this study was to investigate whether children with CP who trained with weight support in a playful, virtual environment would improve upper extremity task performance (i.e. skill acquisition), transfer, and retention, three aspects that indicate whether motor learning might have occurred or not.
Eleven children with CP (mean age 13.3 years, standard deviation 3.4 years), who were mildly to moderately impaired, participated. They played in the Armeo® Spring the exergame Moorhuhn with their more affected arm during 3 days (70 min pure play time). For this within-subject design, kinematic assessments, the Box and Block Test, and five items of the Melbourne Assessment were administered twice during a baseline week (one week before the intervention), directly before and after the intervention, and one day after the training phase (retention).
The average exergame score improved from 209.55 to 339.73 (p < 0.001, Cohen's d = 1.80), indicating skill acquisition. The change in the Box and Block test improved from 0.45 (baseline week) to 3.95 (intervention week; p = 0.008, d = 1.59) indicating skill transfer. The kinematic assessments and the Melbourne items did not change. Improvement in game score and Box and Bock Test persisted one day later (retention).
We found evidence indicating the successful acquisition, transfer, and retention of upper extremity skills in children with CP. We therefore infer that motor learning occurred when children with CP trained their more affected arm with weight-support in a playful, virtual environment.
新型神经康复技术基于运动学习研究得出的治疗原则。然而，很少有研究调查脑瘫（CP）儿童和青少年使用辅助设备进行运动学习的情况。本研究的目的是调查在充满趣味的虚拟环境中借助体重支持进行训练的CP儿童，其上肢任务表现（即技能习得）、迁移和保持情况是否会得到改善，这三个方面表明运动学习是否可能发生。
11名轻度至中度受损的CP儿童（平均年龄13.3岁，标准差3.4岁）参与了研究。他们使用受影响更严重的手臂，在Armeo® Spring上玩“摩尔鸡”（Moorhuhn）体感游戏，为期3天（纯游戏时间70分钟）。对于这个被试内设计，在基线周（干预前一周）、干预前后以及训练阶段后一天（保持阶段），对运动学评估、箱框测试以及墨尔本评估的五个项目进行了两次测量。
体感游戏平均得分从209.55提高到339.73（p < 0.001，科恩d值 = 1.80），表明技能习得。箱框测试的变化从0.45（基线周）提高到3.95（干预周；p = 0.008，d = 1.59），表明技能迁移。运动学评估和墨尔本评估项目没有变化。游戏得分以及箱框测试的改善在一天后（保持阶段）仍然持续。
我们发现有证据表明CP儿童成功习得、迁移并保持了上肢技能。因此，我们推断当CP儿童在充满趣味的虚拟环境中借助体重支持训练其受影响更严重的手臂时，发生了运动学习。
