偏瘫型脑瘫儿童和正常发育儿童在非沉浸式虚拟环境中进行新平衡任务运动学习时的表现变异性
Performance Variability During Motor Learning of a New Balance Task in a Non-immersive Virtual Environment in Children With Hemiplegic Cerebral Palsy and Typically Developing Peers.
作者信息
Cheng Minxin, Anderson Michael, Levac Danielle E
机构信息
Rehabilitation Games and Virtual Reality Laboratory, Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, United States.
Department of Biology, Macalester College, St. Paul, MN, United States.
出版信息
Front Neurol. 2021 Mar 15;12:623200. doi: 10.3389/fneur.2021.623200. eCollection 2021.
Motor impairments contribute to performance variability in children with cerebral palsy (CP) during motor skill learning. Non-immersive virtual environments (VEs) are popular interventions to promote motor learning in children with hemiplegic CP. Greater understanding of performance variability as compared to typically developing (TD) peers during motor learning in VEs may inform clinical decisions about practice dose and challenge progression. (1) To quantify within-child (i.e., across different timepoints) and between-child (i.e., between children at the same timepoint) variability in motor skill acquisition, retention and transfer in a non-immersive VE in children with CP as compared to TD children; and (2) To explore the relationship between the amount of within-child variability during skill acquisition and learning outcomes. Secondary data analysis of 2 studies in which 13 children with hemiplegic CP and 67 TD children aged 7-14 years undertook repeated trials of a novel standing postural control task in acquisition, retention and transfer sessions. Changes in performance across trials and sessions in children with CP as compared to TD children and between younger (7-10 years) and older (11-14 years) children were assessed using mixed effects models. Raw scores were converted to z-scores to meet model distributional assumptions. Performance variability was quantified as the standard deviation of z-scores. TD children outperformed children with CP and older children outperformed younger children at each session. Older children with CP had the least between-child variability in acquisition and the most in retention, while older TD children demonstrated the opposite pattern. Younger children with CP had consistently high between-child variability, with no difference between sessions. Within-child variability was highest in younger children, regardless of group. Within-child variability was more pronounced in TD children as compared to children with CP. The relationship between the amount of within-child variability in performance and performance outcome at acquisition, retention and transfer sessions was task-specific, with a positive correlation for 1 study and a negative correlation in the other. Findings, though preliminary and limited by small sample size, can inform subsequent research to explore VE-specific causes of performance variability, including differing movement execution requirements and individual characteristics such as motivation, attention and visuospatial abilities.
运动障碍会导致脑瘫(CP)患儿在运动技能学习过程中的表现出现差异。非沉浸式虚拟环境(VE)是促进偏瘫型脑瘫患儿运动学习的常用干预手段。与正常发育(TD)的同龄人相比,深入了解在虚拟环境中运动学习期间的表现差异,可能有助于为关于练习剂量和挑战进展的临床决策提供依据。(1)量化与TD儿童相比,CP患儿在非沉浸式虚拟环境中运动技能获取、保留和转移方面的儿童内部(即跨不同时间点)和儿童之间(即同一时间点的儿童之间)的差异;(2)探讨技能获取过程中儿童内部差异量与学习成果之间的关系。对两项研究进行二次数据分析,其中13名偏瘫型CP患儿和67名7至14岁的TD儿童在获取、保留和转移环节对一项新的站立姿势控制任务进行了重复试验。使用混合效应模型评估与TD儿童相比以及年龄较小(7至10岁)和年龄较大(11至14岁)儿童之间CP患儿在各试验和环节中的表现变化。将原始分数转换为z分数以满足模型分布假设。表现差异量化为z分数的标准差。在每个环节中,TD儿童的表现均优于CP患儿,年龄较大的儿童表现优于年龄较小的儿童。年龄较大的CP患儿在获取环节中儿童之间的差异最小,在保留环节中差异最大,而年龄较大的TD儿童则呈现相反的模式。年龄较小的CP患儿儿童之间的差异一直很高,各环节之间没有差异。无论组别如何,年龄较小的儿童儿童内部差异最高。与CP患儿相比,TD儿童的儿童内部差异更为明显。在获取、保留和转移环节中,表现的儿童内部差异量与表现结果之间的关系因任务而异,一项研究呈正相关,另一项研究呈负相关。尽管研究结果初步且受样本量小的限制,但可为后续研究提供参考,以探索表现差异的虚拟环境特定原因,包括不同的运动执行要求以及动机、注意力和视觉空间能力等个体特征。