Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.
Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.
J Neuroeng Rehabil. 2024 Sep 4;21(1):151. doi: 10.1186/s12984-024-01446-2.
Worldwide, children with cerebral palsy (CP) living in underserved communities face barriers to accessing motor therapy services. This study assessed the implementation and effectiveness of an 8-week, upper limb (UL) home-based intervention with a movement-tracking videogame (Bootle Blast) in Costa Rican children with CP.
Children established a weekly playtime goal and two UL activities of daily living (ADLs) that they would like to improve on. A multiple-baseline, single-case experimental design, was used with the Performance Quality Rating Scale (PQRS) as the repeated measure to track changes in performance of the selected ADLs between the baseline (usual care) and intervention (Bootle Blast) phases. The Canadian Occupational Performance Measure (COPM), the Box and Blocks Test (BBT) and the Children's Hand-Use Experience Questionnaire (CHEQ) were collected before and after the intervention. Technical barriers were documented during weekly video calls with a monitoring therapist. Treatment effect size, slope changes and percentage of non-overlapping data were identified for the PQRS. Descriptive statistics summarized results for the BBT, CHEQ, videogame logs (e.g., playtime) and technical barriers.
Fifteen children participated and 13 completed the intervention. Both participants who dropped out did so after completing baseline assessments, but before experiencing Bootle Blast. Children's mean active playtime (i.e., mini-games targeting the UL) across the 8-weeks was 377 min, while mean total time spent engaging with Bootle Blast (active + passive play time [e.g., time navigating menus, reviewing rewards]) was 728 min. In total, eight technical issues (from five children) were reported, and all but three were resolved within 48 h. Partial effectiveness was associated with the intervention. Specifically, 85% of participants improved on the PQRS and 69% achieved clinically important improvements ≥ 2 points in performance on the COPM. Children improved by 1.8 blocks on average on the BBT, while on the CHEQ, five children had a clinically important increase of 10% of the total number of UL activities performed with both hands.
Bootle Blast is a feasible and effective option to facilitate access and engage children with cerebral palsy in UL home rehabilitation. Trial registration Trial registration number: NCT05403567.
在全球范围内，生活在服务不足社区的脑瘫儿童在获得运动治疗服务方面面临障碍。本研究评估了在哥斯达黎加脑瘫儿童中进行为期 8 周的上肢（UL）家庭干预，使用具有运动跟踪功能的视频游戏（Bootle Blast）的实施情况和效果。
儿童设定每周游戏时间目标和两项他们希望改善的日常生活活动（ADL）的 UL 活动。采用多基线、单病例实验设计，使用性能质量评定量表（PQRS）作为重复测量，以跟踪基线（常规护理）和干预（Bootle Blast）阶段之间选定 ADL 的表现变化。在干预前后收集加拿大职业表现测量（COPM）、箱式和积木测试（BBT）和儿童手部使用体验问卷（CHEQ）。每周与监测治疗师进行视频通话时记录技术障碍。根据 PQRS 确定治疗效果大小、斜率变化和非重叠数据百分比。BBT、CHEQ、视频游戏日志（例如，针对 UL 的迷你游戏）和技术障碍的结果汇总描述性统计数据。
共有 15 名儿童参与，其中 13 名完成了干预。两名退出的参与者均在完成基线评估后退出，但在体验 Bootle Blast 之前退出。儿童在 8 周内的平均主动游戏时间（即针对 UL 的迷你游戏）为 377 分钟，而总花费在 Bootle Blast 上的时间（主动+被动游戏时间[例如，浏览菜单、查看奖励的时间]）为 728 分钟。总共有 8 个技术问题（来自 5 个孩子）报告，除了 3 个问题之外，其他问题都在 48 小时内得到解决。干预与部分有效性相关。具体来说，85%的参与者在 PQRS 上有所改善，69%的参与者在 COPM 上的表现改善了 2 分以上，达到了临床重要性改善。儿童在 BBT 上平均提高了 1.8 块，而在 CHEQ 上，5 名儿童双手执行的 UL 活动总数增加了 10%，具有临床重要性提高。
Bootle Blast 是一种可行且有效的选择，可以促进脑瘫儿童接受 UL 家庭康复治疗。
试验注册号：NCT05403567。
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