Motor disorders related to cerebral palsy are often accompanied by sensory, cognitive,
      perceptive, communication and behavioural impairments. It has already been shown that
      intensive bimanual intervention can improve arm movement, but its impact on the spontaneous
      use of the most affected arm in everyday life remains to be established. This project aims to
      understand the impacts of an intensive bimanual therapy on uni- and bi-manual motor functions
      as well as the spontaneous use of the most affected arm. Predictive value of neuroimaging
      variables will also be assessed.

Intensive Bimanual Intervention in Cerebral Palsy Children

Cerebral Palsy

Most activities of everyday life require the use of both hands in a coordinated manner. Motor
      disorders related to cerebral palsy lead to activity limitations due to motor function
      disturbances. It has already been shown that intensive bimanual intervention can improve arm
      movement, but its impact on the spontaneous use of the most affected arm in everyday life
      remains to be established. This project aims to understand the impacts of intensive bimanual
      therapy on the motor functions of both arms (working together or in isolation) as well as on
      the spontaneous use of the most affected limb. Predictive value of neuroimaging variables
      will also be assessed. Thirty children living with cerebral palsy will be recruited over a
      5-year period. The intervention consists of a day camp, where a small group of participants
      will be stimulated (one worker per child) to do activities using both hands 6 hours/day for
      10 days. There will be three periods of evaluation (pre-intervention, post-intervention and
      6-month follow-up). These evaluation periods consist of neuroimaging assessment, clinical
      evaluation, robotic evaluation and movement evaluation using inertial control units. The use
      of more accurate measurements of sensorimotor arm functions using robotic systems will
      clarify the relationship between measurements of brain function and clinical improvements, to
      better understand the significant variability observed in response to interventions.

Intensive bimanual therapy

Predictors of Response to an Intensive Bimanual Intervention in Children With Cerebral Palsy

The participant must reach as quickly and accurately as possible 4 targets spread over a radius of 10 cm around the starting target, presented in a pseudo-random order (total of 32 reaching movements)

The participant must hit the balls with the hand of they choice, each successful contact generating haptic feedback.

Four targets are successively presented to the participant, the objective of the task is to move the ball into each target as quickly and accurately as possible.

In this proprioception task the sense of upper limb position is evaluated

The unilateral and bilateral functions will be quantified by summing the activities detected at the upper limbs with accelerometers, allowing to obtain use-ratio of each limb.

Sensitive test to determine tactile threshold

Sensitive test to determine tactile threshold.

Seven standardized tasks to evaluate the unimanual function. 6 tasks. Sub-task score is the time to complete the task (a maximum of 120s is allowed per task) and the total score is the total time to perform the six tasks (maximum of 720s). Higher time means worse outcome.

Seven standardized tasks to evaluate the unimanual function

Measurement of manual dexterity of each hand. The participant must take one block at a time with one hand to transfer it to the other side of the box.

This test consists of standardized tasks with toys during a semi-structured game session. The test is recorded, and the video is analyzed and scored later. Logit-based 0 to 100 AHA-unit scale (score 0-100; better score means better outcome).

Evaluation of the constrained bilateral use of both upper limbs with an electronic tracking device (eight tests; four clockwise and four counter-clockwise).

Visual perception test that assesses consistency of form, spatial orientation, discrimination, memory and visual closure (Score: 0 - 40; better score means better outcome).

Full Professor, Université Laval, Scientific Director, Cirris

CHEQ is a 29 item child-completed questionnaire that examines how the weaker/affected limb is used in everyday activities. It presents a list of common daily activities that typically require use of two hands. The child then rates the time required, the efficacy of grasp, and how bothered they feel by their hand function on the task. Total score transformed by a Rasch analysis into a scale of 0-100 units (better score means better outcome).

Prior to the intervention, children, parents and therapists will work together to set a therapy goal related to their hand or wrist function. The child will score their current performance/satisfaction on the identified activity and will re-score post-intervention. Performance: scale from 0 to 10, better the score is better is the outcome. Satisfaction: scale from 0 to 10, better the score is better is the outcome.

Prior to the intervention, children, parents and therapists will work together to set a therapy goal related to their hand or wrist function. The child will score their current performance/satisfaction on the identified activity and will re-score post-intervention.Performance: scale from 0 to 10, better the score is better is the outcome. Satisfaction: scale from 0 to 10, better the score is better is the outcome.

Children and youth living with cerebral palsy will take part in a 60-hour intensive bimanual therapy at Peps at Université Laval, during which they will play games and exercise to promote spontaneous use of the most affected hand. Participants will take part to pre-evaluation and 1-week and 6-month post-intervention.

Intensive Bimanual Intervention in Cerebral Palsy Children

About this trial

Study ID

Status

Type

Phase

Placebo

Accepting

Not accepting

Trial Timing

What is this trial about?

What are the participation requirements?

Locations

Location

Status