Can a Novel ‘Serious Gaming’ Technology Improve Upper Limb Sensation and Function in Children with Cerebral Palsy? A Population-based Cohort Study and Pilot Randomised Controlled Trial

Author: David Hobbs

Hobbs, David, 2018 Can a Novel ‘Serious Gaming’ Technology Improve Upper Limb Sensation and Function in Children with Cerebral Palsy? A Population-based Cohort Study and Pilot Randomised Controlled Trial, Flinders University, College of Science and Engineering

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Cerebral palsy (CP) is a permanent condition and the most common cause of physical disability in childhood (Reddihough, 2011; Herbert et al., 2016). Affecting approximately two per 1,000 live births in Australia (ACPR, 2016), the consensus definition for the condition recognises that CP is also accompanied by disturbances of sensation (Rosenbaum et al., 2007). The primary aim of this PhD thesis was to investigate an upper limb somatosensory intervention for children with CP with a known sensory impairment, and was divided into two stages.

Stage 1 involved recruiting children living with CP from the South Australian Cerebral Palsy Register and assessing them for tactile sensory acuity. This was the first time a population-based sensory assessment of children living with CP was conducted in South Australia. Informed by the literature, each child was assessed using validated and reliable sensory tests (tactile registration, proprioception and tactile perception) and a test of functional hand motor skills (the Jebsen-Taylor Hand Function Test, JTHFT). Thirty six children (22 males, age = 10 ± 3.3 years) with either unilateral (n=23) or bilateral (n=13) CP completed the tests satisfactorily. Twenty eight (78%) children recorded a tactile deficit in one or more modality, which is comparable to the literature. Confirming previous reports in the literature, tactile sensory impairments were also recorded in the less-affected (dominant) hand for 52% of children with unilateral CP, and tactile registration deficits were associated with an increased likelihood of tactile perception deficits.

Stage 2 of the research involved a six-week home-based ‘serious games’ randomised controlled trial (RCT) using the OrbIT Gaming System (OGS). The OGS is a haptic accessible computer gaming system that requires coordinated and integrated upper limb use, whereby deliberate and targeted contextualised vibration stimulation is delivered to the child’s hands during gameplay. It was hypothesised that children randomised to treatment with active vibration feedback (Group A) would have significantly better sensory and functional outcomes post-trial compared to children using the OGS but receiving no active vibration stimulation (Group B). This research is the first application of a technology-based intervention directed at improving somatosensory dysfunction in children with CP.

Eighteen children (12 males, age = 10.7 ± 3.4 years) participated in the trial, with 10 children randomised to Group A and eight to Group B. Statistical modelling revealed a significant between group difference for the more affected non-dominant (ND) hand for the test of stereognosis, between baseline (A1) and the immediate post-trial assessment (A2), which did not persist at follow-up assessment (A3) one month later. Since all 18 children participated in a forced bimanual integrated upper limb task, a secondary exploratory analysis and re-modelling was conducted. This analysis revealed a strong statistically significant difference between baseline (A1) and follow-up (A3) assessments for the ND hand for the total time taken to complete the JTHFT (p = 0.001), however, a Type II error cannot be ruled out.

This series of studies has added to our knowledge of upper limb sensory loss in children with CP – its prevalence, nature and potential amelioration. The primary recommendation from this PhD is that sensory impairments should continue to be more intensively addressed, and that systems such as the OGS warrant further research to explore effectiveness and utility through an appropriately powered trial.

Keywords: cerebral palsy, serious games, somatosensory function, disability, impairment, health gaming, games for health, exer-games, accessible, universal design, randomised controlled trial, upper limb, sensation

Subject: Engineering thesis

Thesis type: Doctor of Philosophy
Completed: 2018
School: College of Science and Engineering
Supervisor: Prof Karen J Reynolds