Title: Limbs Alive: Use of computer games to provide motivating, child centred therapy to improve bimanual skills for children with hemiplegic cerebral palsy.
Funder: Department of Health (England)

Abstract: Background Hemiplegic cerebral palsy is common affecting 1 in 1,300 births. The children grow-up using their unaffected hand almost exclusively and neglect their impaired hand. Development of the sensorimotor cortex controlling the affected limb is suppressed and they do not develop effective motor programmes for bimanual activities. Many activities of daily living require two hands and children with hemiplegia often do not develop sufficiently skilful bimanual dexterity to be fully independent in adulthood. The term “never-learned–to-use” (NLTU) is used to describe this common situation. If NLTU is addressed during childhood, by increasing use of the affected arm and hand in bimanual activities, it is preventable or reversible. Aims Well designed computer games provide all the elements for effective motor learning, namely interactivity, repetition, multi-sensory stimulation, immediate feedback and motivation. Flexibility to change interactively task difficulty according to the patients’ initial capabilities, their rate of learning and the therapeutic goals, are additional advantages of using computer games for therapy. Together with children who have hemiplegia, we have designed and piloted computer based video games requiring two hands to be played. The children named the initiative “Limbs Alive”. We aim to assess if children with hemiplegia will play the computer games regularly and whether this is associated with significant improvement in the use and function of their affected arm and hand in everyday activities. Plan of Investigation 70 children with hemiplegia will be randomly allocated to intervention or placebo groups, stratified for sex and severity. The children and families will be told only that computer games are being evaluated for therapy. The research team will be blinded to group allocation.Both groups will be given the same computer games. Intervention group: successful playing will require increasing bimanual dexterity. Placebo group: increasing skill will be required of only the non-affected hand. The date, time, duration of play and score will be recorded automatically. Clinical assessments of upper limb function will be carried out at baseline, 1, 3 and 6 months by an experienced therapist. The study will have 80% power at the 0.05% significance level to detect an effect size of 0.75. Potential Impact If the games are shown to be effective it will provide an evidence-base for treatment of children with hemiplegic cerebral palsy. The approach also has potential for treatment of adult stroke, traumatic brain injury and developmental coordination disorder (dyspraxia). The games are designed to be played within the home and to deliver regular and enjoyable therapy without requiring constant supervision and guidance from a therapist. They are inclusive, allowing parents, siblings and friends to play. Equipment costs for each child are low. The games therefore have the immediate potential to help children with hemiplegia achieve sufficiently skilful bimanual dexterity to increase their independence and quality of life and reduce their need for NHS support now and in adulthood.?


Research activity codes: 6.7 PHYSICAL
Health categories: STROKE;NEUROLOGICAL