Effectiveness of Handwriting Training Program on Handwriting Performance in Cerebral Palsy
Condition: Cerebral Palsy
MeSH terms: Paralysis; Cerebral Palsy
Study type: Interventional

Summary: 
      Visual perception impairment and upper limb disability will affect the handwriting
      performance. Children with cerebral palsy (CP) who have good function on upper extremity may
      associated with visual perception impairment, which will impact the handwriting performance.
      However, there were few studies to investigate the handwriting problems in children with CP
      who have good upper limb functions. To date, there are no studies to investigate the
      effectiveness of computerized handwriting training programs on handwriting performance in
      children with CP. The aims of this study were to establish the relationships of visual
      perception, visual motor integration, and motor coordination of handwriting performance in
      children with typical development (TD) in Taiwan, to establish the norms of handwriting
      performance in children with TD in Taiwan, to compare handwriting performance in children
      with CP and children with TD, to clarify the relationship of visual perception function and
      handwriting performance in children with CP, and to examine the effectiveness of interactive
      computerized handwriting training program (ICHTP) on handwriting performance in children with
      CP.

      The investigators will collect 90 children with TD and 48 children with CP in the 1st phase.
      All children will receive clinical and Chinese handwriting assessment tool (CHAT)
      assessments. The CHAT and ICHTP will be modified as Taiwan-version handwriting assessment
      tool and training programs for children in Taiwan, respectively. Clinical assessments include
      the visual perception, visual motor integration, fine motor skill, and handwriting
      performance. The CHAT assessed the handwriting legibility, accuracy, pen pressure and writing
      speed. In the 2nd phase, the investigators will collect 48 children with CP, who were
      randomly classified into ICHTP group and Traditional Handwriting Training Program (THTP). All
      children with CP will receive clinical and CHAT assessments before and after interventions.

      The expected results of this study are the visual perception function is related to
      handwriting performance in children with CP, and the improvements in the handwriting
      legibility, accuracy, pen pressure and writing speed of ICHTP training group are greater than
      THTP training group.
    

Detailed description: 
      This study were to establish the relationships of visual perception, visual motor
      integration, and motor coordination of handwriting performance in children with TD in Taiwan,
      to establish the norms of handwriting performance in children with TD in Taiwan, to compare
      handwriting performance in children with CP and children with TD, to clarify the relationship
      of visual perception function and handwriting performance in children with CP in the first
      phase, and to examine the effectiveness of interactive computerized handwriting training
      program (ICHTP) via a randomized controlled study in children with CP in the second phase.The
      subjects are ninety children with typical development aged between 6-12 years from elementary
      school and forty-eight children with CP aged between 6-12 years from Chang Gung Memorial
      Hospital (Taipei branch, Linkou branch, Taoyuan branch, Kaohsiung branch), Far Eastern
      Memorial Hospital, Taipei Veterans General Hospital and Buddhist Tzu Chi General Hospital
      (Taipei branch)etc.Experimental design In first phase, we establish the relationships of
      visual perception, visual motor integration, and motor coordination of handwriting
      performance in children with TD in Taiwan, to establish the norms of handwriting performance
      in children with TD among different age groups in Taiwan, a comparison designed study to
      compare the handwriting performance among 2 CP groups and TD groups. All children were
      assigned into diplegia group, hemiplegia group, and typical development (TD) group. Then we
      will assessment the fine motor skill, visual perception and handwriting performance by
      occupational therapist.

      Experimental procedures:

      All children were assessed with clinical assessments and the Chinese handwriting assessment
      tool (CHAT). Clinical assessments included Manual Ability Classification System (MACS),
      Bruininks-Oseretsky Test of Motor Proficiency-second edition (BOT-II), the Test of
      Visual-Perceptual Skills Revised (TVPS-R), Beery-Buktenica Developmental Test of Visual-Motor
      Integration (Berry VMI) and comprehensive test of basic reading and writing. Evaluations were
      performed in about 1.5-2 hours in a silent and restful room, eliminating factors such as
      fatigue and distraction of attention and concentration, which could have an impact on the
      results. All the tests used in the study were individually administered to all children. The
      performance of all children was videotaped for later scoring.

      In second phase, all CP children were randomized assigned into ICHTP group or THTP group. All
      participations will received clinical and CHAT assessments before and after intervention.
      Clinical assessments included Manual Ability Classification System (MACS),
      Bruininks-Oseretsky Test of Motor Proficiency-second edition (BOT-II), the Test of
      Visual-Perceptual Skills Revised (TVPS-R), Beery-Buktenica Developmental Test of Visual-Motor
      Integration (Berry VMI) and comprehensive test of basic reading and writing. Evaluations were
      performed in about 2 hours in a silent and restful room, eliminating factors such as fatigue
      and distraction of attention and concentration, which could have an impact on the results.
      All the tests used in the study were individually administered to all children. The
      performance of all children was videotaped for later scoring. The intervention consisted of
      ICHTP and THTP training programs, which is 45 min/once, three times/one week, and sustain
      four weeks.
    

Intervention name(s): interactive computerized handwriting training program; traditional handwriting training program
Intervention type(s): Other; Other
Intervention description(s): In ICHTP group, they received the training of visual-perception .visual-motor integration skill of children and modulate muscle strength of grasp through ICHTP software. The training program costs 45 min/once, three times/one week, and sustains four weeks.In traditional group, they received the training of paper-pencil activities with visual-perception and visual-motor integration skills. The training duration is as long as ICHTP group.; The THTP group ,they received the training of paper-pencil activities with visual-perception and visual-motor integration skills
Other intervention name(s): computerized handwriting training program
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: handwriting; cerebral palsy; visual perception; sensory function; motor function; computerized handwriting programs