Effectiveness of the Wheelchair Skills Training Program in People With Complex Movement Disorders
Condition: Cerebral Palsy
MeSH terms: Cerebral Palsy; Movement Disorders
Study type: Interventional

Summary: 
      The overall goal of this project is to increase independent mobility in populations with
      complex movement disorders, such as severe cerebral palsy, by adapting The Wheelchair Skills
      Training Program (WSTP) to the needs and capabilities of this population. The primary
      objective is to evaluate the clinical effectiveness of an adapted Wheelchair Skills Training
      Program tailored for children with complex movement disorders and its impact on wheelchair
      mobility skills. Secondary objectives are to evaluate the clinical effectiveness of an
      adapted Wheelchair Skills Training Program tailored for children with complex movement
      disorders, and its impact on stress, fatigue, and symptoms of the movement disorder, and to
      evaluate the clinical effectiveness of an adapted Wheelchair Skills Training Program tailored
      for children with complex movement disorders, and its impact on participation. The
      investigators hypothesize an improvement in wheelchair skill capacity and performance
      post-intervention compared to pre-intervention. In addition, the investigators hypothesize
      that the levels of stress and fatigue are in the general low to moderate throughout the
      training sessions. However, the investigators also expect that higher levels of (perceived)
      stress and fatigue negatively impact task performance and provoke the symptoms of the
      movement disorder. The investigators hypothesize that participation will improve
      post-intervention compared to pre-intervention.
    

Detailed description: 
      Powered wheelchair training for individuals with complex movement disorders, such as severe
      cerebral palsy, is challenging for healthcare providers, funders, and patients: it is highly
      dependent on the expertise of training staff (e.g., physical and occupational therapists),
      time-consuming for staff and patients, and therefore costly for providers. Poor
      personalisation of current training protocols leads to insufficient clinical outcomes. The
      overall goal of this project is to increase independent mobility in populations with complex
      movement disorders, such as severe cerebral palsy, by adapting The Wheelchair Skills Training
      Program (WSTP) to the needs and capabilities of this population.

      This study focuses on the effectiveness and clinical evaluation of the Wheelchair Skills
      Training Program (WSTP), adapted for children with complex movement disorders. Despite the
      proven effectiveness of the WSTP in other wheelchair-dependent populations, it warrants
      cautious implementation in clinical and educational settings within our target population of
      children with Dyskinetic and Spastic CP (GMFCS III- V). The project contains three study
      objectives. In the first objective, the effectiveness of a powered-wheelchair skill training
      program (WSTP) tailored for children with complex movement disorders on wheelchair mobility
      skills will be assessed. In the second study objective, the impact of a powered-wheelchair
      training session on measures as stress, motivation and fatigue will be evaluated. In the
      third study objective, the effect on everyday participation and quality of life will be
      assessed.

      The primary endpoint is the wheelchair mobility skill performance, assessed using the
      Wheelchair Skills Test (WST). This is an objective test of a set of wheelchair skills. It is
      proven to be a reliable and valid assessment tool and is used in a number of studies as an
      outcome measure for (powered) wheelchair skills capacity. The main advantage of the WST is
      that the tester can see how the wheelchair user carries out the skill, permitting problems
      due to the wheelchair or the technique used to be identified and addressed.

      Although WST capacity measures have been found to be sensitive to changes due to training,
      other measures will also be used to identify training effects on wheelchair mobility skills
      as recommended. The Wheelchair Skills Test - Questionnaire (WST-Q) will be used as it allows
      to assess performance as well as capacity and that in subject's own setting which together
      with WST is recommended for a comprehensive assessment.

      Secondary endpoints include measures such as heart rate variability to explore the impact of
      stress and fatigue on task performance. Emotion Faros 360° devices will be used. Secondary
      endpoints also include measures of establishing the relationship of the intervention program
      with the subject's perceived exertion, Intrinsic Motivation Inventory questionnaire,
      participation by Canadian Occupational Performance Measure (COPM), and quality of life via
      the CP-QoL.
    

Intervention name(s): Wheelchair Skills Training Program
Intervention type(s): Other
Intervention description(s): a standardized training method for users of manual and powered wheelchairs and it combines evidence on motor-skills learning with evidence on how to perform specific wheelchair skills. A recent systematic review and meta-analysis provided evidence that WSTP is a safe and effective intervention that has a clinically meaningful effect on powered wheelchair skill capacity, in particular for new wheelchair users. The WSTP has shown to be effective in several wheelchair-dependent populations and promising to be used in people with complex movement disorders. Yet, adaptation to the specific needs and capabilities of individuals with complex movement disorders is necessary as it has not been assessed in this population. During the 4-week training phase, the participants will receive 3 training sessions per week of 45 minutes, including exercises as described in the Wheelchair Skill Training Program Version 5.1.2
Intervention model: Single Group Assignment
Intervention model description: A one-group pretest-posttest design study will be conducted, consisting of three phases (3- or 5-week baseline phase, 4-week training phase, 4-week retention phase) and four wheelchair skill capacity assessment points (T0: baseline; T1: pre-intervention; T2: post-intervention; T3: retention).
Masking: None (Open Label)
Primary purpose: Treatment