Virtual Reality-training in Theory of Mind in the Childhood Form of Myotonic Dystrophy Type 1

Study Overview
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Brief Summary
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The ability of an individual to conceive some alternative representations and to behave in a flexible manner would emerge from preschool age and drastically improve between the ages of 3 and 5 (Doebel and Zelazo, 2013). They constitute, according to Diamond (2013), a prerequisite for the development of the Theory of Mind (ToM). Deficits in Executive Functions (EF) may therefore interfere with the child's ability to understand and adapt to social situations. Treatment failures are often observed when traditional cognitive tools are used. This would be linked to the divergence between non-immersive tests and situations encountered in everyday life (Damasio, 1994; Priore Castelnuovo and Liccione, 2002). For this reason, an increasing number of researchers are using virtual reality for the rehabilitation of executive functions and Theory of Mind in patients with neurodevelopmental pathology (Millen, Edlin-White and Cobb, 2010) or brain damage (Le Gall, Besnard, Louisy, Richard and Allain 2008). There is currently no systematic evaluation of ToM in children with the infantile form of DM1 even though these abilities are considered particularly vulnerable and have a decisive impact on the subsequent development of interpersonal relationships. This research will focus on studying the socio-emotional disorders associated with the infantile form of Myotonic Dystrophy type 1 (DM1). The axis that we propose to develop more specifically will be an interventional study with the aim of remediation with children from 5 to 16 years old suffering from the infantile form of DM1 via a training protocol in low-immersion Virtual Reality (VR) centered on emotional processing and theory of mind.

Official Title
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Virtual Reality-training in Theory of Mind in the Childhood Form of Myotonic Dystrophy Type 1

Conditions
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Myotonic Dystrophy Type 1

Intervention / Treatment
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* Other: Virtual Reality-training in Theory of Mind
* Other: Traditional training in Theory of Mind


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 6 years and < 16 years of age Written informed consent Affiliate or beneficiary of a social security scheme Able to comply with all protocol requirements Infantile form of DM1 with molecular confirmation. Development without incident in the first year Normal development in the pre and neonatal period Native language French Exclusion Criteria: Unable to participate in the study Inability to comply with protocol requirements Congenital form of DM1 IQ<70 (Intellectual Disability)

Ages Eligible for Study
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Minimum Age: 6 Years
Maximum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Patient remediate using the virtual training method<br> | Other: Virtual Reality-training in Theory of Mind<br>* Two social scenarios will be used in a virtual environement. Experimenter and subject participate in the scenario as friends of the main character, Nicolas. During the training session, experimenter asks structured questions about participant's awareness of a mental state. In the case of a wrong answer, a feedback-correction is provided via the avatar's thought bubbles. The participant has access to all avatars thought bubbles. In this way, he is able to compare the desires, beliefs or false beliefs of each story character. Participants included in this condition will also have an eye-tracking assessment before and after the training procedure.<br>|
| Active Comparator: Patient remediate using the traditional training method<br> | Other: Traditional training in Theory of Mind<br>* The same two social scenarios are presented to the participant in a story-telling form. Participant has access to thought bubbles via an illustrated book. These trainings will take place in the same number of sessions and took place for a duration equivalent to those used in low immersion Virtual Reality mode. Each training session (EFB, BE, SOFB, ERA, FP, EFP) will be illustrated via visual aids taken from screenshots of the two virtual environments and the target protagonists.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| NEPSY II | Emotion Recognition and Standardized ToM | Through study completion, an average of 5 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| WISC-V | Wechsler Scale is the international benchmark for measuring children's intelligence | Through study completion, on average 5 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Myotonic Dystrophy type 1, Theory of Mind, Virtual environment, Training protocol