Individualized, home-based interactive training of cerebral palsy children delivered through the Internet

Abstract

Background: The available health resources limit the amount of therapy that may be offered to children with cerebral palsy and the amount of training in each session may be insufficient to drive the neuroplastic changes, which are necessary for functional improvements to take place. The aim of this pilot study was to provide proof of concept that individualized and supervised interactive home-based training delivered through the internet may provide an efficient way of maintaining intensive training of children with cerebral palsy over prolonged periods.

Methods: 9 children (aged 9-13 years) with cerebral palsy were included in the study. Motor, perceptual and cognitive abilities were evaluated before and after 20 weeks of home-based training delivered through the internet.

Results: The children and their families reported great enthusiasm with the training system and all experienced subjective improvements in motor abilities and self-esteem. The children on average trained for 74 hours during a 20 week period equalling just over 30 minutes per day. Significant improvements in functional muscle strength measured as the frontal and lateral step-up and sit-to-stand tests were observed. Assessment of Motor and processing skills also showed significant increases. Endurance measured as the Bruce test showed a significant improvement, whereas there was no significant change in the 6 min walking test. Balance (Romberg) was unchanged. Visual perceptual abilities increased significantly.

Conclusions: We conclude that it is feasible to deliver interactive training of children with cerebral palsy at home through the internet and thereby ensure more intensive and longer lasting training than what is normally offered to this group.

Figure 1

The MiTii training system. A: Illustration made from screenshots of MiTii. The editing window is where the individual settings are done and progressively modified. First step in the editing is to choose the group of patients (purple dot). Next the screen of the individual client in question is selected (green dot). Each individual training programme is made up of a sequence of exercises. The different exercises are represented by icons that can be moved around freely to accomplish the optimal individual sequence. The full program covers from 30 to 45 minutes (blue dot). A basic case record system is provided to store personal patient information (red dot). A double click on each of the icons opens up a new window (arrow). Here it is possible to adjust a range of parameters B: The necessary hardware comprises a computer (1) with a webcam and an Internet connection. A green elastic band (2) is placed on the person in training. The band is placed around the head, on the wrists, the knees, the elbows or wherever the therapists find it to meet the requirements.

Figure 2

Changes in AMPS, muscle strength, gait and TVPS following the 20 week training program. A-C: Black and grey columns give group averages before and after the training, respectively. Each vertical line is one SEM. In A the ordinate gives the ADL ability in the motor skills test (left columns) and processing skills test (right columns). In B the ordinate gives the number of steps that the children could make on average in the frontal step-up (left columns), lateral step-up (middle columns) and sit to stand (right columns) tests. In C the ordinate is the number of minutes that the children were able to walk on average. In D the ordinate is the total score in the 7 TVPS tests as a percentage of the average score for an age-matched healthy population. Black columns are values before training and grey columns are values after training. vertical lines give 1 SEM.