ORIGINAL ARTICLE   Open access

European Journal of Physical and Rehabilitation Medicine 2023 October;59(5):554-63

DOI: 10.23736/S1973-9087.23.07945-5

Copyright © 2023 THE AUTHORS

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language: English

Effectiveness of the home-based training program Tele-UPCAT (Tele-monitored UPper Limb Children Action Observation Training) in unilateral cerebral palsy: a randomized controlled trial

Elena BEANI ^{1, 2}, Valentina MENICI ^{1, 3}, Elisa SICOLA ¹, Adriano FERRARI ⁴, Hilde FEYS ⁵, Katrijn KLINGELS ^{5, 6}, Lisa MAILLEUX ⁵, Roslyn BOYD ⁷, Giovanni CIONI ¹, Giuseppina SGANDURRA ^{1, 2} ✉

¹ Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy; ² Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; ³ University of Pisa, Pisa, Italy; 4Unit of Children Rehabilitation, IRCCS S. Maria Nuova Hospital, Reggio Emilia, Italy; ⁵ Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium; ⁶ Rehabilitation Research Center, Faculty of Rehabilitation Sciences, University of Hasselt, Hasselt, Belgium; ⁷ Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children’s Health Research, Faculty of Medicine, University of Queensland, Brisbane, Australia

BACKGROUND: The effects of unilateral cerebral palsy (UCP) are largely observed in the upper limb (UL), which represents the main focus of rehabilitation for this disorder. Thanks to an increment in home training and progress in technology innovative systems have been created. The Tele-UPCAT (Tele-monitored UPper Limb Children Action Observation Training) platform is dedicated to the delivery at home of a program for UL rehabilitation, based on action observation therapy (AOT).
AIM: This study aimed to investigate the immediate effectiveness of Tele-UPCAT for promoting UL skills in children with UCP and to determine if immediate effects were retained in the medium and long term.
DESIGN: Tele-UPCAT was conducted on an intention-to-treat basis and was proposed as a randomized, allocation concealed (waitlist controlled) and evaluator-blinded clinical trial with two investigative arms: intensive in-home AOT program and standard care (SC).
SETTING: This is a home-based AOT program delivered with a customized ICT platform.
POPULATION: Thirty children (mean age 11.61±3.55 years) with confirmed diagnosis of spastic UCP with predominant UL involvement and cognitive level within or at normal limits were enrolled in this study. Orthopedic surgery or an intramuscular botulinum toxin A injection in the UL within 6 months prior to enrolment represented an exclusion criteria.
METHODS: Participants were randomized using concealed random allocation. They were assessed according to the study design with the Assisting Hand Assessment (AHA), the Box and Block Test (BBT) and the Melbourne Assessment 2 (MA2). Linear mixed models were used for statistical analysis.
RESULTS: A significant difference between the AOT and SC groups was identified immediately after the training on the AHA (6.406 [2.73] P=0.021) with an effect size (ES) of 1.99, and for the BBT of the less affected hand (9.826 [4.535] P=0.032) with an ES of 1.44. These effects were sustained at medium and long term.
CONCLUSIONS: This study supports the effectiveness of AOT home training in promoting UL skills in children with UCP, with immediate effects lasting for 6 months.
CLINICAL REHABILITATION IMPACT: This should encourage the use of technology for rehabilitative purposes and further applications of the AOT paradigm.

KEY WORDS: Cerebral palsy; Information technology; Child; Upper extremity