Task-specific training in the context of augmented reality (INTERACT protocol) in children with spastic cerebral palsy: a controlled and randomized clinical trial

Abstract

Children with cerebral palsy (CP) have impairments in musculoskeletal function, affecting static and dynamic postural control, especially in highly complex environmental conditions. Therefore, interventions with specific task training and focus on motor learning have been recommended. In addition, technological intervention resources have been used in this context, and augmented reality (AR) can be highlighted, as its games provide multisensory stimuli, and its playful way of doing physical activity makes children more engaged, allowing more variety and repetition of activities and body movements. Although studies have identified positive effects of AR training in children with CP, few studies were found. Objective: To verify the effects of a task-specific training protocol associated with augmented reality (INTERACT Protocol) on the postural control of children with spastic CP who walk and perform sit-to-stand (STS) without assistance. As secondary outcomes, the study aims to verify the effect on capacity and motor performance, motivation, and level of satisfaction in motor performance compared with conventional physical therapy treatment; verify the feasibility of recruitment, assessment, and intervention. Methods: Children with spastic CP with Gross Motor Function Classification System (GMFCS) levels I and II, aged between 6 and 12 years, will participate in the study. The analyzed outcomes will be postural sway by a force plate system during the standing; sit-to-stand activity in different constraints and functional reaching; mobility performance by the Pediatric Assessment of Disability Inventory (PEDI-CAT) and motor skills using the GMFM-CM (Challenge Test). Motivation will be assessed using the Motivation Questionnaire (DMQ - Dimensions of Mastery Questionnaire) and feasibility using a face-to-face interview questionnaire. The intervention will be carried out for 12 consecutive weeks, with 2 weekly sessions, individually and on alternate days, lasting 60 minutes each, totaling 24 sessions and 24 hours of training. AR games developed by Brandão et al (2019) and task-specific training based on pre-established goals chosen by the child will be used. The control group will receive conventional training, for the same period and intervention volume as the children in the experimental group in the clinics where they usually go. The evaluations will take place before, after 6 weeks, and in the 12th week of the training, and a 4-month follow-up will be carried out to verify the retention of the outcomes. Statistical tests to verify the normality of data, comparison of effects between groups (t test or Mann-Whitney) and intra-groups in the three pre-post-follow-up evaluations (repeated measures ANOVA or Friedman) will be performed for the variables of postural oscillation, motivation, ability and motor performance. For feasibility data, descriptive analysis will be performed. Relevance: This study will contribute to the advancement of knowledge about the benefits of augmented reality with specific training and will indicate the viability and the best resource to be used in the clinical rehabilitation of children with CP. (AU)