Specific-task training in an augmented reality context (INTERACT Protocol) in children with Spastic Cerebral Palsy: randomized controlled 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 for more variety and repetition of activities. body movements. Although studies have identified positive effects of AR training, there are few studies developed in this area. Objective: to verify the effects of a specific task training protocol associated with augmented reality (INTERACT Protocol) on the postural control of children with spastic CP who walk without a gait aid device. As secondary outcomes, the study aims to verify the effect on capacity and motor performance, motivation, level of satisfaction in motor performance, acceptance and adherence to therapy, compared with conventional physical therapy treatment. 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 and three-dimensional angular variables of lower limbs and trunk during sitting to standing activity in different contexts and postural sway in functional reach, 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 acceptance, satisfaction and adherence to the intervention using an online questionnaire. The intervention will be carried out for 12 consecutive weeks, with 2 weekly sessions, individual 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 specific task training based on pre-established goals chosen by the individual will be used. The control group will receive conventional training, carried out for the same period of time and intervention volume as the children in the experimental group. The evaluations will take place before and after 6 and 12 weeks of the beginning 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 data on acceptance, satisfaction and adherence to treatment, descriptive data analyzes will be carried out. 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)