Contralaterally Controlled Functional Electrical Stimulation and Hand Therapy Video Games for Cerebral Palsy

To determine whether children with cerebral palsy (CP) resulting in upper-extremity hemiplegia can adhere to and gain motor skills from a home-based treatment of hand therapy video games in combination with contralaterally controlled electrical stimulation (CCFES) that opens the paretic hand in direct proportion to the degree of voluntary unimpaired hand opening, as detected by a sensor glove worn on the unimpaired hand.

Video games and functional electrical stimulation are complementary approaches that have independently improved outcomes in children with hemiplegic CP. This device is a unique intervention that combines custom hand therapy video games with CCFES. The video games are played by opening and closing the paretic hand, and they facilitate motor practice on the basis of learning principles. CCFES assists children with hemiparesis in opening their paretic hand in a controlled manner to facilitate motor control learning. It does so by linking movement intent to motor execution and returning somatosensory and proprioceptive sensations back to the brain. The purpose of this poster is to increase awareness about this experimental device and its potential to improve hand function in children who live with hemiplegic CP.

This is a case series pilot in which participants serve as their own control. Comparisons were made between pre- and posttreatment assessments. Data were used to refine the intervention and provide estimates of effect size to be used in sample size calculations for future randomized controlled trials.

A convenience sampling method was used with the following inclusion criteria: upper-extremity hemiparesis from CP, ages 8–17 yr, stable medications, recall two of three items after 30 min, finger extension strength ≤ 4/5 on paretic side, able to follow three-stage commands, adequate active movement of paretic arm to position the hand for table-top task practice, surface neuromuscular electrical stimulation trial opens hand without pain, full volitional hand opening and closing of contralateral hand, upper-extremity hand Fugl–Meyer Assessment ≤ 11/14.

The dose administered was assessed by participant diaries, therapist observation, and logs kept by the electrical stimulator and video games. Several motor assessments were also utilized.

Adherence was determined by downloading usage data from both the stimulator and the computer, which was used to calculate the percentage of prescribed treatment time completed by each participant. Descriptive statistics (e.g., averages) were used to analyze adherence across participants. Qualitative data were obtained from parents and patients at each visit. Descriptive statistics were used to describe the results across patients, and paired t tests were used to analyze the pre–post changes.

Though this study is ongoing, our first completed participant had excellent adherence (missing 1 of 54 home sessions) and had improved outcomes at treatment end and 6-wk follow-up. For instance, Assisting Hands Assessment logit increased from 52 at baseline to 63 at treatment end and 64 at follow-up. Improvements also occurred in finger sine wave tracking, Box & Block Test, Fugl-Meyer Assessment, and Child Hand-Use Experience Questionnaire.

Initial data demonstrated positive results for the use of CCFES with computer games as a treatment intervention for children with hemiplegic CP. The results also showed a positive trend for feasibility of this treatment intervention in younger children along with the use within the home environment.

This study demonstrates potential for a viable and important discovery in technology for occupational therapists to use for the treatment of children with hemiplegic CP. The initial data demonstrates a positive trend toward improved fine motor and improved occupational engagement.