Gaming for Function: Exploring the Feasibility and Efficacy of the MusicGlove ^Ⓡ on Hand Use and Motivation in Children With Hemiparetic Cerebral Palsy

PURPOSE: Cerebral palsy (CP) is the most prevalent pediatric motor disability often affecting daily activity performance involving the upper extremities (Centers for Disease Control and Prevention, 2020). Common occupational therapy interventions are based on the theory of motor learning, which suggests that motor skills are gained through repetitive massed practice and experiences to promote neuroplasticity (Zwicker & Harris, 2019). However, some of these interventions are found to be less meaningful and engaging. Virtual rehabilitation may provide greater motivation to engage in repetitive massed practice and thus have greater potential for functional outcomes. The MusicGlove ^Ⓡ is a wearable video game device designed to facilitate repetitive practice of functional grips, and has been shown to improve participant satisfaction and hand use in the adult stroke population (Friedman et al. 2014), but has not been explored in the pediatric population. The purpose of this study was to determine the feasibility and efficacy of the MusicGlove ^Ⓡ intervention on the functional hand use and internal motivation of children with hemiparetic CP.

DESIGN: This exploratory study was designed as a case series; all participants acted as their own control and participated in the MusicGlove ^Ⓡ intervention. Participants completed twenty three 60-minute sessions over a 5 week period that included an orientation, pretest, posttest, and 20 treatment sessions. Three participants, aged 6-17, with a diagnosis of hemiparetic CP were recruited through convenience sampling using word of mouth and flyers posted on social media support groups. Participants needed to be able to handle most objects successfully with reduced speed or quality, communicate with most people at a comfortable or slow pace, and oppose at least one digit of the affected hand. To isolate the effects of the intervention, potential participants were excluded if they were to receive any type of treatment to the affected upper extremity within the study time frame.

METHOD: Pre- and post-intervention data was collected on successful completion of functional grips as measured by the MusicGlove ^Ⓡ scores and perceived difficulty of daily activities as measured by the responses on the ABILHAND-Kids. The Intrinsic Motivation Inventory (IMI) was used to collect data post-intervention on the participant’s subjective experience using the MusicGlove^® to measure satisfaction and likelihood to continue participating in this intervention. Descriptive statistics was used for data analysis due to the small sample size of three.

RESULTS: Participants demonstrated improvements in the percentage of notes hit correctly in the MusicGlove ^Ⓡ game, as the mean pre-intervention score was 78.61 (SD = 14.21) and the mean post-intervention score was 89.62 (SD = 3.18). Participants and their caregivers reported a decrease in perceived difficulty of daily activities in the ABILHAND-Kids, as the pre-intervention mean score was 0.80 (SD = 1.47) post-intervention mean score was 2.82 (SD = 2.30). Participants reported the MusicGlove ^Ⓡ intervention to be of value/useful and interest/enjoyment on the IMI, using a 7-point Likert scale where 1 is not true at all and 7 is very true, with mean scores of 5.70 (SD = 0.79) and 5.15 (SD = 0.99) respectively.

CONCLUSION: The MusicGlove ^Ⓡ may be a feasible intervention to improve hand use and internal motivation for children with hemiparetic CP. Further research with a larger sample size is recommended.

IMPACT STATEMENT: This research explores the use of the MusicGlove ^Ⓡ in children with CP. As more rehab-based devices come to market, it is best practice that practitioners understand the relevance and benefits of these devices among various ages and populations.

References

Centers for Disease Control and Prevention. (2020, December 31). What is cerebral palsy? https://www.cdc.gov/ncbddd/cp/facts.html

Friedman, N., Chan, V., Reinkensmeyer, A. N., Beroukhim, A., Zambrano, G. J., Bachman, M., & Reinekensmeyer, D. J. (2014). Retraining and assessing hand movement after stroke using the MusicGlove: Comparison with conventional hand therapy and isometric grip training. Journal of NeuroEngineering & Rehabilitation, 11(1), 1-31. https://doi.org/10.1186/1743-0003-11-76

Zwicker, J. G. & Harris, S. R. (2009). A reflection on motor learning theory in pediatric occupational practice. Canadian Journal of Occupational Therapy, 76(1), 29-37. https://doi.org/10.1177/000841740907600108