Can a web-based multi-modal therapy program improve executive functioning in children and adolescents with unilateral cerebral palsy?

Abstract

Background/Objectives: To examine the efficacy of a multimodal web-based therapy program, Move it to improve it (Mitii™) delivered in the child's home to improve executive functioning (EF) capacity and performance in children with unilateral cerebral palsy (UCP). Design: Randomised waitlist controlled trial. Participants and Setting: Eighty children with UCP (41 males; mean±SD age=11.85[2.4]; Full Scale IQ=81.27[17.87]; 41 right hemiplegia; GMFCS I=38, II=42) were recruited. Methods: Participants were matched in pairs and randomly allocated to receive either 20 weeks of 20 to 30 minutes of daily Mitii™ training (a total potential dose 60h), or waitlisted receiving usual care (n=40 Mitii™, n=40 WL control). Each individualised Mitii™ program involved games that targeted areas of working memory (WM, 7% of games), visual processing (VP, 42%), upper limb co-ordination (60%) and physical activity (40%). EF capacity was assessed on four domains using measures from the Wechsler Intelligence Scales for Children (WISC-IV) and the Delis Kaplan Executive Functioning System (DKEFS): attentional control (Digits backwards WISC-IV); cognitive flexibility (inhibition and number/ letter sequencing DKEFs); goal setting (Tower test DKEFs); and information processing (Symbol search and Coding WISC-IV). EF performance was assessed using parent reported Brief Rating Inventory of Executive Function (BRIEF). Data were compared between groups at 20 weeks using two sample t-tests (SPSS 21). Results: Groups were comparable at baseline. At the 20 week follow up eight children withdrew (90% retention, 3 from Mitii ™, 5 from WL). Children completed a mean of 28.03 (range 3.68 to 54.53) hours of training. Post intervention there were no significant between group differences on measures of attentional control (Digits Mitii™=6.22[1.97], WL=5.91[2.05], p=0.52); cognitive flexibility (Inhibition Mitii™=85.78[38.85], WL=85.83[29.54], p=0.99; number/letter sequencing Mitii™=125.73[65.82], WL=131.57[61.09], p=0.69); problem solving (Tower Mitii™=16.00[4.90], WL=15.34[4.43], p=0.59) and information processing (Symbol Mitii™=23.95[7.98], WL=20.89[10.28], p=0.16; Coding Mitii ™=43.05[13.84], WL=39.31[17.68], p=0.32; Number sequencing Mitii™=50.70[29.62], WL=51.06[20.59], p=0.95). There was also no significant differences on EF performance at 20 weeks between groups (Mitii™=134.06[35.01], WL=141.06[37.67], p=0.42). Conclusions: Our results indicate that there is no additional benefit to Executive Functioning domains in undertaking the Mitii™ program. Mitii™ had positive effects on other domains (unimanual and physical capacity) however, the dose or content of cognitive challenge were insufficient to improve Executive Functioning.L717462802015-02-03 <br />