Randomized controlled trial of a web-based multi-modal therapy program for executive functioning in children and adolescents with unilateral cerebral palsy

Abstract

Purpose state: Determine the efficacy of Move-it-to-improve-it (MitiiTM), a multi-modal web-based program, in improving Executive Function (EF) in children with unilateral cerebral palsy (UCP). Method: Participants (n = 102) were matched in pairs then randomized to: intervention (MitiiTM for 20 weeks; n = 51; 26 males; mean age + 11 years 8 months (SD = 2 years 4 months); Full Scale IQ = 84.65 (SD = 15.19); 28 left UCP; GMFCS-E&R (I = 20, II = 31) or waitlist control (n = 50; 25 males; mean age = 11 years 10 months (SD = 2 years 5 months); Full Scale IQ = 80.75 (SD = 19.81); 20 left UCP; GMFCS-E&R (I = 25, II = 25). MitiiTM targeted working memory (WM), visual processing (VP), upper limb co-ordination and physical activity. EF capacity was assessed: attentional control (DSB; WISC-IV); cognitive flexibility (inhibition and number-letter sequencing DKEFS); goal setting (D-KEFs Tower Test); and information processing (WISC-IV Symbol Search and Coding). EF performance was assessed via parent report (BRIEF). Groups were compared at 20 weeks using linear regression (SPSS 21). Results: There were no significant between group differences in attentional control (DSB; p = 0.20; CI = −0.40,1.87); cognitive flexibility (Inhibition, p = 0.34; CI = −0.73,2.11; number/letter sequencing, p = 0.17; CI = −0.55,2.94); problem solving (Tower; p = 0.28; CI = −0.61,2.09), information processing (Symbol; p = 0.08; CI = −0.16, 2.75; Coding; p = 0.07; CI = −0.12,2.52) or EF performance (p = 0.13; CI = −10.04,1.38). Conclusion: In a large RCT, MitiiTM did not lead to significant improvements on measures of EF or parent ratings of EF performance in children with UCP. Implications for rehabilitation: 1. A large RCT of the multi-modal web based training; Move It to Improve It (MitiiTM) improves motor processing, visual perception, and physical capacity but does demonstrate statistically significant improvements or clinical significance in executive function in children with mild to moderate unilateral cerebral palsy (UCP). 2. MitiiTM training completed by an intervention group was highly variable with few children reaching the target dosage of 60 h. Technical issues including server and internet connectively problems lead to disengagement with the program. 3. Web-based training delivered in the home has the potential to increase therapy dose and accessibility, however, MitiiTM needs to be tailored to include tasks involving goal-setting, more complex problem solving using multi-dimensional strategies, mental flexibility, switching between two cognitively demanding tasks, and greater novelty in order to increase the cognitive component and challenge required to drive changes in EF. (PsycINFO Database Record (c) 2017 APA, all rights reserved)Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, University of Queensland, Centre for Children’s Health Research, South Brisbane, Australia. Other Publishers: Informa Healthcare. Release Date: 20171207. Publication Type: Journal (0100), Peer Reviewed Journal (0110). Format Covered: Electronic. Document Type: Journal Article. Language: EnglishGrant Information: Boyd, Roslyn N. Major Descriptor: Cerebral Palsy; Cognitive Ability; Online Therapy. Minor Descriptor: Physical Activity. Classification: Neurological Disorders & Brain Damage (3297); Specialized Interventions (3350). Population: Human (10); Male (30); Female (40). Location: Australia. Age Group: Childhood (birth-12 yrs) (100); School Age (6-12 yrs) (180); Adolescence (13-17 yrs) (200); Adulthood (18 yrs & older) (300); Young Adulthood (18-29 yrs) (320). Tests & Measures: Gross Motor Function Classification-Extended; Gross Motor Function Classification-Revised; Manual Abilities Classification Scale-I; Manual Abilities Classification Scale-II; Manual Abilities Classification Scale-III; Wechsler Intelligence Scale for Children, Fourth Edition Short-Form; Behavior Rating Inventory of Executive Function; Delis-Kaplan Executive Function System DOI: 10.1037/t15082-000; Wechsler Intelligence Scale for Children, Fourth Edition DOI: 10.1037/t15174-000. Methodology: Clinical Trial; Empirical Study; Followup Study; Quantitative Study. References Available: Y. Page Count: 8. Issue Publication Date: Sep, 2017. Publication History: Accepted Date: Jul 13, 2016; Revised Date: Jul 10, 2016; First Submitted Date: Dec 16, 2015. Copyright Statement: Informa UK Limited, trading as Taylor & Francis Group. 2016.Sponsor: Queensland Government, Australia. Other Details: Smart Futures Co-investment Fund. Recipients: No recipient indicated <br />Sponsor: Financial Markets for Children. Grant: 2011–210,. Recipients: No recipient indicated <br />Sponsor: Perpetual Foundation. Other Details: The Aldred Charitable Endowment. Recipients: No recipient indicated <br />Sponsor: Sponsor name not included. Other Details: Margaret Augusta Farrell and Love J S. Recipients: No recipient indicated <br />Sponsor: Williams H P Trust Fund. Recipients: No recipient indicated <br />Sponsor: Jessica and Wallace Hore Foundation. Grant: FR2012/0796. Recipients: No recipient indicated <br />Sponsor: National Health and Medical Research Council, Australia. Grant: 1105038. Other Details: Research Fellowship. Recipients: Boyd, Roslyn N. <br />