A web-based therapy program enhances occupational performance and visual perception in children with unilateral cerebral palsy [commentary]

The efficacy of high-intensity therapy programs in improving upper limb function in children with unilateral spastic cerebral palsy has previously been established. However, these programs can be labour-intensive and are not feasible for all families. The use of interactive computer play to augment face-to-face therapy is appealing as it may afford a low-cost means of intensive therapy delivery, typically in the home setting.
This trial was well designed, conducted and reported. The observed differences between the intervention and control groups in motor and processing skills, occupational performance and visual perception validates the proposal that web-based training permits repetitive practice of the perceptual, cognitive and motor control components of a task. The absence of improvement in the Assisting Hand Assessment and the Melbourne Assessment of Unilateral Upper Limb function scores for the impaired limb could be due to the lack of specificity of the training: it was neither goal-directed nor task-specific. Alternatively, the program may not have been sufficiently intense to achieve experience-dependent neuroplastic changes. Participants completed an average of 32 hours (of the recommended 40 to 60 hours) over 20 weeks, with six participants completing ≤ 10 hours. These training hours were substantially less and were distributed over a longer period than typically advocated for other efficacious ‘high-dose’ therapy programs.
The efficacy of home programs for children with cerebral palsy has been demonstrated and is a central component of service provision for this client population. Web-based programs afford another mode of service delivery for therapists that may, by their tech-based nature, be of greater appeal to children and adolescents than more traditional approaches to home program prescription. Web-based programs facilitate repetitive practice and can improve the quality of performance of activities of living, motor and processing skills. Clinicians should consider the intensity, duration and specificity of training when considering implementing such programs in practice. Provenance: Invited. Not peer-reviewed.