SIGNIFICANCE: Upper-extremity motor control is critical for participation in daily activities. Children who have upper-extremity motor impairment experience difficulty with controlled movement in a variety of planes affecting independent participation in functional tasks.

INNOVATION: This program is novel in that it applies multiple virtual-reality-based technologies along with functional training to improve upper-extremity motor control to maximize functional performance. In this study, we attempted to answer the following research question: Does participation in an intensive neurorehabilitation program improve performance of functional goals?

BACKGROUND/OBJECTIVES: There is a growing trend to incorporate technology into the rehabilitation of children with upper-extremity motor impairment. Virtual-reality technology allows for repetitive practice of specific movement patterns while engaging the participant (Blázquez, 2013). Additionally, intensive functional task training has proven to be effective, and skills are retained over time (Robert, Guberek, Sveistrup, & Levin, 2013). Our intensive upper-extremity neurorehabilitation program combines virtual-reality technologies, each focusing on different segments of upper extremity, with repetitive task practice to improve participation in daily activities.

METHOD: This pre–post design included 7 participants with hemiplegia, aged 9 to 17 yr. Hand function was classified using the Manual Ability Classification System (MACS), with 3 participants at Level 3, 3 participants at Level 2, and 1 participant at Level 1. The intervention took place in a 1:1 setting in an outpatient hospital clinic in the Midwest. The neurorehabilitation program included upper-extremity, virtual-reality-based occupational therapy treatment combined with intensive functional task training delivered three times per week, in 1-hr sessions, for 5 to 6 wk. Outcome measures include the Goal Attainment Scaling (GAS) and the Canadian Occupational Performance Measure (COPM). Pre- and postdata were analyzed utilizing paired t tests.

RESULTS: Children with hemiplegia made statistically significant changes in their individualized goals following participation in the neurorehabilitation program. On the COPM, participants made statistically significant changes in satisfaction (p = .02) and in performance (p = .008). Statistically significant changes were also made in the GAS (p = .002). Therefore, children with hemiplegia made significant gains in their individualized goals after participation in this neurorehabilitation program.

Blázquez, M. P. (2013). Clinical application of robotics in children with cerebral palsy. In J. L. Pons, D. Torricelli, & M. Pajaro (Eds.), Converging clinical and engineering research on neurorehabilitation (pp. 1097–1102). Berlin: Springer-Verlag.

Robert, M. T., Guberek, R., Sveistrup, H., & Levin, M. F. (2013). Motor learning in children with hemiplegic cerebral palsy and the role of sensation in short-term motor training of goal-directed reaching. Developmental Medicine and Child Neurology, 55, 1121–1128. http://dx.doi.org/10.1111/dmcn.12219