Article

Purpose state: Determine the efficacy of Move-it-to-improve-it (Mitii), 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 (Mitii 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). Mitii 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 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). 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. 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.

Langue : ANGLAIS