A Model to Estimate the Optimal Layout for Assistive Communication Touchscreen Devices in Children With Dyskinetic Cerebral Palsy

ICT training for educators of Granada for working with people with autism

Background

Innovative methodologies based on Information and Communication Technology (ICT) are a tested and motivating option for working with people with autism. Their use, however, should not be indiscriminatory and arbitrary, but didactic and appropriate.

Objective

We aimed to discover the training in ICT they had, its frequency of use, and the types of digital resources that they used.

Methods

We administered the questionnaire, "Demands and Potentials of ICT and Apps for Assisting People with Autism" to 310 educators in the city of Granada (Spain). The participants belonged to schools and associations that worked with people with autism. Adopting a quantitative-type study, we carried out descriptive analyses (frequencies, mean, mode, and standard deviation). Having confirmed that the data did not follow a normal distribution (Kolmogorov-Smirnov test for samples of >50 participants), we carried out non-parametric inferential and intrafactorial correlation analyses. We also calculated the effect size.

Results

The educators revealed that they had ICT training for working with people with autism, but not enough. This suggests that there is still a need to improve the digital competence of these professionals. Strong, direct and significant correlations were found between ICT training and the frequency with which they were used. There were also statistically significant differences according to sex, gender, age, type of institution, and type of educator. The educators who worked as Therapeutic Pedagogy teachers and those who worked in Special Education schools were shown to be more competent than the rest in educational technology applied to people with autism.

Conclusions

The results, which were not wholly positive since ICT training should be better and have achieved higher scores, revealed that there is a foundation in ICT education but it needs to be heightened and improved with greater knowledge and more practical experience.

Telehealth and remote interventions for children with cerebral palsy: A scoping review

Background

Remote treatment, or telehealth, has shown promise for children with cerebral palsy (CP) prior to 2020; however, the beginning of the global COVID-19 pandemic limiting access to hospitals for face-to-face treatments has driven the need for telehealth and led to a surge in its development. Due to the recent developments, there has been limited synthesis of the available evidence of telehealth for children with CP.

Objective

This study aimed to analyze and summarize the existing evidence for telehealth interventions for the treatment of children with CP and identify any areas requiring further research.

Methods

A scoping review was performed. A systematic search of available literature in MEDLINE and PubMed was performed during July 2021. Inclusion criteria for articles were primary research and systematic reviews that investigated telehealth, included children with CP, were published between 2010-2021, and were written in English. Exclusion criteria were secondary research other than systematic reviews; interventions that did not meet the World Health Organization definition of telehealth; or studies where all participants were aged >18 years, children’s results were not reported separately, or there were no results reported for children with CP. A scoping review was chosen due to the expected heterogeneity of the participants, as well as the expected small sample sizes and inconsistency of measured outcomes; therefore, a narrative reporting of the results was considered appropriate.

Results

In all, 5 papers were identified, which included the results of 11 studies—2 of the included articles were systematic reviews, which included the results of 3 studies each. These 6 studies, together with 5 primary research articles, were included in this scoping review. The existing evidence is of low methodological quality, primarily consisting of case series. There is some evidence that the requirements of telehealth differ depending on the children’s developmental stage and functional level. Telehealth is reported to reduce caregiver burden. There is mixed evidence on children’s compliance with telehealth. Overall, the results of telehealth interventions for the treatment of children with CP were positive, indicating either comparable or improved results compared with children receiving usual face-to-face care.

Conclusions

The evidence base is lacking in breadth and methodological quality to provide robust clinical recommendations. Most studies investigated hand function only, indicating the limited scope of existing research. However, this review shows that telehealth has demonstrated potential to improve function for children with CP while making health care services more accessible and reducing caregiver burden. Areas requiring further research include telehealth interventions for the lower limb, postural management, and pain control and the barriers to implementing telehealth.

Can spatial filtering separate voluntary and involuntary components in children with dyskinetic cerebral palsy?

The design of myocontrolled devices faces particular challenges in children with dyskinetic cerebral palsy because the electromyographic signal for control contains both voluntary and involuntary components. We hypothesized that voluntary and involuntary components of movements would be uncorrelated and thus detectable as different synergistic patterns of muscle activity, and that removal of the involuntary components would improve online EMG-based control. Therefore, we performed a synergy-based decomposition of EMG-guided movements, and evaluated which components were most controllable using a Fitts' Law task. Similarly, we also tested which muscles were most controllable. We then tested whether removing the uncontrollable components or muscles improved overall function in terms of movement time, success rate, and throughput. We found that removal of less controllable components or muscles did not improve EMG control performance, and in many cases worsened performance. These results suggest that abnormal movement in dyskinetic CP is consistent with a pervasive distortion of voluntary movement rather than a superposition of separable voluntary and involuntary components of movement.

Tuning of Standing Postural Responses to Instability and Cost Function

Whole-body movements are performed daily, and humans must constantly take into account the inherent instability of a standing posture. At times these movements may be performed in risky environments and when facing different costs of failure. The aim of the study was to test the hypothesis that in upright stance participants continuously estimate both probability of failure and cost of failure such that their postural responses will be based on these estimates. We designed a snowboard riding simulation experiment where participants were asked to control the position of a moving snowboard within a snow track in a risky environment. Cost functions were provided by modifying the penalty of riding in the area adjacent to the snow track. Uncertainty was modified by changing the gain of postural responses while participants were standing on a rocker board. We demonstrated that participants continually evaluated the environmental cost function and compensated for additional risk with feedback-based postural changes, even when probability of failure was negligible. Results showed also that the participants' estimates of the probability of failure accounted for their own inherent instability. Moreover, participants showed a tendency to overweight large probabilities of failure with more biomechanically constrained standing postures that results in suboptimal estimates of risky environments. Overall, our results suggest that participants tune their standing postural responses by empirically estimating the cost of failure and the uncertainty level in order to minimize the risk of falling when cost is high.

Technological Advancements in Cerebral Palsy Rehabilitation

Smaller, smarter, more portable rehabilitation technology has the potential to improve the ability of individuals with cerebral palsy to perform activities and increase participation. Robotics and virtual reality may improve movement by maximizing exercise dose, providing feedback, and motivating users. Augmentative and alternative communication technology is facilitating communication. Robots can help with self-care and provide encouragement and instruction in rehabilitation programs. Mobile applications can provide education and resources. Conducting high-quality research to validate technological advances in our field has been a major focus of researchers and advocacy groups.