Date Presented 4/8/2016
Children with surgically treated congenital hydrocephalus (HCP) are at risk for long-term deficits in visual–spatial perception, visual attention, and visual–motor skills. This paper will review the implementation and effectiveness of an intensive, tablet-based intervention for children with HCP.
Primary Author and Speaker: Karen Harpster
Additional Authors and Speakers: Nicole Weckherlin
Contributing Authors: Weihong Yuan, Francesco Mangano, David Limbrick, Jon Dodd, Jack Engsberg, Stephanie Powell, Holly Barnard, Darren Kadis, Amanda Gauthier, Carolyn Darbin
PURPOSE: To develop and test the feasibility of a tablet-based occupational therapy (OT) intervention protocol in school-age children with surgically treated hydrocephalus (HCP) and to assess the impact of the newly developed intervention protocol. Our hypothesis was that children with surgically treated HCP will benefit from the OT intervention with quantifiable changes on the neuropsychological testing.
BACKGROUND: Children with congenital HCP, even after surgical treatment, are at risk for long-term deficits in visual–spatial perception/reasoning, visual attention, and visual–motor coordination domains. Many patients have subtle deficits that may go unnoticed during early childhood, leading to increased difficulty in school performance in school-age children as the demands of the school tasks increase.
DESIGN: Single group, pre–post design
PARTICIPANTS: This study included 13 children with congenital HCP, ages 6–18 yr, who were treated surgically earlier in life. The participants were recruited from two Midwestern institutions.
METHOD: A 6-wk intervention protocol was developed targeting visual–spatial perception/reasoning, visual attention, and visual–motor coordination skills through the use of iPad applications. The protocol included (1) a weekly clinic visit during which an occupational therapist assigned three to four iPad applications at the just-right challenge level for each category and (2) 1 hr of the iPad intervention at home, 4 days per week. Neuropsychological testing was completed before and after the intervention.
ANALYSIS: Paired t tests were used to assess the statistical significance of the changes in neuropsychological testing
RESULTS: Aim 1: The 6-wk intervention protocol was tested in 13 participants. All 13 participants (100%) successfully completed the intervention for the recommended time (24 hr, 6 wk × 4 days/wk × 1 hr/day).
Aim 2: The primary outcome measure, the Perceptual Reasoning Index subscale (PRI) of the Wechsler Abbreviated Scale of Intelligence, Second Edition, increased significantly after the intervention (preintervention, mean [M] = 82.77, standard deviation [SD] = 13.77; postintervention, M = 90.69, SD = 14.63, p = .028). Among the 13 participants, 8 showed a 7 points or more improvement (approximately half the PRI population standard deviation). 4 showed negligible or no change (≤3 points). Only 1 participant scored lower after the therapy, possibly due to the loss of interest in finishing the test.
DISCUSSION: This pilot study demonstrated the feasibility and initial evidence of benefit of the 6-wk tablet-based intervention protocol. It is expected that longer intervention may lead to better therapy effect.
Phase 2 of this pilot study is underway to test a 9-wk protocol using the same intervention. The difference in the therapy response between the 6- and the 9-wk protocol will provide crucial preliminary data before proceeding to a large-scale clinical trial study
IMPACT STATEMENT: Virtual reality–based interventions are being utilized more readily in the therapeutic environment. Tablet-based interventions can be effective to improve visual–motor, visual–spatial perception and reasoning, and visual attention skills. This paper will discuss the implementation and effectiveness for an intensive, tablet-based intervention for children with hydrocephalus.
