Effect of fine motor skills training through telerehabilitation on handwriting and manual skills in children with diplegic cerebral palsy

The limitation in manipulating objects is one of the most important determinants of activities of daily life and participation for children with cerebral palsy. Evaluation and intervention of fine motor skills are among the main components of pediatric occupational therapy practices. The American Occupational Therapy Association recognizes the use of telerehabilitation technologies as an acceptable method of providing services for healthcare practitioners. The aim of the study is to determine the problems experienced by children with diplegic cerebral palsy in their handwriting performance, daily life activities, fine motor, and hand skills; and to demonstrate the effect of the applied occupational therapy intervention on the performance of children in these areas. 40 children between the ages of 7-12 years old, diagnosed with diplegic cerebral palsy, at levels I-III of the Hand Skills Classification System, and possessing the necessary infrastructure for video calls were included in the study. Children who did not give consent or had an additional neurological/psychiatric diagnosis were not included in the study. Children who received services from the sensory integration unit of the Department of Occupational Therapy of Biruni University Faculty of Health Sciences were included in the study. The children to be included in the study were divided into two groups, intervention (n:20) and control (n:20), by randomization. Occupational therapy home program tailored to the intervention goals was given to both groups of children. In addition, fine motor skill training was given with telerehabilitation 3 days a week, 45 minutes a day for a total of 8 weeks to the children in the intervention group. In the evaluation, first, demographic information about the child was obtained from the parent, and the Children's Hand‐Skills Ability Questionnairewas filled out with the parent. In the second stage, the Canadian Occupational Performance Measure, Assessment of Children's Hand Skills, Minnesota Handwriting Test, Shriners Hospital Upper Extremity Evaluation, and Bruininks-Oseretsky Motor Proficiency Test 2-Short Form evaluations were applied through a video call with the child. Evaluations were repeated for both groups at the end of the eighth week. SPSS 22.0 program was used in the analysis of the data. Variables were expressed as mean +/- standard deviation in groups, and nominal variables were expressed as a percentage. The intra-group and inter-group data were compared at the second evaluation. A p-value <0.05 was taken in all tests. In our study, the normal distribution suitability of the variables was determined by the Shapiro-Wilk test. Paired samples t-test was used for intra-group analysis in parametric variables, and independent samples t-test was used for inter-group analysis. The Wilcoxon signed-rank test was used for intra-group analysis in non-parametric variables, and the Mann-Whitney U test was used for inter-group analysis. As a result of the study, compared to the initial evaluations, performance scores in COPM, Minnesota Handwriting Test measurement and range scores, Assessment of Children's Hand Skills score, Shriners Hospital Upper Extremity Evaluation Spontaneous Functional Analysis and Dynamic Positional Analysis scores, and Bruininks-Oseretsky Motor Proficiency Test 2-Short Form "Making dots in circles with preferred hand" scores were significantly improved in the intervention group(p<0.05). Only improvement in the COPM performance score was observed in the control group (p < 0.05). In conclusion, tele-rehabilitation is an effective method in improving handwriting performance, fine motor skills, occupational performance, and hand skills in children with bilateral cerebral palsy. Larger-scale studies examining the effectiveness of tele-rehabilitation programs should be conducted.