Hydrocephalus iPad-App Based Intervention Study

NCT03595033 | Completed

• 1 other identifier: CIN_HCPiPad_001
• Study Type: interventional
• Target: 14
• Locations: 0 countries
• Sites: N/A

Brief Summary

This is a pilot study examining the feasibility and efficacy of using Apple iPad applications ("apps") during therapy interventions that target visual motor, visual attention, and visual-spatial reasoning skills in school age children who were previously treated surgically for hydrocephalus. Each subject will participate in an initial assessment and baseline MRI, followed by 6-weeks of iPad app-based interventions, and finally a follow-up assessment and a follow-up MRI.

Conditions

Hydrocephalus; Hydrocephaly; Hydrocephalus in Children

Outcome Measures

Primary Outcomes (9)

• General intellectual functioning, including visual-spatial reasoning

  The Perceptual Reasoning Index (PRI) of the revision of the Wechsler Abbreviated Scale of Intelligence (WASI-II). PRI includes the subtests Block Design and Matrix Reasoning. The Raw scores of the subtests are converted to T-scores, which are summed for a Sum of T-scores for Perceptual Reasoning. The Sum of T-scores for Perceptual Reasoning is converted to a Composite Score of the PRI, which can be used to find the Percentile Rank. The Block Design raw scores range from 0-51 and the Matrix Reasoning raw scores range from 0-23. The T-score ranges are from 20-54. The Composite Scores range from 40-160.The higher the scores of the subtests, the higher the score on the PRI, the greater the subject's ability to analyze and synthesize abstract visual stimuli and the subject's fluid intelligence, broad visual intelligence, classification and spatial ability, knowledge of part-whole relationships, simultaneous processing, and perceptual organization.

  Initial assessment and Follow-up assessment (6-8 weeks after Initial assessment)

• Basic visual perception, visual-motor integration, and graphomotor skills

  The Beery-Buktenica Developmental Test of Visual Motor Integration 6th Edition (Beery VMI). The composite score is the sum of the scores of three subtests: Visual-Motor Integration, Visual Perception, and Motor Coordination. The scores for the subtests are calculated using pre-formatted tables to determine the standard score, scaled score, and percentile based off of the raw score. The composite score has a mean of 100 and a standard deviation of 15 for all ages groups, and are based on the means of raw score distribution. The higher the score, the higher the percentile, the greater the subject's ability for visual perception, visual motor-integration, and graphomotor skills.

  Initial assessment and Follow-up assessment (6-8 weeks after Initial assessment)

• Visual-spatial processing

  The Arrows subtest of the revision of A Developmental Neuropsychological Assessment (NEPSY-II), designed to assess the ability to judge line orientation. The Arrows subtest-level scores range from 1-19, with a low score indicating poor visuospatial skills, while a high score indicates excellent visuospatial skills.

  Initial assessment and Follow-up assessment (6-8 weeks after Initial assessment)

• Visual-spatial processing and mental rotation

  The Geometric Figures subtest of the revision of A Developmental Neuropsychological Assessment (NEPSY-II), designed to assess mental rotation, visuospatial analysis, and attention to detail. The Geometric Figures subtest-level scores range from 1-19, with a low score indicating difficulty with visuospatial perception, including mental rotation and with a high score indicating excellent visuospatial perception.

  Initial assessment and Follow-up assessment (6-8 weeks after Initial assessment)

• Selective visual attention

  The Cancellation subtest of the revision of the Wechsler Intelligence Scale for Children (WISC-IV), designed to measure processing speed. The Raw Score is converted to a Scaled Score (1-19), which is converted to a Percentile Rank. The higher the raw score, the higher the Scaled Score, and the Percentile Rank. The higher the score, the better the visual processing speed.

  Initial assessment and Follow-up assessment (6-8 weeks after Initial assessment)

• Visual-spatial decision making and visual-motor speed

  Coding subtest of the revision of the Wechsler Intelligence Scale for Children (WISC-IV), designed to measure visual-motor speed and complexity and motor coordination. The Raw Score is converted to a Scaled Score (1-19), which is converted to a Percentile Rank. The higher the raw score, the higher the Scaled Score, and the Percentile Rank. The higher the score, the better the visual-spatial and visual-motor skills.

  Initial assessment and Follow-up assessment (6-8 weeks after Initial assessment)

• Fine motor dexterity

  The Purdue Pegboard test, designed to measure manual dexterity and bimanual coordination.The test is comprised of 5 scores, each of the subtests are timed. Scores are continuous, the higher the score the greater the subjet's manual dexterity and bimanual coordination.

  Initial assessment and Follow-up assessment (6-8 weeks after Initial assessment)

• Visual-motor control

  The Visuomotor Precision subtest of the revision of A Developmental Neuropsychological Assessment (NEPSY-II), designed to assess graphomotor speed and accuracy. The Visuomotor Precision subtest-level scores range from 1-19, with a low score indicating difficulty with visuomotor control and with a high score indicating excellent visuomotor skills.

  Initial assessment and Follow-up assessment (6-8 weeks after Initial assessment)

• Neuroanatomical alterations in brain tissue structure

  Diffusion Tensor Imaging (DTI) scan: a spin-echo EPI DTI sequence (FOV = 240 x 240 mm, matrix = 96 x 96, in-plane resolution = 2.5 x 2.5 mm, slice thickness = 2.5 mm, number of slices =76, TR/TE = 9400/93.2 msec; sense factor = 2; NEX = 2). DTI measures anisotropic diffusion properties via diffusion indices.

  Baseline MRI and Follow-up MRI (6-8 weeks after Baseline MRI)

Secondary Outcomes (1)

• Adherence to the training plan

  6 weeks

Study Arms (1)

Intervention Phase

EXPERIMENTAL

Throughout the intervention phase, participants will attend weekly intervention visits. During these visits, an occupational therapist (OT) will educate the participant and their caregiver on the therapy plan which includes the iPad apps to be completed during the week. The participants will be asked to complete their therapy plan for 1 hour per day at home, 4 days per week.

Device: iPad app-based intervention

Interventions

iPad app-based intervention DEVICE

The 1-hour of home based intervention will break into three 20-min sessions, each including iPad apps targeting one of the three domains of deficits: visual attention, visual-spatial reasoning, and visual-motor skills.

Intervention Phase

Eligibility Criteria

• Age: 6 Years - 6 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Children, aged 6 to 17 years, with hydrocephalus who have had a surgical intervention
• Deficits in 2 of more of the following neuropsychological testing categories: visual motor, visual attention, or visual reasoning.

You may not qualify if:

• Shunt revision within the past one year
• MRI-sensitive programmable shunt or any other MRI-sensitive implant
• Braces or other dental hardware that would interfere with the quality of MRI images (participants with braces are only excluded from the MRI portion of the study)
• Intellectual disability: IQ \< 70
• Deficits in one or none of the three following neuropsychological testing categories: visual motor, visual attention, or visual reasoning
• Age 18 years or greater
• Non-English speaking: We will not enroll non-English speaking participants because the iPad applications are not readily available in other languages. All neuropsychological testing materials are also in English.

Sponsors & Collaborators

• Children's Hospital Medical Center, Cincinnati: lead

MeSH Terms

Conditions

Hydrocephalus

Condition Hierarchy (Ancestors)

Brain Diseases; Central Nervous System Diseases; Nervous System Diseases

Study Officials

• Karen L Harpster, PhD, OTR/L

  Children's Hospital Medical Center, Cincinnati

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: May 29, 2018
• First Posted: July 23, 2018
• Study Start: November 24, 2015
• Primary Completion: December 28, 2018
• Study Completion: December 28, 2018
• Last Updated: February 26, 2021

Record last verified: 2021-02