I’m a 5, I’m Paralyzed, but I’m Learning to Move! Fostering the Development of Voluntary Motor Skills in Spastic Quadriplegic Cerebral Palsy Child using a Novel Psychomotor Sensory Substitution Paradigm : A case report

Background: Cerebral palsy, particularly spastic quadriplegia (SQ), severely impairs motor development. Developing voluntary motor skills is therefore one of the most challenging issues when considering these children! Movement relies on sensation, yet quadriplegia not only impairs motor control but also somatosensory sensitivity, particularly proprioception, hindering clear perception of body movement.Objective: The present project aims to evaluate the efficacy of a novel sensory substitution paradigm utilizing visuo-auditory feedback through a serious game (SG) in fostering the development of voluntary motor skills among SQ children.Methods: We tested one 5-year-old girl with severe motor disabilities due to SQ, who are unable to sit or control her head (GMFCS grade V, SATCo score 0) and demonstrate no manual ability (MACS grade V). She can only voluntarily control her eyes, moving and focusing on a target when asked. The child is non-verbal but can respond to simple questions by looking at basic communicative targets. Using an EMG device, muscle contractions were translated into visual and auditory feedback according to a sensory substitution paradigm. A right-arm contraction prompts the appearance of a cat on the right side of the screen, while a left arm contraction positions it on the left. Conversely, the onset of a spasm triggers a soothing melody. The child attended 9 bi-weekly 60-minute sessions at her institution. Data collection was conducted using video recordings reporting 1) the number of spasms versus voluntary movements event per minute, 2) movement pattern and 3) gaze orientation. A baseline before the intervention was established over 4 sessions of standard treatment for comparison.Results: our preliminary findings show that the sensory substitution SG we designed for this SQ CP child prove to be effective to provide visuo-auditive feedback to the child’s contractions and therefore allows the child to produce more controlled movements. Moreover, they highlight the potential of providing visuo-auditive feedback to the child's contractions as a substitute for impaired proprioception, restoring crucial cues for motor development and control.