Discussion
repetitive motor training
This study compared the effects of kinect-based CIMT and that of the therapist-based CIMT on UE and trunk motor control and on daily motor function in children with UCP. Compared to therapist-based CIMT, kinect-based CIMT yielded comparable improvement on UE motor control and daily motor function. Moreover, kinect-based CIMT demonstrated extra benefits on improving trunk motor control.Kinect-based CIMT resolved the practical issues with CIMT, which improved the clinical utility of CIMT. To our knowledge, this kinect-based CIMT program is the first to integrate the CIMT principles into VR games. To restraint the less-affected UE, limb-specific games were designed for the Kinect sensor and a contextual restraint method was adopted. Contextual restraint was first adopted in camp-based CIMT [Kinect-based CIMT demonstrated effects comparable to that of therapist-based CIMT on the affected UE motor control and daily function. The possible factors which contributed to the motor improvement of the affected UE being similar to those of therapist-based CIMT were the intensive repetitive practice, structured training approach and functional motor training goals used in kinect-based CIMT. First, intensive repetitive practice, a crucial principle of CIMT, is embedded in the fun VR games of kinect-based CIMT. Intensive repetitive motor training can drive neuroplasticity and motor learning and thus improve the motor control of the affected UE [Compared with therapist-based CIMT, kinect-based CIMT may provide extra benefits on improving trunk motor control in children with UCP. During forward reaching, typically developing children tend to use their arm first, followed by the trunk if the target is too far to reach, which is an efficient strategy for forward reaching [During a pandemic (e.g., COVID-19), the kinect-based CIMT program may also serve as a no-contact or low-contact rehabilitation program. Due to COVID-19, social distancing (e.g., minimal to no contact) are imposed [This study has some limitations. First, the sample size was relatively small. Moreover, the children with UCP in the present study encompassed a homogeneous population, so the generalizability of the study findings might be limited. Further research on larger and diverse samples is needed. Second, the long-term effects of the interventions were not investigated with follow-up assessments. Future studies on this topic are warranted. Third, the kinect-based CIMT program only consisted of two games. More games based on the CIMT principles can be developed in the future to improve the clinical utility of the kinect-based CIMT.