Limbs Alive: Use of video games to provide motivating, child centred therapy to improve bimanual skills for children with hemiplegic cerebral palsy

INTERVENTION: 70 children with hemiplegia will be randomly allocated to intervention or placebo groups, stratified for sex and severity. The children and families will be told only that computer games are being evaluated for therapy. The research team will be blinded to group allocation. Both groups will be given the same computer games. Intervention group: successful playing will require increasing bimanual dexterity. Placebo group: increasing skill will be required of only the non‐affected hand. The date, time, duration of play and score will be recorded automatically. The Intervention Group The initial grade of difficulty of the task for the paretic hand will be set to make use of their maximum skill. Bimanual dexterity will be required and the task difficulties will be interactively adjusted as part of the game to take account of increasing skill in bimanual hand use. Clinical assessments of upper limb function will be carried out at baseline, 1, 3 and 6 months by an experienced therapist. CONDITION: Hemiplegic cerebral palsy ; Nervous System Diseases ; Spastic hemiplegic cerebral palsy PRIMARY OUTCOME: Melbourne Unilateral Upper Limb Assessment at 1 month, 3 months and 6 months SECONDARY OUTCOME: 1. Assisting Hand Assessment at 1 month, 3months and 6 months; 2. Beery‐Buktenica Developmental Test of Visual‐Motor Integration at 1 month, 3 months and 6 months; 3. Canadian Occupational Performance Measure at 1 month, 3months and 6 months; 4. Kidscreen at 1 month and 6 months INCLUSION CRITERIA: 1. Hemiplegic cerebral palsy 2. Able to actively grasp the game controller with the paretic hand, though grasp need not be maintained. 3. Male & Female, age 7‐15 years