Effect of Computerized Visual Games on Handwriting, Visual Perception and Visual Motor Integration in the Children with Spastic Cerebral Palsy in the second and third grades of elementary schools.

The effect of computerized visual games on handwriting, visual perception skills and visual-motor integration in children with spastic cerebral palsy in second and third grades of elementary school.

A clinical trial with a control group, parallel groups, single blind, randomized, on 30 children. A stratified permuted block randomization method will be used.

The study population is spastic cerebral palsy. Interventions are in the field of handwriting, visual perception and motor visual integrity. Interventions in occupational therapy clinics or exceptional schools in Tehran. Interventions will be computeized visual games ( 20 sessions . Interventions are for individual children. Games will be played on the computer and the child will play these games with the mouse in a quiet environment). After the end of interventions, final evaluation and then data analysis will be carried out. The study is a blind type that will be a blind statistical analyzer. The statistical analyzer who does not know the participants will perform these analyses.)

Inclusion criteria: Children with spastic cerebral palsy diagnosed by pediatric neuroscience Exit Criteria: People who do not want to participate in the study at any stage of the study

One of the intervention groups will receive the visual perception game alongside traditional handwriting exercises. The other intervention group will receive the visual-motor integration game in addition to traditional handwriting exercises, while the third group, serving as the control group, will not receive any of these games and will only perform traditional handwriting exercises.

Handwriting; visual perception; visual-motor integration

Update of randomization method, recruitment status, and further clarification of interventions to ensure consistency with the final study protocol and in response to journal requirements.

A stratified permuted block randomization method will be used in this trial. Participants will first be stratified based on the type of spastic cerebral palsy into three strata: hemiplegia, diplegia, and quadriplegia. Within each stratum, participants will be randomly assigned to one of the three study groups: Group A (visual-motor integration intervention), Group B (visual perception intervention), and Group C (control group). Thus, randomization will be performed separately within each CP subtype to ensure balance across groups. To achieve allocation concealment, we will use sealed, opaque envelopes made with foil and carbon paper to prevent any visibility of group assignment. Since we are not certain about the exact number of participants in each CP subtype in advance, and to follow recommendations from similar studies (e.g., Doig et al., 2005), we will prepare more than the planned 30 envelopes specifically, 81 envelopes in total, consisting of 27 for each group (A, B, and C). These envelopes will be distributed across three Tupperware-style containers, each labeled according to the CP subtype (hemiplegia, diplegia, quadriplegia). In each container, 9 envelopes from each group (A, B, and C) will be placed (totaling 27 envelopes per stratum). These envelopes will not be mixed between strata. Within each stratum, random blocks of size 3 and 6 will be created, and envelopes will be shuffled within each block. To determine the sequence of blocks, a coin-flipping method will be used: if the coin lands on heads, a block of size 3 will be selected; if tails, a block of size 6. This process will be repeated until a complete block sequence is generated for each stratum. Once the block order is finalized, it will remain fixed. Subsequently, envelopes within each stratum will be numbered sequentially: H1–H27 for hemiplegia, D1–D27 for diplegia, and Q1–Q27 for quadriplegia. As each participant enters the trial, after being classified by CP subtype, the next available envelope in that stratum will be assigned to them in sequence. Importantly, this entire randomization and allocation process will be performed by an independent researcher who is not involved in recruitment, intervention delivery, or outcome assessments, in order to minimize potential bias 54.

Given that all relevant information is included in the informed consent form, participants in this study will be fully aware of the group to which they are assigned after allocation. Specifically, participants in the intervention groups will receive computerized games, whereas participants in the control group will not receive any intervention from the therapist during the study. Therefore, blinding of participants is not possible. In this study, only the data analysts will be blinded to allow for a single-blind design. The principal investigator will conduct both the baseline assessments and the interventions, as well as the post-intervention evaluations, and will be fully aware of the entire study process.

Data related to the variables will be made available to the Occupational Therapy Education Research Department and, upon request by the corresponding author, will be provided to them for use in meta-analysis studies.

The first part, concerning the provision of data to the Occupational Therapy Education group, will be carried out after the article is published. For the second part, data will be sent whenever an official request is received from the authors of meta-analysis studies.

For researchers working in academic and scientific institutions

For further studies in this field, based on the recommendations provided in the article.

corresponding author (Dr. Hamid Dalvand)

First, a message regarding the purpose of data usage, along with sufficient information about the researcher’s name and contact details, will be emailed to the researcher. If the details are reviewed and the procedures are verified, it will be sent within a short period of time.