Difficulties in learning to write affect a large number of children and can have a significant impact on their personal and professional future. To facilitate this learning process, develop fun, motivating and effective devices for the different skills involved in writing (motor skills, postural control, visual attention, letter recognition) is needing. Virtual Reality (VR) seems to be a promising tool for this purpose.
The SCED (Single Case Experimental Design) methodology is adapted to this study to evaluate the impact of VR on learning to write, as it allows a high level of evidence and is applicable to a heterogeneous population such as that affected by difficulties in learning to write. The study will include an original study of 3 children and 3 replications of 3 children each. In total, 12 children will be included in four different settings. This study will determine whether VR training can facilitate learning to write.
The main objective of this study is to evaluate the impact of immersive virtual reality training on handwriting using the Evaligo tool to assess static, kinematic and pressure parameters of handwriting in children aged 6 to 13 with handwriting difficulties according to a SCED methodology.
Age : 6-13 years
BHK: degradation score ≥ 1 standard deviation. The BHK will be administered at the time of the inclusion visit (V1) and/or child with writing difficulties in in daily activities.
Children benefiting or to benefit from rehabilitation care to improve handwriting skills.
Be able to understand instructions and complete all assessments.
Contraindications to using a virtual reality HMD
Severe visual impairment
Facial injury
Epilepsy
Single group
Baseline
Other interventionDuring the baseline, children will carry out their standard paper-and-pencil exercises for writing difficulties (that their perform during usual rehabilitation).
Intervention
Other interventionDuring the intervention, they will carry out usual exercises and they will use VR 15 minutes during each session
Evaluation of the impact of immersive virtual reality training on learning using the Evaligo score.
The Evaligo score assesses static, kinematic and pressure parameters of handwriting in children aged 6 to 13 with handwriting learning difficulties, using a SCED methodology. This assessment has several advantages in this study design: its validity has been verified, it can be repeated a large number of times without test-retest effect, it is sensitive to change and is quick to set up (around 5 minutes), which reduces the burden of assessments for the participating children and therapists. • This score is obtained on the basis of a brief evaluation of around 5 minutes (and repeated, according to the SCED methodology) of trained items (during the intervention), throughout participation in the research (baseline, intervention). The minimum score is 0 (worst), the maximum score is 1 (best).
Assess fine and gross motor skills
Evolution of the score of the Bruininks-Oseretsky Test of Motor Proficiency Brief Form. This test has been validated in a population aged 4 to 21 years. It assesses gross and fine motor skills. The strength subtest will be our control measure in this SCED. The control measure will make it possible to assess an untrained parameter (in this case strength), which is supposed to remain stable during the intervention. The maximum score for fine motor skills part is 60, the minimum score is 0. A high score means high performance in fine motor skills. The maximum score for gross motor skills part is 65, the minimum score is 0. A high score means high performance in gross motor skills.
Assess visual attention
Evolution of the score of the sky search and geographic map subtests of the Test of Everyday Attention for Children (TEA-CH). It assesses visual attention. This test has been validated in a population aged 6 to 16 years. Two subtest will be used: "Map Mission" and "Sky Search" in this study. The maximum score for Map Mission subtest is 80, the minimum score is 1. A high score means high performance in visual attention. The maximum raw score for Sky Search is 20, the minimum score is 1. A high score means high performance in visual attention.
Assess postural control
Evolution of the Pediatric Reach Test (PRT) score, validated in children aged 5 to 15 with or without motor disorders. This test assesses postural control. The score is the difference, in cm, between the starting position and the finishing position.
Determine whether a generalization of learning to write takes place on the paper/pencil writing activity.
Evolution of the BHK score, the benchmark test for assessing handwriting. In the BHK (Brave Handwriting Kindergarten), the child is asked to copy a text for 5 minutes. Blind double scoring is used (the scorer does not know when the child has copied the text). A degradation score is calculated: the higher the score, the more "degraded" the quality of the child's handwriting. The standardized score is taken into account for inclusion (to situate the child's performance in relation to his class), while the raw score is taken into account over the course of the intervention (allowing comparison of the subject with himself). The maximum score for the handwriting quality is 65. A high score means low performance in handwriting.
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