{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T23:10:31Z","timestamp":1764889831444,"version":"3.46.0"},"reference-count":63,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"unspecified","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,9,24]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Visual perception and visual-motor integration skills are key predictors of handwriting. Children with cerebral palsy often experience difficulties in these areas, which can negatively affect handwriting. Interventions targeting these skills may improve handwriting outcomes in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This single-blind (data analyst blinded), three-arm randomised controlled trial will include 30 children with spastic cerebral palsy. Participants will be randomly allocated to one of three groups: (1) a computerised visual-motor integration training group, (2) a computerised visual perception training group or (3) a control group. Randomisation will be performed using a stratified permuted block design based on cerebral palsy subtype (hemiplegia, diplegia and quadriplegia). Each intervention group will receive 20 individual sessions (two times per week for 10 weeks) using validated computerised games. The primary outcome is handwriting performance, assessed by the Persian Handwriting Assessment Tool. Secondary outcomes include visual-motor integration, assessed by the Beery\u2013Buktenica Developmental Test of Visual\u2013Motor Integration, and visual perception, assessed by the Test of Visual\u2013Perceptual Skills\u2013Revised.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study was approved by the Ethics Committee of Tehran University of Medical Sciences. Written informed consent will be obtained from parents. Participation is voluntary, free and confidential. Control group participants may receive the intervention after the trial. Results will be published in peer-reviewed journals and shared with relevant stakeholders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>IRCT20230219057447N1.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-101304","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T05:26:01Z","timestamp":1759901161000},"page":"e101304","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of computerised visual-motor integration and visual perception training games on handwriting and visual skills in children with spastic cerebral palsy: study protocol for a randomised controlled trial"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1759-6182","authenticated-orcid":false,"given":"Aida","family":"kazemnazhand_Asl","sequence":"first","affiliation":[{"name":"Department of Occupational Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2725-5081","authenticated-orcid":false,"given":"Hamid","family":"Dalvand","sequence":"additional","affiliation":[{"name":"Department of Occupational Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8991-9782","authenticated-orcid":false,"given":"Hooshang","family":"Dadgar","sequence":"additional","affiliation":[{"name":"Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8270-9704","authenticated-orcid":false,"given":"Masoud","family":"Khorrami-Nejad","sequence":"additional","affiliation":[{"name":"Department of Optometry, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5452-4596","authenticated-orcid":false,"given":"Kheirollah","family":"Rahsepar Fard","sequence":"additional","affiliation":[{"name":"Department of Computer Engineering and Information Technology, University of Qom, Qom, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,10,7]]},"reference":[{"key":"2025120415061360000_15.10.e101304.1","first-page":"179","article-title":"The Persian Handwriting Assessment Tool for Primary School-Aged Children: Further Validation","volume":"45","author":"Meimandi","year":"2020","journal-title":"Iran J Med Sci"},{"key":"2025120415061360000_15.10.e101304.2","doi-asserted-by":"publisher","DOI":"10.5014\/ajot.62.3.298"},{"key":"2025120415061360000_15.10.e101304.3","doi-asserted-by":"publisher","DOI":"10.3109\/09638281003654789"},{"key":"2025120415061360000_15.10.e101304.4","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1111\/j.1469-8749.2007.00312.x","article-title":"Handwriting development, competency, and intervention","volume":"49","author":"Feder","year":"2007","journal-title":"Develop Med Child Neuro"},{"key":"2025120415061360000_15.10.e101304.5","doi-asserted-by":"publisher","DOI":"10.5014\/ajot.59.4.377"},{"key":"2025120415061360000_15.10.e101304.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ridd.2010.06.001"},{"key":"2025120415061360000_15.10.e101304.7","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1111\/j.1440-1630.2009.00804.x","article-title":"Rater reliability of the adapted scoring criteria of the Minnesota Handwriting Assessment for children with cerebral palsy","volume":"56","author":"Tam","year":"2009","journal-title":"Aust Occup Ther J"},{"key":"2025120415061360000_15.10.e101304.8","unstructured":"Lemire G , Lalibert\u00e9 T , Turcot K , et al . 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