Active Video Gaming for Children with Cerebral Palsy: Does a Clinic-Based Virtual Reality Component Offer an Additive Benefit? A Pilot Study

ABSTRACT

Aims: To compare changes in gross motor skills and functional mobility between ambulatory children with cerebral palsy who underwent a 1-week clinic-based virtual reality intervention (VR) followed by a 6-week, therapist-monitored home active video gaming (AVG) program and children who completed only the 6-week home AVG program. Methods: Pilot non-randomized controlled trial. Five children received 1 hour of VR training for 5 days followed by a 6-week home AVG program, supervised online by a physical therapist. Six children completed only the 6-week home AVG program. The Gross Motor Function Measure Challenge Module (GMFM-CM) and Six Minute Walk Test (6MWT) evaluated change. Results: There were no significant differences between groups. The home AVG-only group demonstrated a statistically and clinically significant improvement in GMFM-CM scores following the 6-week AVG intervention (median difference 4.5 points, interquartile range [IQR] 4.75, p = 0.042). The VR + AVG group demonstrated a statistically and clinically significant decrease in 6MWT distance following the intervention (median decrease 68.2 m, IQR 39.7 m, p = 0.043). All 6MWT scores returned to baseline at 2 months post-intervention. Conclusion: Neither intervention improved outcomes in this small sample. Online mechanisms to support therapist-child communication for exercise progression were insufficient to individualize exercise challenge.

KEYWORDS:

• Active video games
• cerebral palsy
• home exercise programs
• virtual reality

Declarations of Interest

The authors report no declarations of interest.

Acknowledgments

The authors would like to thank participating children and families, physiotherapists Kerri Burgess and Melissa Cormier for their assistance in delivering the interventions, physiotherapy assistants Sandy Schafer and Shannon Theriault for assisting with home Kinect setup, and Patrick Vienneau for designing the website.

About the Authors

Danielle Levac was a postdoctoral fellow at the University of Ottawa at the time of this study and is now Assistant Professor, Department of Physical Therapy, Movement and Rehabilitation Science at Northeastern University where she directs the Rehabilitation Games and Virtual Reality Laboratory. Anna McCormick is Associate Professor, Department of Pediatrics, Faculty of Medicine, University of Ottawa and Medical Director, Pediatric Rehabilitation, Children's Hospital of Eastern Ontario. Mindy F. Levin is Professor, School of Physical and Occupational Therapy, McGill University. Marie Brien was a physiotherapist at the Ottawa Children's Treatment Centre at the time of the study. Richard Mills is a PhD candidate in the School of Human Kinetics, Faculty of Health Sciences at the University of Ottawa and Lecturer in Department of Exercise and Sport Sciences at Manchester Metropolitan University, UK. Elka Miller is Pediatric Neuroradiologist, Medical Imaging Department, Children's Hospital of Eastern Ontario and Associate Professor, Faculty of Medicine, University of Ottawa. Heidi Sveistrup is Professor, Faculty of Health Sciences, University of Ottawa.

Additional information

Funding

This study was funded by the Ontario Federation for Cerebral Palsy and the Ottawa Children's Treatment Center. Dr. Levac's postdoctoral studies were supported by a fellowship from the Canadian Institutes of Health Research and NeuroDevNet and a career enhancement award from the Canadian Child Health Clinician Scientist Program.