Advertisement

Active Video Game Play in Children With Cerebral Palsy: Potential for Physical Activity Promotion and Rehabilitation Therapies

      Abstract

      Howcroft J, Klejman S, Fehlings D, Wright V, Zabjek K, Andrysek J, Biddiss E. Active video game play in children with cerebral palsy: potential for physical activity promotion and rehabilitation therapies.

      Objective

      To evaluate the potential of active video game (AVG) play for physical activity promotion and rehabilitation therapies in children with cerebral palsy (CP) through a quantitative exploration of energy expenditure, muscle activation, and quality of movement.

      Design

      Single-group, experimental study.

      Setting

      Human movement laboratory in an urban rehabilitation hospital.

      Participants

      Children (N=17; mean age ± SD, 9.43±1.51y) with CP.

      Intervention

      Participants played 4 AVGs (bowling, tennis, boxing, and a dance game).

      Main Outcome Measures

      Energy expenditure via a portable cardiopulmonary testing unit; upper limb muscle activations via single differential surface electrodes; upper limb kinematics via an optical motion capture system; and self-reported enjoyment via the Physical Activity Enjoyment Scale (PACES).

      Results

      Moderate levels of physical activity were achieved during the dance (metabolic equivalent for task [MET]=3.20±1.04) and boxing (MET=3.36±1.50) games. Muscle activations did not exceed maximum voluntary exertions and were greatest for the boxing AVG and for the wrist extensor bundle. Angular velocities and accelerations were significantly larger in the dominant arm than in the hemiplegic arm during bilateral play. A high level of enjoyment was reported on the PACES (4.5±0.3 out of 5).

      Conclusions

      AVG play via a low-cost, commercially available system can offer an enjoyable opportunity for light to moderate physical activity in children with CP. While all games may encourage motor learning to some extent, AVGs can be strategically selected to address specific therapeutic goals (eg, targeted joints, bilateral limb use). Future research is needed to address the challenge of individual variability in movement patterns/play styles. Likewise, further study exploring home use of AVGs for physical activity promotion and rehabilitation therapies, and its functional outcomes, is warranted.

      Key Words

      List of Abbreviations:

      AVG (active video game), CP (cerebral palsy), DDR (Dance Dance Revolution), EE (energy expenditure), FCR (flexor carpi radialis), GMFCS (Gross Motor Function Classification System), MET (metabolic equivalent for task), MVE (maximum voluntary exertion), OMNI (OMNI Perceived Exertion Scale), PACES (Physical Activity Enjoyment Scale), V̇o2 (oxygen consumption), V̇co2 (expired carbon dioxide), VRT (virtual reality therapy), WE (wrist extensor bundle)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Mears D.
        • Hansen L.
        Active gaming: definitions, options, and implementation.
        Strateg J Phys Sport Educ. 2009; 23: 1-40
        • Bandini L.G.
        • Curtin C.
        • Hamad C.
        • Tybor D.J.
        • Must A.
        Prevalence of overweight in children with developmental disorders in the continuous National Health and Nutrition Examination Survey (NHANES).
        J Pediatr. 2006; 146: 738-743
        • Hurvitz E.A.
        • Green L.B.
        • Hornyak J.E.
        • Khurana S.R.
        • Koch L.G.
        Body mass index measures in children with cerebral palsy related to gross motor function classification.
        Am J Phys Med Rehabil. 2008; 87: 395-403
        • Rimmer J.
        Physical fitness levels of persons with cerebral palsy.
        Dev Med Child Neurol. 2001; 43: 208-212
        • Spears B.A.
        • Barlow S.E.
        • Ervin C.
        • et al.
        Recommendations for treatment of child and adolescent overweight and obesity.
        Pediatrics. 2007; 120: S254-S288
        • Yamaki K.
        • Rimmer J.H.
        • Lowry B.D.
        • Vogel L.C.
        Prevalence of obesity-related chronic health conditions in overweight adolescents with disabilities.
        Res Dev Disabil. 2011; 32: 280-288
        • Michelsen S.I.
        • Flachs E.M.
        • Uldall P.
        • et al.
        Frequency of participation of 8-12-year-old children with cerebral palsy: a multi-centre cross-sectional European study.
        Eur J Paediatr Neurol. 2009; 13: 165-177
        • Eagle T.F.
        • Gurm R.
        • Goldberg C.S.
        • et al.
        Health status and behavior among middle-school children in a Midwest community: what are the underpinnings of childhood obesity?.
        Am Heart J. 2010; 160: 1185-1189
        • Kuhle S.
        • Allen A.C.
        • Veugelers P.J.
        Prevention potential of risk factors for childhood overweight.
        Can J Public Health. 2010; 101: 365-368
        • Faith M.S.
        • Berman N.
        • Heo M.
        • et al.
        Effects of contingent television on physical activity and television viewing in obese children.
        Pediatrics. 2001; 107: 1043-1048
        • Maloney A.E.
        • Carter Bethea T.
        • Kelsey K.S.
        • et al.
        A pilot of a video game (DDR) to promote physical activity and decrease sedentary screen time.
        Obesity. 2008; 16: 2074-2080
        • Biddiss E.
        • Irwin J.
        Active video games to promote physical activity in children and youth.
        Arch Pediatr Adolesc Med. 2010; 164: 664-672
        • Ainsworth B.E.
        • Haskell W.L.
        • Whitt M.C.
        • et al.
        Compendium of physical activities: an update of activity codes and MET intensities.
        Med Sci Sports Exerc. 2000; 32: S498-S516
        • Hurkmans H.L.
        • van den Berg-Emons R.J.
        • Stam H.J.
        Energy expenditure in adults with cerebral palsy playing Wii Sports.
        Arch Phys Med Rehabil. 2010; 91: 1577-1581
        • Frost G.
        • Dowling J.
        • Dyson K.
        • Bar-Or O.
        Cocontraction in three age groups of children during treadmill locomotion.
        J Electromyogr Kinesiol. 1997; 7: 179-186
        • Weiss P.L.
        • Rand D.
        • Katz N.
        • Kizony R.
        Video capture virtual reality as a flexible and effective rehabilitation tool.
        J Neuroeng Rehabil. 2004; 1: 12
        • Saposnik G.
        • Levin M.
        Virtual reality in stroke rehabilitation: a meta-analysis and implications for clinicians.
        Stroke. 2011; 42: 1380-1386
        • Akhutina T.
        • Foreman N.
        • Krichevets A.
        • et al.
        Improving spatial functioning in children with cerebral palsy using computerized and traditional game tasks.
        Disabil Rehabil. 2003; 25: 1361-1371
        • Bryanton C.
        • Bosse J.
        • Brien M.
        • McLean J.
        • McCormick A.
        • Sveistrup H.
        Feasibility, motivation, and selective motor control: virtual reality compared to conventional home exercise in children with cerebral palsy.
        Cyberpsychol Behav. 2006; 9: 123-128
        • Brown S.H.
        • Lewis C.A.
        • McCarthy J.M.
        • Doyle S.T.
        • Hurvitz E.A.
        The effects of internet-based home training on upper limb function in adults with cerebral palsy.
        Neurorehabil Neural Repair. 2010; 24: 575-583
        • Golomb M.R.
        • McDonald B.C.
        • Warden S.J.
        • et al.
        In-home virtual reality videogame telerehabilitation in adolescents with hemiplegic cerebral palsy.
        Arch Phys Med Rehabil. 2010; 91: 1-8
        • Huber M.
        • Rabin B.
        • Docan C.
        • Burdea G.C.
        • AbdelBaky M.
        • Golomb M.R.
        Feasibility of modified remotely monitored in-home gaming technology for improving hand function in adolescents with cerebral palsy.
        IEEE Trans Inf Technol Biomed. 2010; 14: 526-534
        • Li W.
        • Lam-Damji S.
        • Chau T.
        • Fehlings D.
        The development of a home-based virtual reality therapy system to promote upper extremity movement for children with hemiplegic cerebral palsy.
        Technol Disabil. 2009; 21: 107-113
        • Deutsch J.E.
        • Borbely M.
        • Filler J.
        • Huhn K.
        • Guarrera-Bowlby P.
        Use of a low-cost, commercially available gaming console (Wii) for rehabilitation of an adolescent with cerebral palsy.
        Phys Ther. 2008; 88: 1196-1207
        • Levac D.
        • Pierrynowski M.
        • Canestraro M.
        • Gurr L.
        • Leonard L.
        • Neeley C.
        Exploring children's movement characteristics during virtual reality video game play.
        Hum Mov Sci. 2010; 29: 1023-1038
        • Damiano D.L.
        Activity, activity, activity: rethinking our physical therapy approach to cerebral palsy.
        Phys Ther. 2006; 86: 1534-1540
        • Howley E.
        Type of activity: resistance, aerobic and leisure versus occupational physical activity.
        Med Sci Sports Exerc. 2001; 33: S364-S369
        • Palisano R.J.
        • Rosenbaum P.L.
        • Walters S.D.
        • Russell D.
        • Wood E.
        • Galuppi B.
        Development and reliability of a system to classify gross motor function in children with cerebral palsy.
        Dev Med Child Neurol. 1997; 39: 214-223
        • Adams R.
        Revised Physical Activity Readiness Questionnaire.
        Can Fam Physician. 1999; 45 (, 995, 1004-5): 992
        • Chisholm D.M.
        • Collis M.L.
        • Kulak L.L.
        • Davenport W.
        • Gruber N.
        • Stewart G.W.
        PAR-Q validation report: the evaluation of self-administered pre-exercise screening questionnaire for adults.
        BC Ministry of Health and Health and Welfare Canada, Victoria1978
        • Mellecker R.R.
        • McManus A.M.
        Energy expenditure and cardiovascular responses to seated and active gaming in children.
        Arch Pediatr Adolesc Med. 2008; 162: 886-891
        • Mellecker R.R.
        • McManus A.M.
        • Lanningham-Foster L.M.
        • Levine J.A.
        The feasibility of ambulatory screen time in children.
        Int J Pediatr Obes. 2009; 4: 106-111
        • Rab G.
        • Petuskey K.
        • Bagley A.
        A method for determination of upper extremity kinematics.
        Gait Posture. 2002; 15: 113-119
        • Butler E.E.
        • Ladd A.L.
        • Louie S.A.
        • LaMont L.E.
        • Wong W.
        • Rose J.
        Three-dimensional kinematics of the upper limb during a Reach and Grasp Cycle for children.
        Gait Posture. 2010; 32: 72-77
        • Mackey A.H.
        • Walt S.E.
        • Lobb G.A.
        • Stott S.
        Reliability of upper and lower limb three-dimensional kinematics in children with hemiplegia.
        Gait Posture. 2005; 22: 1-9
        • Gordon A.M.
        • Charles J.
        • Wolf S.L.
        Methods of constraint-induced movement therapy for children with hemiplegic cerebral palsy: development of a child-friendly intervention for improving upper-extremity function.
        Arch Phys Med Rehabil. 2005; 86: 837-844
        • Robertson R.J.
        • Goss F.L.
        • Boer N.F.
        • et al.
        Children's OMNI scale of perceived exertion: mixed gender and race validation.
        Med Sci Sports Exerc. 2000; 32: 452-458
        • Moore J.B.
        • Yin Z.
        • Hanes J.
        • Duda J.
        • Gutin B.
        • Barbeau P.
        Measuring enjoyment of physical activity in children: validation of the Physical Activity Enjoyment Scale.
        J Appl Sport Psychol. 2009; 21: S116-S129
        • Donatelli R.A.
        • Carp K.C.
        • Ekstrom R.A.
        Electromyographic analysis of core trunk, hip, and thigh muscles during 9 rehabilitation exercises.
        J Orthop Sports Phys Ther. 2007; 37: 754-762
        • van Heest A.E.
        • House J.H.
        • Cariello C.
        Upper extremity surgical treatment of cerebral palsy.
        J Hand Surg [Am. 1999; 24: 323-330
        • Vaz D.V.
        • Cotta Mancini M.
        • Fonseca S.T.
        • Vieira D.S.
        • de Melo Pertence A.E.
        Muscle stiffness and strength and their relation to hand function in children with hemiplegic cerebral palsy.
        Dev Med Child Neurol. 2006; 48: 728-733
        • Utley A.
        • Sugden D.
        Interlimb coupling in children with hemiplegic cerebral palsy during reaching and grasping at speed.
        Dev Med Child Neurol. 1998; 40: 396-404
        • Sutcliffe T.L.
        • Logan W.J.
        • Fehlings D.L.
        Pediatric constraint-induced movement therapy is associated with increased contralateral cortical activity on functional magnetic resonance imaging.
        J Child Neurol. 2009; 24: 1230-1235
        • Jaspers E.
        • Desloovere K.
        • Bruyninckx H.
        • Molenaers G.
        • Kilingels K.
        • Feys H.
        Review of quantitative measurements of upper limb movements in hemiplegic cerebral palsy.
        Gait Posture. 2009; 30: 395-404
        • Bonis J.
        Acute Wiiitis.
        N Engl J Med. 2007; 356: 2431-2432
        • Nett M.P.
        • Collins M.S.
        • Sperling J.W.
        Magnetic resonance imaging of acute “wiiitis” of the upper extremity.
        Skeletal Radiol. 2008; 37: 481-483
        • Boehm K.M.
        • Pugh A.
        A new variant of Wiiitis.
        J Emerg Med. 2009; 36: 80-82
        • Robinson R.J.
        • Barron D.A.
        • Grainger A.J.
        • Venkatesh R.
        Wii knee.
        Emerg Radiol. 2008; 15: 255-257
        • Beddy P.
        • Dunne R.
        Achilles Wiitis.
        Am J Roentgenol. 2009; 192: W79
        • Berry T.
        • Howcroft J.
        • Klejman S.
        • Fehlings D.
        • Wright V.
        • Biddiss E.
        Variations in movement patterns during active video game play in children with cerebral palsy.
        J Biomed Sci Bioeng. 2011 Nov 9; ([Epub ahead of print])
        • Sell K.
        • Lillie T.
        • Taylor J.
        Energy expenditure during physically interactive video game playing in male college students with different playing experiences.
        J Am Coll Health. 2008; 56: 505-511
        • Haddock B.L.
        • Siegel S.R.
        • Wikin L.D.
        The addition of a video game to stationary cycling: the impact on energy expenditure in overweight children.
        Open Sports Sci J. 2009; 2: 42-46
        • Lanningham-Foster L.
        • Jensen T.B.
        • Foster R.C.
        • et al.
        Energy expenditure of sedentary screen time compared with active screen time for children.
        Pediatrics. 2006; 118: e1831-e1835
        • Tan B.
        • Aziz A.R.
        • Chua K.
        • Teh K.C.
        Aerobic demands of the dance simulation game.
        Int J Sports Med. 2002; 23: 125-129
        • Unnithan V.B.
        • Houser W.
        • Fernhall B.
        Evaluation of the energy cost of playing a dance simulation video game in overweight and non-overweight children and adolescents.
        Int J Sports Med. 2006; 27: 804-809
        • Maltais D.B.
        • Pierrynowski M.R.
        • Galea V.A.
        • Bar-Or O.
        Physical activity level is associated with the O2 cost of walking in cerebral palsy.
        Med Sci Sports Exerc. 2005; 37: 347-353
        • Whyte J.
        • Hart T.
        It's more than a black box; it's a Russian doll: defining rehabilitation treatments.
        Am J Phys Med Rehabil. 2003; 82: 639-652
        • Straker L.
        • Pollock C.
        • Piek J.
        • Abbott R.
        • Skoss R.
        • Coleman J.
        Active-input provides more movement and muscle activity during electronic game playing by children.
        Int J Hum Comput Interact. 2009; 25: 713-728