Original article| Volume 93, ISSUE 8, P1448-1456, August 2012

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


      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.


      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.


      Single-group, experimental study.


      Human movement laboratory in an urban rehabilitation hospital.


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


      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).


      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).


      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)
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