Feasibility of Computer-Based Videogame Therapy for Children with Cerebral Palsy

Abstract

Objectives: Standing and gait balance problems are common in children with cerebral palsy (CP), resulting in falls and injuries. Task-oriented exercises to strengthen and stretch muscles that shift the center of mass and change the base of support are effective in improving balance. Gaming environments can be challenging and fun, encouraging children to engage in exercises at home. The aims of this project were to demonstrate the technical feasibility, ease of use, appeal, and safety of a computer-based videogame program designed to improve balance in children with CP.

Materials and methods: This study represents a close collaboration between computer design and clinical team members. The first two phases were performed in the laboratory, and the final phase was done in subjects' homes. The prototype balance game was developed using computer-based real-time three-dimensional programming that enabled the team to capture engineering data necessary to tune the system. Videogame modifications, including identifying compensatory movements, were made in an iterative fashion based on feedback from subjects and observations of clinical and software team members.

Results: Subjects (n=14) scored the game 21.5 out of 30 for ease of use and appeal, 4.0 out of 5 for enjoyment, and 3.5 on comprehension. There were no safety issues, and the games performed without technical flaws in final testing.

Conclusions: A computer-based videogame incorporating therapeutic movements to improve gait and balance in children with CP was appealing and feasible for home use. A follow-up study examining its effectiveness in improving balance in children with CP is recommended.

FIG. 1.

Screen shot of the videogame. The player flew the airplane by weight-shifting in a standing position to move through the rings. The outermost ring awarded lowest points; the center star awarded the highest point score. Audio feedback was a positive chime for points, crashing sound for hitting the outside rim, and no sound effect for missing the target all together. Color graphics available online at www.liebertonline.com/g4h

FIG. 2.

Results for one subject when the motion detection-feedback system was turned on and off as the player attempted different, equivalent versions of the game. When the subject executed undesired movements, the system detected the movements and provided the subject with feedback that enabled him to reduce the number of undesired movements. The graph illustrates that when feedback was turned on (levels 3, 4, 7, and 8), the subject dramatically decreased the amount of undesired movement. When the feedback was turned off (levels 1, 2, 5, and 6), the amount of undesired movement was much higher.