Effects of physically active video gaming on cognition and activities of daily living in childhood brain tumor survivors: a randomized pilot study

Abstract

Background: Physical activity can enhance cognitive functions in both animals and humans. We hypothesized that physically active video gaming could: i) improve cognitive functions and ii) improve the execution of activities of daily living among survivors of childhood brain tumors.

Methods: Children 7 to 17 years old who completed treatment, including radiotherapy, for a brain tumor 1 to 5 years earlier were randomized to either intervention or waiting list. After 10 to 12 weeks the groups crossed over. The intervention consisted of active video gaming, using a motion-controlled video console (Nintendo Wii), for a minimum of 30 minutes a day, 5 days a week and weekly Internet-based coaching sessions. Evaluations before and after each period included tests of the execution of activities of daily living, using the Assessment of Motor and Process Skills (AMPS) and cognitive tests. Test scores before and after the intervention were compared. A parallel group comparison was performed as a sensitivity analysis.

Results: All 13 children enrolled completed the program. Compared to baseline, the motor (P= .012) and process (P=.002) parts of AMPS improved significantly after active video gaming. In the parallel group analysis the improvement in the process part of AMPS remained statistically significant (P= .029), but not the change in AMPS motor score (P= .059). No significant change was found in cognitive tests although there were trends for improvement in sustained attention (P = .090) and selective attention (P = .078).

Conclusion: In this pilot study, active video gaming used as a home-based intervention for childhood brain tumor survivors improved motor and process skills in activities of daily living.

Keywords: activities of daily living; brain tumor; cognition; exercise therapy; video games..

Fig. 1.

A) Inclusion and exclusion. Patients could be included if they had completed brain tumor treatment (including radiotherapy) 1 to 5 years before and were between 7 to 17 years old. Patients were excluded if 1) not in clinical remission or stable disease (ongoing treatment), 2) in a medically unstable situation or suffering from another medical condition making them unable to follow the study protocol (eg, severe mental retardation, severe autism, photosensitive seizures), 3) not Swedish-speaking. No patient had to be excluded due to physical limitations. The patient excluded due to “other disease/condition” had severe autism. B) Study design. After inclusion, participants were randomized (R) to either start with the intervention or waiting list. Tests were performed at 3 time points as indicated in figure. All enrolled subjects completed the study.

Fig. 2.

A) Z scores for AMPS motor score, before and after the intervention. Participants had significantly lower values compared to the norm before the intervention, and although the score improved after the intervention, it was still significantly lower than the norm (1-sample t test). B) AMPS motor skill scores in logits before and after the intervention increased significantly in the within-subjects analysis. The cut-off level for independent living (indicated in figure) is regarded to be 2.0 for AMPS motor skills. C) Z scores for AMPS process score before and after the intervention. Participants had significantly lower process scores compared to the norm before the intervention but after the intervention the score was within the normal range (1-sample t test). D) AMPS process skill scores in logits before and after the intervention also increased significantly in the within-subjects analysis. The cut-off level for independent living (indicated in figure) is regarded to be 1.0 for AMPS process skills.