Serious Game Platform as a Possibility for Home-Based Telerehabilitation for Individuals With Cerebral Palsy During COVID-19 Quarantine - A Cross-Sectional Pilot Study

Abstract

Introduction: There is a need to maintain rehabilitation activities and motivate movement and physical activity during quarantine in individuals with Cerebral Palsy (CP).

Objective: This paper sets out to evaluate the feasibility and potential benefits of using computer serious game in a non-immersive virtual reality (VR) implemented and evaluated completely remotely in participants with CP for Home-Based Telerehabilitation during the quarantine period for COVID-19.

Methods: Using a cross-sectional design, a total of 44 individuals participated in this study between March and June 2020, 22 of which had CP (14 males and 8 females, mean age = 19 years, ranging between 11 and 28 years) and 22 typically developing individuals, matched by age and sex to the individuals with CP. Participants practiced a coincident timing game¹ and we measured movement performance and physical activity intensity using the rating of perceived exertion Borg scale.

Results: All participants were able to engage with the VR therapy remotely, reported enjoying sessions, and improved performance in some practice moments. The most important result in this cross-sectional study was the significant increasing in rating of perceived exertion (through Borg scale) in both groups during practice and with CP presenting a higher rating of perceived exertion.

Conclusion: Children with CP enjoyed participating, were able to perform at the same level as their peers on certain activities and increased both their performance and physical activity intensity when using the game, supporting the use of serious games for this group for home therapy and interactive games.

Clinical trials registration: https://Clinicaltrials.gov, NCT04402034. Registered on May 20, 2020.

Keywords: cerebral palsy; motor rehabilitation; physical functional performance; serious game; telerehabilitation.

FIGURE 1

Participant positioning and game design.

FIGURE 2

Overview of study design.

FIGURE 3

Absolute Error mean and standard error for both CP and TD-groups during familiarization phase (M0) and the three following matches (M1 to M3), in the four positions of the targets (P1 to P4). P1 to P4: positions of the targets of the MoveHero task; M0 to M3: Matches of the task, in which M0 is the familiarization phase and M1 to M3 are the three matches; CP, cerebral palsy group; TD, typical development group. *p < 0.05 between CP and TD groups; ^∞p < 0.05 between match 0 and all other matches.

FIGURE 4

Variable Error mean and standard error for both CP and TD-groups during familiarization phase (M0) and the three following matches (M1 to M3), in the four positions of the targets (P1 to P4). P1 to P4: positions of the targets of the MoveHero task; M0 to M3: Matches of task, in which M0 is the familiarization phase and M1 to M3 are the three matches; CP, cerebral palsy group; TD, typical development group. *p < 0.05 between CP and TD groups.

FIGURE 5

Mean and standard error of the percentage of hits for both CP and TD-groups during familiarization phase (M0) and the three following matches (M1 to M3), in the four positions of the targets (P1 to P4). P1 to P4: positions of the targets of the MoveHero task; M0 to M3: Matches of task, in which M0 is the familiarization phase and M1 to M3 are the three matches; CP, cerebral palsy group; TD, typical development group. *p < 0.05 between CP and TD groups; ^∞p < 0.05 between match 0 and all other ma.

FIGURE 6

Mean and standard error of percentage of hits, misses, and the continuous score, for both CP and TD-groups during the familiarization phase (M0) and the three following matches (M1 to M3), in the four positions of the targets (P1 to P4). M0 to M3: Matches of task, in which M0 is the familiarization phase and M1 to M3 are the three matches; CP, cerebral palsy group; TD, typical development group. *p < 0.05 between CP and TD groups; ^∞p < 0.05 between match 0 and all other matches.

FIGURE 7

Mean and standard error of RPE score, for both CP and TD-groups before first match (Mo0), after first (Mo1), second (Mo2), and third matches (Mo3), in the four positions of the targets (P1 to P4). M0 to M3: Moments of task, in which M0 is the familiarization phase and M1 to M3 are the three games; CP, cerebral palsy group; TD, typical development group. *p < 0.05 between CP and TD groups; ^∞p < 0.05 between moments.

FIGURE 8

Representation of the answers of the individuals from both CP and TD groups regarding their satisfaction with the game. TD, Typical Development; CP,Cerebral Palsy; n = number of participants who chose this option. (A) shows the results of the participants who found the game fun. (B) shows the results of the participants who felt tired after the intervention. (C) shows the results of the participants who would like to continue using the game in the rehabilitation clinic. (D) shows the results of the participants who would like to keep using the game at home.