Therapist's research digest: Active video games, robots and virtual reality for children's rehabilitation.
"AbleGamers Charity proudly announces the launch of this year’s Holiday Gift Guide for gamers, with gaming systems, video games and assistive devices for the disabled. This year we have several recommendations on which games were the most accessible and which assistive devices are the best bets to help the disabled gamer in your life, but we also included several items you may want to avoid altogether".
Link to guide: www.ablegamers.com/ablegamers-news/ablegamers-2013-holiday-gift-guide.
Scoping review
Defining the active ingredients of interactive computer play interventions for children with neuromotor impairments: A scoping review.
Levac, D., Rivard, L. & Missiuna C. in Research in Developmental Disabilities 33 (2012) 214 – 223
Link to abstract: www.ncbi.nlm.nih.gov/pubmed/22093667
Scoping reviews summarize research activity in an area of health evidence to clarify concepts, disseminate information or identify gaps; typically without evaluating the strength of the studies, and often in emerging areas where there is little RCT-based evidence.
Objective: “New rehabilitation interventions are often evaluated in research and incorporated into practice without a clear understanding of their active ingredients.” The authors focus on the components of video game interventions that may affect motor performance in children with neuromotor impairments.
Process: A literature search based on the kernels ‘interactive computer play’ and ‘intervention’ resulted in 23 articles, and led to a thematic analysis explicitly and implicitly linking intervention components with outcomes.
Results: Themes that emerged…
Video games are an emerging technology applied to rehabilitation. Identifying the components of video games that may contribute to outcomes is a step on the way.
Systematic review
Interactive computer play as ‘motor therapy’ for individuals with cerebral palsy
Fehlings, D., Switzer, L., Findlay, B. & Knights, S. in Seminars in Pediatic Neurology, 20:127 – 138
Link to abstract: ncbi.nlm.nih.gov/pubmed/23948687Objective: To evaluate the quality of evidence for the use of interactive computer games (including video games or virtual reality games) to help motor control and fitness for children with cerebral palsy.
This review covered "any kind of computer game or virtual reality technology where the individual can interact and play with virtual objects in a computer-generated environment". The articles were separated into three groups based on whether the intervention targeted upper extremity, lower extremity or general fitness outcomes.
Process: Literature searching resulted 17 articles that met all the inclusion critera. The American Academy of Neurology Classification of Evidence (AANCE) was used to classify the strength of the articles. Link to document: //qibawiki.rsna.org/images/3/33/American_Academy_of_Neurology_Classification_of_Evidence-20100504.doc
Results: The evidence for use of interactive video games to improve upper extremity function or overall fitness is not ‘statistically conclusive or clinically significant’ – AANCE level U (unproven). The AANCE rating for lower extremity (gross motor) improvements is level B (probably effective). More randomized controlled trials of longer duration with bigger subject sizes will add to the existing evidence.
Design: Case study
The effects of virtual reality game training on trunk to pelvis coupling in a child with cerebral palsy
Barton, G.J., Hawken, M.B., Foster, R.J., Holmes, G. & Butler, P.B. Journal of NeuroEngineering and Rehabilitation 2013, 10:15
doi:10.1186/1743-0003-10-15
Link to full text www.jneuroengrehab.com/content/10/1/15
Coupling between pelvic and trunk muscles is a common strategy when attempting a new activity and often decreases with familiarity. Co-contraction increases stability by connecting the more stable trunk to help stabilize the pelvis. Some children with cerebral palsy experience body function limitations related to coupling and uncoupling of their trunk and pelvis.
Objective: This study explored how a video game driven by pelvic rotation in high kneeling could be exploited to help reduce limitations related to coupling and to increase selective movement patterns.
Method: One 10 year old boy with spastic diplegic CP (GMFCS 1) completed 13 twice-weekly, 30 minute sessions in a CAREN virtual reality environment playing a custom, pelvic rotation-mediated game.
Results: Playing the game did not result in decreased coupling,. However, it may result in increased selective control with further training and in shorter pelvis range of movements, closer to the midline.
Design: Randomized controlled trial
Effect of Wii-intervention on balance of children with poor motor performance
Mombarg, R., Jelsma, D. & Hartman, E.
Research in Developmental Disabilities, 34 (2013) 2996-3003
Objective: What is the effect of Wii training on balance in children with motor delay? Does a training effect transfer to other activities?
Method: 30 children aged 7 – 12 with balance problems (as determined by falling below the 16th percentile on the total and balance scores on the Movement Assessment Battery for children - 2) were recruited and randomized into Wii and control groups. All performed pre- and post-tests of the MABC2 and Bruininks-Oseretsky test of motor proficiency -2 (balance, running speed and agility items). The Wii group exercised with the Wii for 30 minutes three times weekly for 6 weeks. The control group had no intervention.
Results: Pre- and post-test scores of Wii group and control group were compared. A “small to medium” intervention effect was found for balance across the Wii and control groups. No intervention effect was apparent in the transfer of skills from Wii balance games to running speed and agility tasks.
Design: Repeated-measures study
Exploring motion-based touchless games for Autistic children’s learning
Bartoli, L., Corradi, C., Garzotto, F. & Valoriani, M.
Proceedings of Interaction Design and Children (IDC) conference, June 24 – 27, 2013, New York, NY, USA
Link to abstract... http://dl.acm.org/citation.cfm?id=2485774
Objective: Do children with autism increase in selective and sustained attention after motion-based video game play?
Method: A convenience sample of five 10 – 12 year old autistic boys were selected from a larger group of children at a therapeutic centre in Florence, Italy. The boys attended five “gaming meetings” of 45 minutes gameplay over a period of three months. Five Kinect Xbox 360 games were chosen in order to present the boys with a variety of short games with graded tasks. The Bells test for visual neglect, used here to measure attention, was administered before, during and one week after the treatment regime.
Results: Children showed increased selective and sustained attention up to seven days following the end of treatment sessions. These results “are in line with existing studies concerning the positive effects of motion-based games on engagement”.
Design: Cross-sectional study
Evaluating exercise intensity levels in children with cerebral palsy playing the Wii
Robert, M., Ballaz, L., Hart, R & Lemay, M,
Physical Therapy, Early online, April 11, 2013 DOI: 10.2.2522/ptj.20120204
Link to abstract: http://www.ncbi.nlm.nih.gov/pubmed/23580626
Objective: Measuring the difference in exercise intensity of children with cerebral palsy compared with typically developing children playing the Wii Fit.
Method: Ten 7-to-12 year old children with spastic diplegic cerebral palsy (GMFCS I or II) were matched with 10 typically developing children. All children played one session of four Wii Fit (lower-extremity focused) games of 10 minutes duration. Heart rate was measured and exercise intensity was measured as percent of heart rate reserve.
Results: No difference was observed between groups for time spent at an intensity of > 40% of heart rate reserve across all games.
Development article: Assessing multiple object tracking in young children using a game
Ryokai, K., Farzin, F., Kaltman, E. & Niemeyer, G.
Education Technology Research Development (2013) 61:153-170
DOI 10.1007/s11423-012-9278-x
Link to article: people.ischool.berkeley.edu/~kimiko/papers/ETRD2012.Ryokai.TrackFX.pdf
Multiple object tracking (MOT) - identifying, visually tracking and maintaining continued attention to multiple moving objects, is both a complex and a critical life skill. Object tracking skills increase between childhood and young adulthood.
Objective: There is little understanding of the emergence of MOT in young children. The authors create an MOT assessment task that engages children from 30 months of age, uses touch or tangible interface, and has scientific validity. They pose the questions:“Can young children under the age of five interact with digital objects on a touch-tablet to accomplish a visual-motor task such as MOT?” and “Would young children’s tracking ability improve over time with more game play?”. Transferability “do computer games transfer to the real world”, effective game design and choice of the tablet as a touch or tangible user interface arise as issues in this MOT assessment’s creation.
Findings: 31 children between 30 and 58 months each played an average of six sessions. This group could track an average of three objects or one object with two distracters. The threshold of successful game play did not vary within this age group. Within sessions, children’s play did not differ from adults when the game presented three or less objects (without distracters), but differed significantly as four or more objects were presented, or when distracting objects were present. Across sessions, the study did not demonstrate a learning effect (possibly due to a large number of subjects who played only two sessions) and an overall decline in performance after six sessions, (possibly due to distracted attention).
Single-subject research
Wii-habilitation as balance therapy for children with acquired brain injury
Tatla, S. K., Radomski, A., Cheung, J., Maron, M. & Jarus, T. Developmental Neurorehabilitation, 2012, 1 – 15, Early Online
Link to abstract: www.ncbi.nlm.nih.gov/pubmed/23231377
Objective: Comparing Nintendo Wii balance therapy to standard therapeutic balance activities for change in balance, motivation and functional ability in children during brain injury rehabilitation.
Method: Single subject testing occurred over four weeks. Three subjects were randomly assigned to one of several protocols that provided standard therapeutic balance activities (baseline) either following or preceding Wii balance activities. Each condition was delivered as a 30-minute therapy, five times a week. Balance was measured with the Timed Up and Go (TUG) test, the Modified Functional Reach Test (MFRT) and the Wii-Fit balance board; motivation by the use of the Pediatric Motivation Scale, and functional abilities with the Pediatric Evaluation of Disability Index (PEDI).
Findings: Dynamic balance improved for all participants regardless of whether baseline followed or preceded Wii balance therapy and static balance results were inconclusive. Balance activities were equally motivating for 2 of 3 subjects and Wii balance activities were more motivating for one. Functional ability improved for all participants regardless of whether baseline followed or preceded Wii balance therapy.