A new video game assessment tool?

Instrument Development

Development and Use of an Observation Tool for Active Video Gaming and Movement (OTAGM) to Measure Children’s Movement Skill Components During Active Video Game Play

Rosa, R.L., Ridgers, N.D. & Barnett, L.M. in Perceptual and Motor Skills 117:3 (2013) 935-949

doi: 10.2466/03.25.PMS.117x28z4

Link to abstract amsciepub.com/doi/abs/10.2466/03.25.PMS.117x28z4

Objective: There is a growing interest in usefulness of active video games (AVG) for improving movement skills for children with CP. The Observation Tool of Active Gaming and Movement (OTAGM) is an observational tool for movement skills during AVG play. It aims to “capture and quantify specific skill components of children’s movement skills” during free play of AVG. The OTAGM was developed from the Test of Gross Motor Development-2ed (TGMD-2) with a subset of items that mesh with Nintendo Wii game offerings: strike, throw and roll. Specific components of movement skills are coded as well as task engagement, coded as ON/OFF; and body movement, further categorized as stationary-no movement, stationary-some movement, arm movement, leg movement, whole body movement.

This article reports on development, pilot testing and within-rater reliability of the measurement tool.

Process: 18 typically developing children 5 – 8 y/o played Nintendo one hour a week for six weeks. During play, 55-10 minute observations were coded. One child was videotaped for rating after a ten day interval.

Results: The tool needs to have further clarification between categories. Within-rater reliability was at least 83% across all categories. The usefulness of this tool will grow as it is tested in differently-abled populations and as it is able to report typical changes in the motor skills of children with CP.

AbleGamers Holiday Guide

"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.

What make up good video game interventions?

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 game properties: opportunities for practice, similarity of tasks to real-world movements , adaptability for individuals, feedback, social play.
• Outcomes for the user: neuroplastic changes, problem-solving & motivation due to competition and game characteristics.
• Therapist role as support person.

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.

Evidence for video games as therapy for children with CP

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/23948687

Objective: 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.

Trunk-to-pelvis rotation mediates Virtual Reality

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.

Wii for balance. Does it transfer?

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

Link to abstract

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.

Xbox engagement and children with Autism

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”.