Patterns of Home Gameplay

Observational Study

Do people with intellectual disability use Nntendo Wii when placed in their home as part of a physitherapy program? An observational study.
Chung, A. M. J., Harvey, L. A, & Hassett, L. M.
Disability and Rehabilitation Assistive Techology Early online 1 – 6
DOI: 10.3109/17483107.2014.938705

Link to abstract www.ncbi.nlm.nih.gov/pubmed/25052846

Objective: In people with intellectual disability, how much Nintendo is played when prescribed as home physiotherapy?

Method: 20 participants with intellectual disability, average age 19, were receiving home-based physiotherapy. They were assigned Wii play for 12 weeks as an effective part of their therapy intervention. Participants or their carers recorded data biweekly. It is unknown whether or not the participants were encouraged to play by their carers or physiotherapists.

Findings: Weeks one and two recorded a median value of 100minuntes a week of play over a median of three days per week; in weeks 11 and 12, a median value of 35 muinutes of play once per week. Note: Averages were not available in the published data.

Kids Report on Active Videogames at Home

Qualitative Report

Real life active gaming practices of 7 – 11 year old children
Allsop, S., Rumbold, P.L.S., Debuse, D. & Dodd-Reynolds, C.
Games for Health Journal, 2(6), 2013 pp. 347 - 353
DOI: 10.1089/g4h.2013.0050

Link to abstract

Objective: to determine real life behaviors during children’s active videogame play.

Method: 40 questionnaires were returned from 7-11 year old children and their parents.

Findings: of this sample, most children play Wii Sports for around 80 minutes once or twice a week. More than half the children ate or drank during game play and this extended game play. Most perceive active videogaming as “an alternative form of exercise, and the main reasons for active videogame play included for entertainment, health benefits and the environment.”

Therapist-friendly Kinect games

Qualitative study

Design and Evaluation of Virtual Reality-Based Therapy Games with Dual Focus on Therapeutic Relevance and User Experience for Children with Cerebral Palsy Ni, L. T., Fehlings, D. & Biddiss, E., Games for Health, 3(3), 2014-07-18
DOI 10.1089/g4h.2014.0003

Link to abstract: online.liebertpub.com/doi/abs/10.1089/g4h.2014.0003 journalCode=g4h

Objective: This qualitative study evaluates two therapist-made Xbox Kinect games, designed for fun, engagement and therapeutic value, for therapeutic relevance and user experience.

Process: Six therapists and eight 8 – 12 year old children (GMFCS I – III) scored questionnaires before and after playing custom Kinect games designed by therapists.

Outcomes: Therapists rated the games as of "average usability" and were able to focus and grade game play. They reported tracking problems (the system had difficulty distinguishing children’s movements from the assisting therapist’s). Children learned to beat the game. The games were "engaging to the child and therapeutically relevant".

Kinect game for children with CP

Gamification of physical therapy for the treatment of pediatric cerebral palsy: A pilot study examining player preferences. Whittinghill, D. & Brown, J. (2014), American Society for Engineering Education 121st Annual Conference & Exposition, Indianapolis, IN.

Pilot study

Link to content: www.asee.org/public/conferences/32/papers/10954/view

Objective: Few active games are made to meet the clinical needs of children with cerebral palsy. The authors created a Microsoft Xbox Kinect game based on the upper body physical therapy routines typically prescribed for children with cerebral palsy, and tested it for player satisfaction. Burnie is juvenile, whimsical and rich in positive feedback. "Reframing the therapy experience is the essence of Burnie’s gamification."

Method: A convenience sample of 21 6 – 34 year olds with and without cerebral palsy played Burnie for 15 minutes, then completed a post-game questionnaire.

Results: A Likert scale with 1 being least favourable and 10 most favourable returned values of overall enjoyment 6.75, pleasing esthetics 7.65 and pleasing game controls 5.4. A lower value on game controls may be a function of the discomfort experienced as a part of therapy exercise, a desired therapy outcome. Overall, the authors feel this study leads to a better 'behaviorally oriented physical therapy game experience'.

Wii for UE for CP hemiplegia

Upper limb training using Wii Sports Resort for Children with Hemiplegic Cerebral Palsy: a Randomized, Single-blind Trial
Chiu, HC., Ada, L. & Lee, HM. Clinical Rehabilitation, 2014, May 21
DOI: 10.1177/0269215514533709

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/24849793

Objective: For children with cerebral palsy, are there sustainable gains from a six-week home trial of Wii vs. traditional therapy?

Method: 62 children 6 – 13 years old (GMFCS levels I – V) played Wii bowling, air sports, frisbee and basketball at home 3 times weekly for 6 weeks. In addition all children received traditional therapy 3 times weekly. Participation, coordination, strength and hand function were measured at baseline, 6 and 12 weeks.

Results: Overall, the children completed 96% of all home-based Wii sessions and increased their Wii scores on all games through the test period. There were no differences in coordination or hand function noted. An increase in grip strength between the experimental and control groups was shown at 12 weeks. This may be related to the forced use of the children’s affected hand and arm. Anecdotes from caregivers report new hand movements and increased functional movements.

VR on UE in Children with CP: Meta-analysis

Effect of Virtual Reality on Upper Extremity Function in Children with Cerebral Palsy: A Meta-analysis
Chen, Y-P., Lee, S-Y. & Howard A.M. Pediatric Physical Therapy 2014:00 1 - 12
DOI: 10.1097/PEP.0000000000000046

Link to abstract:
www.ncbi.nlm.nih.gov/pubmed/24819682

Purpose: To systematically examine studies that consider the effect of active video games, virtual reality and robot therapy (VR) on improving upper extremity motor function in children with CP.

Method: A considered search strategy was used to include 14 research articles. A scoring system was used for the 3 RCTs, for 10 case series and one cohort study; a level of evidence was assigned to each based on the Oxford Centre for Evidence Based Medicine rating system.

Results: The RCT studies compared VR to traditional therapy, and the case series compared children before and after VR interventions. 5 studies were based on commercially available systems: Wii (1), Sony EyeToy Play (1), Gesturetek (3); the rest were experimental, custom engineered systems (7) or robot assisted interventions (2). The meta-analysis reports the 3 RCTs showed effectiveness for VR vs. traditional therapy, and ‘at least one positive change in one outcome measure in all the case series’. No relationship was seen between effectiveness and intervention length, duration, or frequency. Engineer-built experimental systems are found to be more effective than commercial systems. Commercially available active video games do not meet children’s needs as they cannot be adjusted individually to the child. Overall, the evidence was poor to fair. This meta-analysis makes no conclusive recommendations.

The GestureTek Virtual Reality system in Rehabilitation: a Scoping Review

Scoping Review

Glegg, S.M.N., Tatla, S.K. & Holstii, L., Disability and Rehabilitation Assistive Technology 2014, 9(2); 89 – 111

Link to abstract:
www.ncbi.nlm.nih.gov/pubmed/23713408

Objective: This scoping review examines research literature with quantitative data specific to the GestureTek virtual reality system used in physical and cognitive rehabilitation. The purpose of this scoping review is to determine the practicality of a systematic review, to identify areas for further research, “…and to allow therapists to be able to seek out readily pertinent evidence to support their clinical decisions about their use of the technology”.

Method: An explicit search strategy was used, resulting in 44 included studies mostly relating to stroke. For cerebral palsy, five studies were reported with evidence level I, II or III: one single case study reported level III evidence for balance and mobility improvement, and another single case reported level I evidence for improved reach, by American Academy for Cerebral Palsy and Developmental Medicine criteria.

Findings: Few strong quality or high level evidence studies are available: lack of common outcome measures limits the possibility of a systematic review. High level, larger studies are needed. This scoping review provides a database of rated studies related to cerebral palsy habilitation and outcomes of balance, mobility and upper extremity improvement.