Video Game Treatment for Kids with Developmental Disabilities

Single group

Upper-Limb Rehabilitation with Adaptive Video Games for Preschool Children with Developmental Disabilities

Hsieh HC, Lin HY, Chiu WH, Meng LF & Liu CK.

American Journal of Occupational Therapy 2015 Jul-Aug;69(4):6904290020p1-5.

doi: 10.5014/ajot.2015.014480.

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/26114467

Objective: For children with developmental disabilities, does active video game play, compared before and after the intervention, increase motor function and visual-motor integration?

Method: 20 children with developmental disability (Beery-Buktenica Developmental Test of Visual Motor Integration (VMI) score of less than 80) played a novel video game for 30 minutes, 3 times a week for 5 weeks. Before and after, the children were scored on VMI and the Peabody Developmental Motor Scale – 2 (PDMS-2).

Findings: Game play had a positive and significant effect on visual-motor integration as measured by the VMI, and on motor function as measured on the fine motor quotient, gross motor quotient and total motor quotient subscales of the PDMS-2.

Measuring Upper Extremity Function - Systematically

Systematic Review

Upper limb function evaluation scales for individuals with cerebral palsy: A systematic review

Journal of Physical Therapy Science 27:1617 – 1620, 2015.

Santos, C. A., Franco de Moura, R. C., Lazzari, R. D., Dumont, A. J., Braun, L. A. & Oliveira, C. S.

Link to full text: www.ncbi.nlm.nih.gov/pmc/articles/PMC448345

Objective: What is the state of the evidence for scales and methods used to evaluate upper extremity function in cerebral palsy?

Method: Two reviewers independently assessed randomized controlled (RCT) trial articles published between 2006 and 2014. The Physiotherapy Evidence Database (PEDRO) scale was used to evaluate studies to see if there is sufficient accompanying information for (internal) validity and for the reader to interpret and reproduce results.

Findings: Five studies achieved 6/10 “good” or higher on PEDRO (1 – 9/10, 1 – 8/10, 2 – 7/10, 1 – 6/10). The various studies analyzed:

• Quality Upper Extremity Skill Test and the Besta scale (Fedrizzi et al.)
• Upper Extremity Functional Test and Peabody Developmental Motor Scales-2 (PDMS-2), Xu et al.
• PDMS-2, Bruninks-Oseretsky Test of Motor Proficiency and Pediatric Motor Activity Log, Lin et al.
• Melbourne Assessment of Unilateral Upper Limb Function, Koman et al.
• Redman et al. used the Pediatric Quality of Life Scale.

"…no consensus has been reached on the most appropriate scale or which has ideal clinical applicability to this population".

References
PEDRO www.pedro.org.au/

Fedrizzi E, Rosa-Rizzotto M, Turconi AC, et al. : GIPCI Study Group: Unimanual and bimanual intensive training in children with hemiplegic cerebral palsy and persistence in time of hand function improvement: 6-month follow-up results of a multisite clinical trial. J Child Neurol, 2013, 28: 161–175. [PubMed]

Xu K, Wang L, Mai J, et al. : Efficacy of constraint-induced movement therapy and electrical stimulation on hand function of children with hemiplegic cerebral palsy: a controlled clinical trial. Disabil Rehabil, 2012, 34: 337–346. [PubMed]

Lin KC, Wang TN, Wu CY, et al. : Effects of home-based constraint-induced therapy versus dose-matched control intervention on functional outcomes and caregiver well-being in children with cerebral palsy. Res Dev Disabil, 2011, 32: 1483–1491. [PubMed]

Koman LA, Smith BP, Williams R, et al. : Upper extremity spasticity in children with cerebral palsy: a randomized, double-blind, placebo-controlled study of the short-term outcomes of treatment with botulinum A toxin. J Hand Surg Am, 2013, 38: 435–46.e1. [PubMed]

Redman TA, Finn JC, Bremner AP, et al. : Effect of upper limb botulinum toxin-A therapy on health-related quality of life in children with hemiplegic cerebral palsy. J Paediatr Child Health, 2008, 44: 409–414.[PubMed]

Down syndrome and VR effectiveness

Systematic Review

Motor Learning and Virtual Reality in Down Syndrome: A Literature Review

Del Ciello de Menezes, L., Massetti, T., Olivereira, F. R., de Abreu, L., C., Herrero, D., Malheiros, S. R. P., Trevizan, I. L., Moriyama, C. H. & de Mello Monteiro, C. B.

International Archives of Medicine, 8:119 2015.

DOI:10.3823/1718

Link to full text: www.imed.pub/ojs/index.php/iam/article/download/1157/945

Objective: In children with Down syndrome, do virtual reality games result in positive outcomes compared with conventional therapy interventions?

Method: Literature search results were screened and full texts were read by two reviewers. Of 194 studies, 7 articles were selected; 5 studies analyzed Down syndrome and motor learning, and 2, Down syndrome and virtual reality. Three studies had PEDRO (Physiotherapy Evidence Database http://www.pedro.org.au/ ) scores of 6/10 "good", three had 5/10 and one had 4/10 "fair".

Findings: "The motor learning in individuals with Down syndrome… is more effective in the presence of visual feedback and self-control. Individuals with Down syndrome respond positively and effectively…when stimulated with different and complementary tasks to conventional therapy".

Wii Fit improves GMFCS 3 motor skills

RCT

Effects of interactive games on motor performance in children with cerebral palsy

AlSaif, A. A.& Alsenany, S.

Journal of Physical Therapy Science 27: 2001-2003, 2015

Link to full text: www.ncbi.nlm.nih.gov/pmc/articles/PMC4500030/

Objective: For children with cerebral palsy, what is the effect of training with Nintendo Wii on motor performance compared with no training?

Method: 40 6-to-10 year old children GMFCS 3 were randomly divided into a ‘no training’ group and a group that received game time at home for 20 minutes a day for 12 weeks. Subjects had a lower limb muscle power of no less than grade 4 and no fixed lower limb contractures.

Findings: Outcome measures used were the Movement Assessment Battery for Children-2 (mABC-2) manual dexterity, ball skills of aiming and catching and balance; Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) upper limb co-ordination (subtest 5:6), and the one-minute walk test. Significant results were found before and after the intervention between groups and within the treatment group, but not within the control group.

Active video games and Developmental Coordination Disorder

RCT

A crossover randomised and controlled trial of the impact of active video games (AVG) on motor coordination and perceptions of physical ability in children at risk of Developmental Coordination Disorder (DCD)

Straker, L., Howie, E., Smith, A., Jensen, L., Piek, J. & Campbell, A.

Human Movement Science, 42 (2015) 146 – 160

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/26037276

Objective: In children with DCD, does exposure to AVG vs video game avoidance result in changes to motor coordination, or changes to parents’ or subjects’ perception of motor coordination.

Method: Twenty-one 9 to 12 year old children at risk of DCD were randomized in an unblinded cross-over study. They completed the Movement Assessment Battery for Children-2 (MABC-2) and 3D motion analysis at the beginning of the study and after each condition; video game avoidance and AVG. AVG was done for a minimum of 20 minutes a day for at least 4 days a week for 16 weeks. Parents completed the Developmental Coordination Disorder Questionnaire (DCDQ) and their children, used a global scale to report changes in their physical skills.

Findings: No significant differences were noted in MABC-2 scores, in 3D motion analysis or in the parents DCDQ ratings. "The children reported their motor skills to be significantly enhanced as a result of the AVG intervention in comparison to the period of no intervention".

Kinect: Clinician's Resource

Resource development
Levac, D., Espy, D., Fox, E., Pradhan, S. & Deutsch, J. E.
"Kinect-ing" with Clinicians: A Knowledge Translation Resource to Support Decision Making About Video Game Use in Rehabilitation
Physical Therapy 2015;95:426-440.

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/25256741

Problem: There is a perceived need for support to use of Kinect clinically.

Objective: “…development and preliminary evaluation of a knowledge translation resource to support clinical decision making about selection and use of Kinect games in physical therapy”.

Process: Interviews or focus groups were conducted with 16 clinician participants over 4 sites.

Outcome: Production of “Kinecting With Clinicians Resource (KWIC). Categories include game selection (player or game driven, stability, mobility, mobility plus); game play (spatial accuracy, temporal accuracy, duration, cognitive operators, augmented feedback, progression, score).

Rapid Review: Commercial Gaming Systems for Neurorehabilitation

Commercial Gaming Systems for Neurorehabilitation: Clinical Effectiveness
Published February 18th, 2015 by CADTH

Link to full text

This rapid review is provided by the Canadian Agency for Drugs and Technologies in Health. CADTH reviews drugs, devices, tests and treatments. Rapid reviews are an increasingly popular product, with a turn-around in as little as 3 days.

Objective: What is the evidence of clinical effectiveness of commercial gaming systems for patients undergoing neurorehabilitation?

PICO

• Patients undergoing rehabilitation therapy (acquired or traumatic brain injury, stroke, cerebral palsy, multiple sclerosis, etc.)
• Intervention Use of commercial gaming systems (e.g., Xbox, Kinect, Wii, Wii Fit, etc.)
• Comparator None, or any other established method of neurorehabilitation
• Outcomes Clinical benefits: improved function outcomes (e.g., upper extremity function, range of motion, strength, coordination, balance, mobility, gait, etc.)
• Study Designs Health technology assessments, systematic reviews, meta-analyses, randomized controlled trials, non-randomized studies.

Process: Searches identified six systematic reviews and seventeen randomized controlled trials that were suitable for inclusion.

Outcomes: Each article is summarized in a table; general conclusions are not drawn.