A crossover randomised and controlled trial of the impact of active video games on motor coordination and perceptions of physical ability in children at risk of Developmental Coordination Disorder. Wii-based interactive video games as a supplement to conventional therapy for rehabilitation of children with cerebral palsy: A pilot, randomized controlled trial An active video game intervention does not improve physical activity and sedentary time of children at-risk for developmental coordination disorder: a crossover randomized trial. Video-game based therapy performed by children with cerebral palsy: a cross-over randomized controlled trial and a cross-sectional quantitative measure of physical activity. Effectiveness of virtual reality using Wii gaming technology in children with Down syndrome. Effects of live and video form action observation training on upper limb function in children with hemiparetic cerebral palsy. A pilot single-blind multicentre randomized controlled trial to evaluate the potential benefits of computer-assisted arm rehabilitation gaming technology on the arm function of children with spastic cerebral palsy Active Video-Gaming Effects on Balance and Mobility in Individuals with Chronic Stroke: A Randomized Controlled Trial Effects of conventional neurological treatment and a virtual reality training program on eye-hand coordination in children with cerebral palsy Eliciting Upper Extremity Purposeful Movements Using Video Games Use of Virtual Reality to Improve Upper-Extremity Control in Children With Cerebral Palsy: A Single-Subject Design Upper limb children action-observation training (UP-CAT): a randomised controlled trial in Hemiplegic Cerebral Palsy In-class Active Video Game Supplementation and Adherence to Cardiac Rehabilitation Optimising motor learning in infants at high risk of cerebral palsy: a pilot study Improving upper limb motor functions through action observation treatment: a pilot study in children with cerebral palsy. Active Video Gaming to Improve Balance in the Elderly Improvements in muscle symmetry in children with cerebral palsy after equine-assisted therapy (hippotherapy).
BACKGROUND Impaired motor development can significantly affect a child 's life and may result in an increased risk of a range of physical and psychological disorders . Active video game ( AVG ) interventions have been demonstrated to enhance motor skills in children with Developmental Coordination Disorder ( DCD ) ; however a home-based intervention has not been assessed . OBJECTIVES The primary aim of this study was to compare the changes in motor coordination between a 16 week period of AVG use , with 16 weeks of normal activities ( NAG ) . The secondary aim was to compare the child and parent perceptions of their physical performance between the AVG and NAG conditions . METHODS Twenty-one 9 - 12 year olds ( 10 males ) were confirmed to be at risk of DCD ( ⩽ 16th percentile Movement Assessment Battery for Children-2nd edition ( MABC-2 ) and ⩽ 15th percentile Developmental Coordination Disorder Question naire ( DCDQ ) ) and participated in this crossover r and omised and controlled trial . Data was collected at study entry , after the first 16 week condition and following the final 16 week condition , including ; ( 1 ) the MABC-2 , ( 2 ) three-dimensional motion analysis of single leg balance and finger-nose tasks , and ( 3 ) parent perception of physical skills . Participant perception of physical skills was collected only after the first and second conditions . RESULTS There was no significant difference between AVG and NAG for any of the primary variables including the MABC-2 , balance centre-of-mass path distance and finger-nose path distance . There was no significant intervention effect for secondary measures of motor coordination ; however the children perceived their motor skills to be significantly enhanced as a result of the AVG intervention in comparison to the period of no intervention . CONCLUSION A 16 week home based AVG intervention did not enhance motor skills in children with DCD , although they perceived their physical skills to be significantly improved . TRIAL REGISTRATION Australia and New Zeal and Clinical trials Registry ( ACTRN 12611000400965 ) ABSTRACT Objective : To assess the effect of interactive video gaming ( IVG ) with Nintendo Wii ( Wii ) supplemented to conventional therapy in rehabilitation of children with cerebral palsy ( CP ) . Design : R and omized , controlled , assessor-blinded study . Participants : Children with CP ; 10 children each in the control and intervention groups . Intervention : IVG using Wii , given as a supplement to conventional therapy , for 45 min per day , 6 days a week for 3 weeks . The children in the control group received conventional therapy alone . Outcome Measures : Posture control and balance , upper limb function , visual-perceptual skills , and functional mobility . Results : Significant improvement in upper limb functions was seen in the intervention group but not in the control group . Improvements in balance , visual perception , and functional mobility were not significantly different between control and intervention groups . Conclusions : Wii-based IVG may be offered as an effective supplement to conventional therapy in the rehabilitation of children with CP BACKGROUND Children with developmental coordination disorder ( DCD ) are highly inactive and sedentary . The purpose of this study was to assess the impact of a home-based active video game intervention on objective ly measured physical activity and sedentary behaviour in children at risk for DCD . METHODS In a crossover r and omized clinical trial , 21 children ( mean age 11.0 , SD 1.0 ; n = 11 girls ) in Perth , Western Australia participated in two 16-week periods : no active video games ( AVGs ) control period and AVGs intervention period . Two active input consoles were provided to participants along with a selection of non-violent AVGs for participants to play at home . Participants wore accelerometers at baseline and following each period to determine minutes of sedentary , light , moderate and vigorous times in addition to self-reported types of activities in a diary . Linear mixed models , adjusted for the order of periods , compared physical activity and sedentary time during the last week of each period . RESULTS There were no significant differences between the intervention and control periods in time spent in sedentary ( decrease of -1.0 min/day during the intervention period , 95%CI -12.1 , 10.1 ) , light ( increase of 2.2 min/day , 95%CI -8.8 , 13.2 ) , moderate ( decrease of 0.7 min/day , 95%CI -4.6 , 3.3 ) or vigorous ( decrease of -0.6 min/day , 95%CI -1.6 , 0.4 ) . CONCLUSIONS Among children at risk for DCD , participating in this AVG intervention did not improve objective ly measured physical activity and sedentary time BACKGROUND Previous studies reported controversial results about the efficacy of video-game based therapy ( VGT ) in improving neurorehabilitation outcomes in children with cerebral palsy ( CP ) . AIM Primary aim was to investigate the effectiveness of VGT with respect to conventional therapy ( CT ) in improving upper limb motor outcomes in a group of children with CP . Secondary aim was to quantify if VGT leads children to perform a higher number of movements . DESIGN A cross-over r and omized controlled trial ( RCT ) for investigating the primary aim and a cross-sectional study for investigating the secondary aim of this study . SETTING S Out patients . POPULATION INCLUSION CRITERIA clinical diagnosis of CP , age between 4 and 14 years , level of GMFC between I and IV . EXCLUSION CRITERIA QI<35 , severe comorbidities , incapacity to st and even with an external support . METHODS Twenty-two children with CP ( 6.89±1.91-year old ) were enrolled in a cross-over RCT with 16 sessions of VGT ( using Xbox with Kinect device ) and then 16 of CT or vice versa . Upper limb functioning was assessed using the Quality of Upper Extremities Skills Test ( QUEST ) and h and abilities using Abilh and -kids score . According to the secondary aim of this study a secondary cross-sectional study has been performed . Eight children with CP ( 6.50±1.60-year old ) were enrolled into a trial in which five wireless triaxial accelerometers were positioned on their forearms , legs and trunk for quantifying the physical activity during VGT vs. CT .  RESULTS QUEST scores significantly improved only after VGT ( P=0.003 ) , and not after CT ( P=0.056 ) . The reverse occurred for Abilh and -kids scores ( P=0.165 vs. P=0.013 , respectively ) . Quantity of performed movements was three times higher in VGT than in CT ( + 198 % , P=0.027 ) . CONCLUSION VGT result ed effective in improving the motor functions of upper limb extremities in children with CP , conceivably for the increased quantity of limb movements , but failed in improving the manual abilities for performing activities of daily living which benefited more from CT . CLINICAL REHABILITATION IMPACT VGT performed using the X-Box with Kinect device could enhance the number of upper limb movements in children with CP during rehabilitation and in turn improving upper limb motor skills , but CT remained superior for improving performances in manual activities of daily living This quasi-experimental study compared the effect of st and ard occupational therapy ( SOT ) and virtual reality using Wii gaming technology ( VRWii ) on children with Down syndrome ( DS ) . Children ( n = 105 ) were r and omly assigned to intervention with either SOT or VRWii , while another 50 served as controls . All children were assessed with measures of sensorimotor functions . At post-intervention , the treatment groups significantly outperformed the control group on all measures . Participants in the VRWii group had a greater pre-post change on motor proficiency , visual-integrative abilities , and sensory integrative functioning . Virtual reality using Wii gaming technology demonstrated benefit in improving sensorimotor functions among children with DS . It could be used as adjuvant therapy to other proven successful rehabilitative interventions in treating children with DS PURPOSE The purpose of this study was to investigate the effects of live and video form action observation training ( AOT ) on upper limb ( UL ) movement acceleration and function in children with cerebral palsy ( CP ) . METHODS In total , 12 children ( 7 boys , 5 girls ) with CP participated in this study . The children were allocated r and omly to live ( experimental ) and video ( control ) AOT groups . All children completed 20 treatment sessions , each 30 minutes in duration , 5 days per week for a month . Mediolateral ( ML ) and vertical ( VT ) acceleration data , Jebsen-Taylor H and Function ( JTHF ) scores , and Box and Block Test ( BBT ) scores were obtained at baseline and at 4 weeks after the intervention . RESULTS ML and VT movement acceleration and JTHF scores were significantly lower in the live group ( p < 0.05 ) . The BBT score was significantly higher in the live than in the video group ( p < 0.05 ) . CONCLUSIONS Our findings suggest that live AOT is more effective than video AOT for improving UL movement acceleration and function . Clinical ly , our findings offer important insights for clinicians when planning AOT interventions to reduce UL movement acceleration and improve UL function Objective : To evaluate the potential benefits of computer-assisted arm rehabilitation gaming technology on arm function of children with spastic cerebral palsy . Design : A single-blind r and omized controlled trial design . Power calculations indicated that 58 children would be required to demonstrate a clinical ly important difference . Setting : Intervention was home-based ; recruitment took place in regional spasticity clinics . Participants : A total of 15 children with cerebral palsy aged five to 12 years were recruited ; eight to the device group . Interventions : Both study groups received ‘ usual follow-up treatment ’ following spasticity treatment with botulinum toxin ; the intervention group also received a rehabilitation gaming device . Main measures : ABILH AND -kids and Canadian Occupational Performance Measure were performed by blinded assessors at baseline , six and 12 weeks . Results : An analysis of covariance showed no group differences in mean ABILH AND -kids scores between time points . A non-parametric analysis of variance on Canadian Occupational Performance Measure scores showed a statistically significant improvement across time points ( χ2 ( 2,15 ) = 6.778 , p = 0.031 ) , but this improvement did not reach minimal clinical ly important difference . Mean daily device use was seven minutes . Recruitment did not reach target owing to unanticipated staff shortages in clinical services . Feedback from children and their families indicated that the games were not sufficiently engaging to promote sufficient use that was likely to result in functional benefits . Conclusion : This study suggests that computer-assisted arm rehabilitation gaming does not benefit arm function , but a Type II error can not be ruled out Abstract Background : Treatments that provide feedback , increase practice with multiple repetitions , and motivate patients are essential to rehabilitation post stroke . Objective : To determine whether playing active video games results in improved balance and mobility post stroke . Methods : Thirty participants with chronic ( time since stroke = 3.0 [ 2.9 ] years ) hemiparesis post stroke were r and omly assigned to a gaming group or normal activity control group . Gaming systems provided participants with an interactive interface of real-time movement of either themselves or an avatar on the screen . Participants played games 50–60 minutes/day , 4 days/week , for 5 weeks . The intervention was strictly game-play , in st and ing position , without physical therapy . The control group received no special intervention and continued with normal activity . Both groups were tested prior to , following the 5 weeks ( post test ) , and 3 months following the completion of the study . Outcome measures included the Fugl-Meyer Assessment , Berg Balance Scale , Dynamic Gait Index , Timed Up & Go , 6-minute walk test , 3-meter walk ( self-selected and fast ) , and perception of recovery . Results : No statistically significant differences between or within groups were found through analysis of covariance ( covaried for side of hemiparesis ) at post test or follow-up . Although the within-group effect sizes were primarily indexed as “ small ” ( < .36 ) , the gaming group exhibited higher within-group effect sizes before and after testing than did the control group on all 7 dependent variables analyzed . Conclusions : Even though the only intervention was game-play , there were small positive effects . Therapist assistance in making more optimum movement choices may be needed before significant improvements are seen with commercially available , general purpose games [ Purpose ] The purpose of the study was to evaluate the effects of conventional neurological treatment and a virtual reality training program on eye-h and coordination in children with cerebral palsy . [ Subjects ] Sixteen children ( 9 males , 7 females ) with spastic diplegic cerebral palsy were recruited and r and omly assigned to the conventional neurological physical therapy group ( CG ) and virtual reality training group ( VRG ) . [ Methods ] Eight children in the control group performed 45 minutes of therapeutic exercise twice a week for eight weeks . In the experimental group , the other eight children performed 30 minutes of therapeutic exercise and 15 minutes of a training program using virtual reality twice a week during the experimental period . [ Results ] After eight weeks of the training program , there were significant differences in eye-h and coordination and visual motor speed in the comparison of the virtual reality training group with the conventional neurological physical therapy group . [ Conclusion ] We conclude that a well- design ed training program using virtual reality can improve eye-h and coordination in children with cerebral palsy Background . Video games have become popular in stroke rehabilitation ; however , the nature of this intervention is not fully understood . Objectives . To compare the number of ( a ) purpose ful and non purpose ful repetitions of the weaker upper extremity ( UE ) and ( b ) movement accelerations as assessed by accelerometer activity counts of the weaker and stronger UEs of individuals with chronic stroke while playing video games or participating in traditional therapy .  Methods . Twenty-nine individuals ( mean age 59 years , 1 - 7 years poststroke ) took part in a group intervention of  video -games ( n = 15 ) or traditional therapy ( n = 14 ) as part of a r and omized controlled trial . During 1 - 2 sessions , participants were video-taped while wearing wrist accelerometers . Assessors counted the number of repetitions and classified movements as purpose ful or non purpose ful using videotapes . The weaker UE motor impairments were correlated to movement accelerations , to determine if participants were using their potential during the sessions . Results . Participants in the video game group performed a median of 271 purpose ful movements and 37 970 activity counts compared to 48 purpose ful movements and 14 872 activity counts in the traditional group ( z = −3.0 , P = .001 and z = −1.9 , P = .05 , respectively ) . Participants in the traditional group performed a median of 26 non purpose ful ( exercises ) compared with 0 in the video game group ( z = −4.2 , P = .000 ) . Strong significant correlations were found between the motor ability of the weak UE to repetitions of participants in both groups ( r = .86 , P < .01 ) . Participants with higher motor ability performed more repetitions .  Conclusions . Video games elicited more UE purpose ful repetitions and higher acceleration of movement compared with traditional therapy in individuals with chronic stroke Background and Purpose : Virtual reality ( VR ) creates an exercise environment in which the intensity of practice and positive feedback can be systematic ally manipulated in various context s. The purpose of this study was to investigate the training effects of a VR intervention on reaching behaviors in children with cerebral palsy ( CP ) . Participants : Four children with spastic CP were recruited . Method : A single-subject design ( A-B with follow-up ) was used . All children were evaluated with 3 baseline , 4 intervention , and 2 follow-up measures . A 4-week individualized VR training program ( 2 hours per week ) with 2 VR systems was applied to all children . The outcome measures included 4 kinematic parameters ( movement time , path length , peak velocity , and number of movement units ) for mail-delivery activities in 3 directions ( neutral , outward , and inward ) and the Fine Motor Domain of the Peabody Developmental Motor Scales – Second Edition ( PDMS-2 ) . Visual inspection and the 2-st and ard-deviation – b and method were used to compare the outcome measures . Results : Three children who had normal cognition showed improvements in some aspects of reaching kinematics , and 2 children ’s change scores on the PDMS-2 reached the minimal detectable change during the intervention . The improvements in kinematics were partially maintained during follow-up . Discussion and Conclusion : A 4-week individualized VR training program appeared to improve the quality of reaching in children with CP , especially in children with normal cognition and good cooperation . The training effects were retained in some children after the intervention Background Rehabilitation for children with hemiplegic cerebral palsy ( HCP ) aim ed to improve function of the impaired upper limb ( UL ) uses a wide range of intervention programs . A new rehabilitative approach , called Action-Observation Therapy , based on the recent discovery of mirror neurons , has been used in adult stroke but not in children . The purpose of the present study is to design a r and omised controlled trial ( RCT ) for evaluating the efficacy of Action-Observation Therapy in improving UL activity in children with HCP . Methods / Design The trial is design ed according to CONSORT Statement . It is a r and omised , evaluator-blinded , match-pair group trial . Children with HCP will be r and omised within pairs to either experimental or control group . The experimental group will perform an Action-Observation Therapy , called UP-CAT ( Upper Limb-Children Action-Observation Training ) in which they will watch video sequences showing goal -directed actions , chosen according to children UL functional level , combined with motor training with their hemiplegic UL . The control group will perform the same tailored actions after watching computer games . A careful revision of psychometric properties of UL outcome measures for children with hemiplegia was performed . Assisting H and Assessment was chosen as primary measure and , based on its calculation power , a sample size of 12 matched pairs was established . Moreover , Melbourne and ABILH AND -Kids were included as secondary measures . The time line of assessment s will be T0 ( in the week preceding the onset of the treatment ) , T1 and T2 ( in the week after the end of the treatment and 8 weeks later , respectively ) . A further assessment will be performed at T3 ( 24 weeks after T1 ) , to evaluate the retention of effects . In a subgroup of children enrolled in both groups functional Magnetic Resonance Imaging , exploring the mirror system and sensory-motor function , will be performed at T0 , T1 and T2 . Discussion The paper aims to describe the methodology of a RCT for evaluating the efficacy of  Action-Observation Therapy  in improving UL activity in children with hemiplegia . This study will be the first to test this new type of treatment in childhood . The paper presents the theoretical background , study hypotheses , outcome measures and trial methodology .Trial Registration Purpose : The application of active video games ( AVGs ) during cardiac rehabilitation ( CR ) sessions could potentially facilitate patient adherence . The feasibility , safety , and efficacy of in-class AVG supplementation as an alternative to conventional phase 2 programs were investigated . Methods : A pilot , evaluator-blinded , intention-to-treat , r and omized controlled trial recruited 32 low-moderate risk CR participants and allocated them to conventional or AVG-supplemented exercise . Both groups experienced equal exercise loads for 6 weeks . Patients were assessed at baseline , end of the program , and after an 8-week followup . Adherence and safety-related outcomes were the primary endpoints . Secondary outcomes included change in exercise capacity , daily physical activity ( PA ) , energy expenditure ( EE ) , and psychometric profiling . Results : Patients ( males 81 % ; 60 ± 10 years ) presented with typical cardiovascular risk factors and similar baseline characteristics . Participants did not perceive an increased risk of injury and were more interactive . At the end of the program , there was a lower tendency for dropping out ( 6 % vs 19 % , P > .05 ) , a significant improvement in PA ( 322 vs 247 arbitrary acceleration units/min , P = .047 ) and related EE per body weight ( 13 vs 11 kcal/kg/d , P = .04 ) among AVG participants compared with controls . No significant differences between groups for adverse medical events , exercise capacity , affect toward exercise , anxiety , depression , or quality -of-life changes were reported . Conclusions : The additional use of AVGs during CR sessions is feasible , safe , and significantly improved daily PA and EE . A dropout reduction trend among its users , which needs to be confirmed in a larger trial , raises awareness to AVG supplementation as a promising strategy to increase CR adherence Background The average age for the diagnosis of cerebral palsy ( CP ) is 19 months . Recent neuroplasticity literature suggests that intensive , task-specific intervention ought to commence as early as possible and in an enriched environment , during the critical period of neural development . Active motor interventions are effective in some population s , however the effects of active motor interventions on the motor outcomes of infants with CP have not been research ed thoroughly , but pilot work is promising . The aim of this study was to determine the short- term effects of “ GAME ” ; a new and novel goal -oriented activity-based , environmental enrichment therapy programme on the motor development of infants at high risk of CP and test study procedures for a r and omized controlled trial ( RCT ) . Methods Pragmatic 2-group pilot RCT to assess motor outcomes , goal attainment , parent well-being and home environment quality , after 12-weeks of GAME intervention versus st and ard care . GAME included : creation of movement environments to elicit motor behaviours ; parent training in motor learning and task analysis ; frequent practice of motor tasks using a programme that was individualised to the child , was varied and focused on self-initiated movement . Data were analyzed using multiple regression . Results Thirteen infants were consented , r and omised , treated and completed the study . At study conclusion , the GAME group ( n = 6 ) demonstrated an advantage in Total Motor Quotient of 8.05 points on the Peabody Developmental Motor Scale-2 ( PDMS-2 ) compared to the st and ard care group ( n = 7 ) ( p < .001 ) . No significant differences existed between groups on any other measure . Conclusions GAME appears to offer a promising and feasible new motor intervention for CP , with favourable short-term motor outcomes . A pressing need exists for an adequately powered RCT with long-term end points , to determine if GAME may advance these children ’s motor trajectory AIM The aim of this r and omized controlled trial was to assess whether action observation treatment may improve upper limb motor functions in children with cerebral palsy ( CP ) . METHOD All children with CP admitted to our unit for rehabilitation from May 2009 to May 2010 were eligible . Inclusion criteria were age between 6 years and 11 years , an IQ of at least 70 , and no major visual and /or auditory deficits . Fifteen children were enrolled and r and omly assigned to either a case group ( n=8 ; four males , four females ; median age 7 y 6 mo ) or control group ( n=7 ; five males , two females ; median age 8 y ) . Six participants had left-sided hemiplegia , six right-sided hemiplegia , and three had tetraplegia ; 10 were independent walkers . Those in the case group were asked to observe video clips showing daily age-appropriate actions , and afterwards to imitate them . Participants in the control group were asked to observe video clips with no motor content and afterwards to execute the same actions as cases . The primary outcome measure was the Melbourne Assessment Scale . Children were scored twice at baseline ( 2 wks apart ) , and at the end of treatment , by a physician blind to group assignment . RESULTS At baseline groups did not differ on functional evaluation . After treatment , the functional score gain ( Δ ) was significantly different in the case and control groups ( p=0.026 ) . INTERPRETATION The present results support the notion that action observation treatment can be an effective part of the rehabilitation programme in children with CP The combination of active video gaming and exercise ( exergaming ) is suggested to improve elderly people 's balance , thereby decreasing fall risk . Exergaming has been shown to increase motivation during exercise therapy , due to the enjoyable and challenging nature , which could support long-term adherence for exercising balance . However , scarce evidence is available of the direct effects of exergaming on postural control . Therefore , the aim of the study was to assess the effect of a six-week videogame-based exercise program aim ed at improving balance in elderly people .  Task performance and postural control were examined using an interrupted time series design . Results of multilevel analyses showed that performance on the dot task improved within the first two weeks of training . Postural control improved during the intervention . After the intervention period task performance and balance were better than before the intervention . Results of this study show that healthy elderly can benefit from a videogame-based exercise program to improve balance and that all subjects were highly motivated to exercise balance because they found gaming challenging and enjoyable OBJECTIVE To evaluate the effect of hippotherapy ( physical therapy utilizing the movement of a horse ) on muscle activity in children with spastic cerebral palsy . DESIGN Pretest/post-test control group . SETTING /LOCATION Therapeutic Riding of Tucson ( TROT ) , Tucson , AZ . SUBJECTS Fifteen ( 15 ) children ranging from 4 to 12 years of age diagnosed with spastic cerebral palsy . INTERVENTIONS Children meeting inclusion criteria were r and omized to either 8 minutes of hippotherapy or 8 minutes astride a stationary barrel . OUTCOME MEASURES Remote surface electromyography ( EMG ) was used to measure muscle activity of the trunk and upper legs during sitting , st and ing , and walking tasks before and after each intervention . RESULTS After hippotherapy , significant improvement in symmetry of muscle activity was noted in those muscle groups displaying the highest asymmetry prior to hippotherapy . No significant change was noted after sitting astride a barrel . CONCLUSIONS Eight minutes of hippotherapy , but not stationary sitting astride a barrel , result ed in improved symmetry in muscle activity in children with spastic cerebral palsy . These results suggest that the movement of the horse rather than passive stretching accounts for the measured improvements
All articles showed improvement in outcomes with AVG , although differences were not consistently significant compared with conventional therapy .
However , AVG is feasible and shows potential for improving outcomes in this population .
AIM To examine current evidence on use of active video gaming ( AVG ) to improve motor function in children with movement disorders including cerebral palsy , developmental coordination disorder , and Down syndrome .