Exergaming improves balance in children with spastic cerebral palsy with low balance performance: results from a multicenter controlled trial

Abstract

Purpose: Previous studies investigating the effectiveness of exergame balance-training (using videogames) in children with cerebral palsy (CP) yielded inconsistent results that could be related to underpowered studies. Therefore, in this multicenter intervention study, we investigated whether exergaming improves balance clinically in spastic CP. Materials and methods: In total, 35 children with unilateral or bilateral spastic CP (GMFCS-level I-II) were included (age-range: 7-16 years); 16 at VUMC (trial: NTR6034), 19 at UHG (trial: NCT03219112). All participants received care as usual. The intervention group (n ¼ 24) additionally performed exergametraining; 6-8 weeks home-based X-box One Kinect training focused on balance. Balance performance was assessed with the pediatric balance scale (PBS) and two subscales of the Bruininks-Oseretsky Test of Motor Proficiency-2nd edition ("balance" [BOTbal] and "running speed and agility" [BOTrsa]). Mixed model ANOVAs with between and within factors were used to test differences between and within groups.Results: On group level, no post-intervention differences were found between the intervention and control group (PBS:248, g p 2 ¼ 0.040; BOTbal: p ¼ 0.374, g p 2 ¼ 0.024; BOTrsa: p ¼ 0.841, g p 2 ¼ 0.001). Distribution of CP-symptoms (unilateral versus bilateral) did not affect training (PBS: p ¼ 0.373, g p 2 ¼ 0.036; BOTbal: p ¼ 0.127, g p 2 ¼ 0.103; BOTrsa: p ¼ 0.474, g p 2 ¼ 0.024). Children with low baseline balance performance (based on PBS) in the intervention group showed improvements in balance performance after training (PBS: p ¼ 0.003, g p 2 ¼ 0.304; BOTbal: p ¼ 0.008, g p 2 ¼ 0.258), whereas children with high baseline balance performance did not. Conclusions: This exergame-training resulted in balance improvements for the current population of CP that had a low baseline function.ä IMPLICATIONS FOR REHABILITATION Exergame-training (training using video-games) shows mixed results in children with cerebral palsy (CP). Children with spastic CP (GMFCS level I-II) with a high baseline balance-level did not show functional balance improvements after this home-based exergame-training, suggesting that these children should not be enrolled in this type of exergame-training protocol. Children with spastic CP (GMFCS level I-II) with a low baseline balance-level showed clinically relevant functional balance improvements after this home-based exergame-training, suggesting that these children can benefit from enrolment in this type of exergame-training protocol to improve their balance. The distribution of CP-symptoms did not affect the effectiveness of this balance exergame-training in children with spastic CP with GMFCS-level I and II.

Research Status and Emerging Trends in Virtual Reality Rehabilitation: Bibliometric and Knowledge Graph Study

“…Nambi et al [ 34 ], in their psychological and hormone analysis study, discovered that VR exergame training was effective for American soccer players with chronic low back pain when compared with conventional exercise training programs. In a multicenter controlled trial, Meyns et al [ 35 ] demonstrated that exergaming in children with spastic cerebral palsy improved balance after previous poor balance performances.…”

Design of Virtual Reality-Based Hippotherapy Simulator Exergaming Software and Its Controller for Rehabilitation of Children with Cerebral Palsy in Indonesia: An Engineering Concept

“…One of the fun activities is exergaming or active video gaming that requires bodily movements to play [12]. Exergaming also benefits children with CP by improving muscle strength [13], balance [14], range of motion [15], and physical fitness [16] depending on the type of body movements required to control the game. In this report, we design an exergaming video game to solve the problem mentioned earlier in the form of a horse racing-like game with tasks to pick apples and avoiding obstacles.…”