Game-Based Dual-Task Exercise Program for Children with Cerebral Palsy: Blending Balance, Visuomotor and Cognitive Training: Feasibility Randomized Control Trial

Abstract

The objective of this exploratory randomized controlled trial (RCT) was to provide evidence for the feasibility and therapeutic value of a novel game-based dual-task balance exercise program in children with cerebral palsy (CP). Twenty children with CP were recruited and randomized into two groups: (a) the conventional balance training group (CG) and (b) the experimental group (XG), which received a game-based dual-task (DT) balance exercise program. Both groups received their respective therapy programs for 12 weeks at a frequency of three sessions per week. Semi-structured interviews with the parents and children and qualitative analysis were conducted to evaluate the children’s experiences with the game-based exercise program. The quantitative analysis included (a) the Pediatric Balance Scale (PBS), (b) Gross Motor Function Measure-88 (GMFM-88), and (c) computerized measures of standing balance performance during various dual-task conditions. Compliance was 100% for all 20 participants. Four themes captured the range of each participant’s experiences and opinions: (a) reasons for participation, (b) likes and dislikes with the technologies, (c) positive effects of the program, and (d) future expectations. Children in the XG demonstrated greater improvements in PBS, GMFM, and DT balance measures as compared to children in the CG. The findings demonstrate feasible trial procedures and acceptable DT-oriented training with a high compliance rate and positive outcomes. These findings support further research and development and progression to the next phase of a full-scale RCT to evaluate the clinical effectiveness of the game-based DT balance exercise program for children with CP.

The Use of Tele-Occupational Therapy for Children and Adolescents with Different Disabilities: Systematic Review of RCT Articles

“…In their study, which was conducted on 20 children aged 4 to 8 years with CP, the results indicated a positive effect of the Game-Based Dual-Task Exercise Program online, which was conducted for 12 sessions (3 sessions per week) on motor performance. It was large for children and also balanced for children ( 12 ). In addition, Surana, BK., et al (2019) also found improvements in mobility in Lower-Extremity Intensive Functional Training (LIFT), which was performed as TR for 9 weeks (5 days per week, each two-hour session) on 24 children with CP.…”

A Scoping Review of the Serious Game-Based Rehabilitation of People with Cerebral Palsy

“…One article completely fulfilled the requirements of each criterion, was assessed as being of a high quality, and achieved 100% with a total score of 15 points, according to the quantified McMaster Guidelines criteria [29]. The remaining articles were assessed as being in the good-quality range; three articles analyzed achieved over 80% with total scores of 13 points [15,30,31], 12 articles achieved over 70% with total scores of between 11 [13,[32][33][34][35] and 12 points [14,28,[36][37][38][39][40], and one article achieved a total score of 10 points [41]. According to the quantified McMaster Guidelines criteria, eight of the selected articles did not meet the full total score in terms of the sample, intervention, and results.…”

“…Regarding the level of evidence of interventions in games used in serious contexts, four articles at level I applied serious game interventions targeting body functions according to the ICF concept [15,29,31,40]. The remaining article of level I focused on body functions along with activities and participation [28].…”

Effects of non-immersive virtual reality intervention on children with spastic cerebral palsy: a meta-analysis and systematic review

“…In addition, central nervous system damage can lead to secondary damage in children with CP. Physical spasm, myasthenia, muscle atrophy/weak muscle tone, skeletal deformity, and developmental coordination disorders can result in dysfunctions in movement and balance 10 . These secondary injuries can further restrict patients’ social participation and negatively impact their physical and mental health development, 11 thus impairing their quality of life 12 …”

“…Physical spasm, myasthenia, muscle atrophy/weak muscle tone, skeletal deformity, and developmental coordination disorders can result in dysfunctions in movement and balance. 10 These secondary injuries can further restrict patients' social participation and negatively impact their physical and mental health development, 11 thus impairing their quality of life. 12 Different types of cerebral palsy can be identified depending on the predominant type of movement disorder.…”