Games Used With Serious Purposes: A Systematic Review of Interventions in Patients With Cerebral Palsy

Abstract

The purpose of the present systematic review was to examine extant research regarding the role of games used seriously in interventions with individuals with cerebral palsy. Therefore, PubMed, PsyINFO, Web of Science, Scopus, and IEEE databases were used. Search terms included: “serious games” OR “online games” OR “video games” OR “videogame” OR “game based” OR “game” AND “intervention” AND “cerebral palsy.” After the full reading and quality assessment of the papers, 16 studies met the inclusion criteria. The majority of the studies reported high levels of compliance, motivation, and engagement with game-based interventions both at home and at the clinical setting intervention. Regarding the effectiveness of the use of games, the results of the studies show both positive and negative results regarding their effectiveness. The efficacy was reported to motor function (i.e., improvements in the arm function, hand coordination, functional mobility, balance and gait function, postural control, upper-limbs function) and physical activity. Findings of this review suggest that games are used as a complement to conventional therapies and not as a substitute. Practitioners often struggle to get their patients to complete the assigned homework tasks, as patients display low motivation to engage in prescribed exercises. Data of this review indicates the use of games as tools suited to promote patients’ engagement in the therapy and potentiate therapeutic gains.

State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy

“…There are also several adjunctive interventions that when combined with task-specific motor training may augment the positive effects of training. These include electrical stimulation [65,[92][93][94], hydrotherapy [108,110,111], taping [159][160][161][162][163][164], transcranial direct current stimulation [101,[166][167][168], and virtual reality serious gaming [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] (yellow lights, weak positive). These interventions warrant more research as children reported finding gaming interventions rewarding and normalizing, and preferred electrical stimulation to wearing ankle-foot orthoses from a comfort perspective [93].…”

Toward Evaluation of The Subjective Experience of A General Class of User-Controlled, Robot-Mediated Rehabilitation Technologies for Children with Neuromotor Disability

“…(See for example, the 16 studies retrieved from the systematic review of games used seriously in CP conducted by Lopes and colleagues. [21] Six of these efforts reported sample sizes in the single digits and only one reported on a cohort of more than 20 children.) There was also a disproportionate number of girls versus boys (7:1) who volunteered to participate in the pilot of PedBotHome.…”

“…games used seriously) has likewise been shown to spur interest and motivate engagement fairly consistently across a wide range of therapeutic targets involving both lower and upper extremities. [21,22] Bringing these two strands of research together, robot-guided therapeutic maneuvers and games used seriously, has effectively created a new class of rehabilitative technology, which we will call assistive and/or rehabilitative (A/R) gamebots for ease of reference. The medical device payment structure in the US, for example, as yet has no classification under which A/R gamebots might be reimbursed in a child's therapy program.…”

“…Positive evidence supporting the effectiveness of robotic and game-based strategies (separately and in combination), in promoting progress toward motor-therapeutic milestones in CP has been aggregated across several reviews. [1,21,22] However, no work has addressed the emerging drivers of adoption of A/R gamebots or the range of subjective factors underpinning their use either clinically, or in support of the intensive home exercise regimen recommended to effect lasting motor improvement in children with CP. [24] Similarly, there are no valid and reliable tools to guide the design iteration of these technologies, advise trade studies, identify best practice heuristics, or support other decision-making processes inherent in prototype development.…”

Manual Dexterity is not Related to Media Viewing but is Related to Perceptual Bias in School-Age Children

“…Bedford et al [35] showed that there was a significant correlation between the age of first touchscreen use and the achievement of fine motor milestones and suggested that infants who actively use a touchscreen earlier also develop earlier manual dexterity abilities. In addition, interventions using interactive media such as video games have been shown to be effective in improving childhood movement disorders such as cerebral palsy [38] and developmental coordination disorder [39].…”