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Kou R, Zhang Z, Zhu F, Tang Y, Li Z. Effects of Exergaming on executive function and motor ability in children: A systematic review and meta-analysis. PLoS One 2024; 19:e0309462. [PMID: 39240840 PMCID: PMC11379181 DOI: 10.1371/journal.pone.0309462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 08/12/2024] [Indexed: 09/08/2024] Open
Abstract
This study aimed to evaluate the effectiveness of Exergaming in improving executive function and motor ability across different groups of children and adolescents. We searched several databases, including PsycINFO, Web of Science, Embase, PubMed, SPORT Discus, Scopus, and the Cochrane Central Register of Controlled Trials, for randomized controlled trial (RCT) studies published from inception until November 25, 2023, to identify studies investigating the effect of Exergaming on motor and executive function in children. The protocol was registered with PROSPERO (CRD42023482281). A total of 37 randomized controlled trials were included in this study. Our results indicate that Exergaming can influence children's cognitive flexibility [SMD = 0.34, 95%CI(0.13,0.55), I2 = 0.0%, P = 0.738], inhibition control [SMD = 0.51, 95%CI (0.30,0.72), I2 = 0.0%, P = 0.473], global cognitive [SMD = 0.87, 95%CI (0.50,1.23), I2 = 0.0%, P = 0.974], working memory [SMD = 0.18, 95%CI(-0.16, 0.52), I2 = 46.5%, P = 0.096], gross motor skills [SMD = 0.82, 95%CI (0.30, 1.35), I2 = 79.1%, P<0.001], fine motor skills [SMD = 0.71, 95%CI (0.22,1.21), I2 = 78.7%, P<0.001], balance [SMD = 0.61, 95%CI (0.34, 0.88), I2 = 59.5%, P = 0.001], and cardiorespiratory [SMD = 0.48, 95%CI (0.16, 0.79), I2 = 58.4%, P = 0.019]. While these findings suggest that Exergaming can promote children's cognitive flexibility, inhibitory control, global cognition and motor abilities, the effect on working memory was not statistically significant. Further high-quality randomized controlled trials are warranted to explore the potential benefits of Exergaming for different groups of children, including those with specific needs.
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Affiliation(s)
- Ruijie Kou
- Capital University of Physical Education and Sports, Beijing, China
| | - Zhenjie Zhang
- Capital University of Physical Education and Sports, Beijing, China
| | - Feilong Zhu
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Yanli Tang
- Capital University of Physical Education and Sports, Beijing, China
| | - Zixuan Li
- School of Psychological and Cognitive Sciences, Peking University, Beijing, China
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Gözaçan Karabulut D, Maden Ç, Karabulut Y, Aslan M. Effects of Video-Based Exercises and Conventional Physiotherapy on Upper Extremity Functionality, Selective Motor Control, and Proprioception in Unilateral Cerebral Palsy: A Randomized Controlled Trial. Games Health J 2024; 13:305-312. [PMID: 39069879 DOI: 10.1089/g4h.2024.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
Objective: The present study was conducted to evaluate the effects of video-based exercises added to conventional physiotherapy (CPT) on upper extremity functionality, selective motor control, and proprioception in individuals with unilateral cerebral palsy (UCP). Materials and Methods: Thirty patients with UCP were randomized into two groups: the intervention group (15 individuals with a mean age of 9.2 ± 3.8 years) and the control group (15 individuals with a mean age of 8.3 ± 4.1 years). The intervention group received 8 weeks of video-based exercises, and the control group received 8 weeks of conventional physiotherapy. Upper extremity functional abilities, upper extremity selective motor control, proprioception, and entertainment levels were evaluated before and after the intervention for all groups. Results: While a significant change was observed in the mean scores of the ABILHAND-Kids, Selective Control of the Upper Extremity Scale right-left scores, shoulder flexion, shoulder abduction, and elbow flexion proprioception angles after the video-based exercises in the intervention group (P < 0.05), a significant change was observed only in the 60-degree flexion angle in the control group (P = 0.001). In the comparison between the groups, there were significant differences in post-intervention value only in shoulder flexion and abduction angles, whereas there was no difference between the groups in elbow flexion angles (P > 0.05). Conclusion: Incorporating video-based exercises into the upper extremity rehabilitation processes of individuals with UCP is beneficial in terms of upper extremity functionality, selective motor control, and proprioception.
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Affiliation(s)
- Demet Gözaçan Karabulut
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Gaziantep Islam Science and Technology University, Gaziantep, Turkey
| | - Çağtay Maden
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Gaziantep Islam Science and Technology University, Gaziantep, Turkey
| | - Yalçın Karabulut
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Mehmet Aslan
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Hasan Kalyoncu University, Gaziantep, Turkey
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Hao J, Huang B, Remis A, He Z. The application of virtual reality to home-based rehabilitation for children and adolescents with cerebral palsy: A systematic review and meta-analysis. Physiother Theory Pract 2024; 40:1588-1608. [PMID: 36847396 DOI: 10.1080/09593985.2023.2184220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Home-based rehabilitation enables children and families to participate in therapeutic activities built into their daily routines without the barriers of arrangement and transportation to facilities. Virtual reality is an emerging technology which has shown promising outcomes in rehabilitation. PURPOSE This systematic review aims to examine the feasibility and effects of virtual reality-enhanced home rehabilitation on Body functions and structures, Activity, and Participation outcomes in children and adolescents with cerebral palsy. METHODS Interventional studies were searched across five biomedical databases on November 26, 2022. Two independent reviewers conducted study selection, data extraction, and quality assessment. The Physiotherapy Evidence Database scale and National Institutes of Health Study Quality Assessment Tools were used to evaluate the quality of included studies. Meta-analysis was performed to examine the effects of the intervention. RESULTS Eighteen studies were included in this review. Home-based virtual reality rehabilitation appears feasible with effects on upper extremity and gross motor function, strength, bone density, cognition, balance, walking, daily activity performance, and participation. Meta-analyses revealed significant improvements in hand function (SMD = 0.41, p= .003), gross motor function (SMD = 0.56, p= .0002), and walking capacity (SMD = 0.44, p= .01) following home-based virtual reality intervention. CONCLUSION Home-based virtual reality may serve as an adjunct to conventional facility-based therapy to promote participation in therapeutic exercises and maximize rehabilitation outcomes. Further properly designed randomized controlled trials using valid and reliable outcome measures with adequately powered sample sizes are warranted to enhance the current body of evidence using home-based virtual reality in cerebral palsy rehabilitation.
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Affiliation(s)
- Jie Hao
- Department of Health and Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, United States
| | - Biying Huang
- Department of Health and Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, United States
| | - Andréas Remis
- Department of Physical Medicine and Rehabilitation, Gate Parkway Primary Care Center, Jacksonville
| | - Zhengting He
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore
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Sañudo B, Sánchez-Oliver AJ, Fernández-Gavira J, Gaser D, Stöcker N, Peralta M, Marques A, Papakonstantinou S, Nicolini C, Sitzberger C. Physical and Psychosocial Benefits of Sports Participation Among Children and Adolescents with Chronic Diseases: A Systematic Review. SPORTS MEDICINE - OPEN 2024; 10:54. [PMID: 38750266 PMCID: PMC11096140 DOI: 10.1186/s40798-024-00722-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 05/01/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND This study aims to identify sports interventions for children and adolescents (CaA) with chronic diseases and evaluate their impact on physical, psychological, and social well-being. The findings of this study will contribute to our understanding of the potential benefits of sports interventions for CaA with chronic diseases and inform future interventions to promote their overall health and well-being. METHODS A systematic review was conducted in eight databases. This systematic review followed PRISMA guidelines and utilized a comprehensive search strategy to identify studies on sport-based interventions for CaA with chronic diseases. The review included randomized controlled trials and observational studies that focused on physical and psychosocial outcomes. RESULTS We screened 10,123 titles and abstracts, reviewed the full text of 622 records, and included 52 primary studies. A total of 2352 participants were assessed with an average of 45 ± 37 participants per study. Among the included studies involving CaA with chronic diseases with an age range from 3 to 18 years, 30% (n = 15) autism spectrum disorders, 21% (n = 11) cerebral palsy, 19% (n = 10) were attention deficit hyperactivity disorder, and 17% (n = 9) obesity. Other diseases included were cancer (n = 5), asthma (n = 1) and cystic fibrosis (n = 1). Interventions involved various sports and physical activities tailored to each chronic disease. The duration and frequency of interventions varied across studies. Most studies assessed physical outcomes, including motor performance and physical fitness measures. Psychosocial outcomes were also evaluated, focusing on behavioural problems, social competencies, and health-related quality of life. CONCLUSION Overall, sport-based interventions effectively improved physical and psychosocial outcomes in CaA with chronic diseases. Interventions are generally safe, and participants adhere to the prescribed protocols favorably. Despite that, there is little evidence that interventions are being implemented. Future studies should include interventions tailored to meet the common issues experienced by CaA with chronic conditions, providing a comprehensive understanding of the impact of sports interventions on those affected. REGISTRATION The methodology for this review was pre-determined and registered in the PROSPERO database (registration number: CRD42023397172).
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Affiliation(s)
- Borja Sañudo
- Department of Physical Education and Sport, University of Seville, Seville, Spain
| | | | | | - Dominik Gaser
- Chair of Preventive Pediatrics, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Nicola Stöcker
- CRETHIDEV. Creative Thinking Development, Attiki, Greece
| | - Miguel Peralta
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Faculdade de Medicina, ISAMB, Universidade de Lisboa, Lisbon, Portugal
| | - Adilson Marques
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Faculdade de Medicina, ISAMB, Universidade de Lisboa, Lisbon, Portugal
| | | | - Chiara Nicolini
- CEIPES. Centro Internazionale per la Promozione dell'Educazione e lo Sviluppo, Palermo, Italy
| | - Christina Sitzberger
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
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Del Lucchese B, Parravicini S, Filogna S, Mangani G, Beani E, Di Lieto MC, Bardoni A, Bertamino M, Papini M, Tacchino C, Fedeli F, Cioni G, Sgandurra G. The wide world of technological telerehabilitation for pediatric neurologic and neurodevelopmental disorders - a systematic review. Front Public Health 2024; 12:1295273. [PMID: 38694988 PMCID: PMC11061864 DOI: 10.3389/fpubh.2024.1295273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/08/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction The use of Information and Communication Technology (ICT) for assessing and treating cognitive and motor disorders is promoting home-based telerehabilitation. This approach involves ongoing monitoring within a motivating context to help patients generalize their skills. It can also reduce healthcare costs and geographic barriers by minimizing hospitalization. This systematic review focuses on investigating key aspects of telerehabilitation protocols for children with neurodevelopmental or neurological disorders, including technology used, outcomes, caregiver involvement, and dosage, to guide clinical practice and future research. Method This systematic review adhered to PRISMA guidelines and was registered in PROSPERO. The PICO framework was followed to define the search strategy for technology-based telerehabilitation interventions targeting the pediatric population (aged 0-18) with neurological or neurodevelopmental disorders. The search encompassed Medline/PubMed, EMBASE, and Web of Science databases. Independent reviewers were responsible for selecting relevant papers and extracting data, while data harmonization and analysis were conducted centrally. Results A heterogeneous and evolving situation emerged from our data. Our findings reported that most of the technologies adopted for telerehabilitation are commercial devices; however, research prototypes and clinical software were also employed with a high potential for personalization and treatment efficacy. The efficacy of these protocols on health or health-related domains was also explored by categorizing the outcome measures according to the International Classification of Functioning, Disability, and Health (ICF). Most studies targeted motor and neuropsychological functions, while only a minority of papers explored language or multi-domain protocols. Finally, although caregivers were rarely the direct target of intervention, their role was diffusely highlighted as a critical element of the home-based rehabilitation setting. Discussion This systematic review offers insights into the integration of technological devices into telerehabilitation programs for pediatric neurologic and neurodevelopmental disorders. It highlights factors contributing to the effectiveness of these interventions and suggests the need for further development, particularly in creating dynamic and multi-domain rehabilitation protocols. Additionally, it emphasizes the importance of promoting home-based and family-centered care, which could involve caregivers more actively in the treatment, potentially leading to improved clinical outcomes for children with neurological or neurodevelopmental conditions. Systematic review registration PROSPERO (CRD42020210663).
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Affiliation(s)
- Benedetta Del Lucchese
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris Foundation, Pisa, Italy
| | - Stefano Parravicini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Pediatric Neuroscience Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Silvia Filogna
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris Foundation, Pisa, Italy
| | - Gloria Mangani
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris Foundation, Pisa, Italy
| | - Elena Beani
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris Foundation, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maria Chiara Di Lieto
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris Foundation, Pisa, Italy
| | | | - Marta Bertamino
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Marta Papini
- Scientific Institute, IRCCS E. Medea, Lecco, Italy
| | - Chiara Tacchino
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris Foundation, Pisa, Italy
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris Foundation, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Bell J, Decker B, Eichmann A, Palkovich C, Reji C. Effectiveness of Virtual Reality for Upper Extremity Function and Motor Performance of Children With Cerebral Palsy: A Systematic Review. Am J Occup Ther 2024; 78:7802180180. [PMID: 38350039 DOI: 10.5014/ajot.2024.050374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
IMPORTANCE Research on the functional and motor performance impact of virtual reality (VR) as an intervention tool for children with cerebral palsy (CP) is limited. OBJECTIVE To understand whether VR is an effective intervention to improve upper extremity (UE) function and motor performance of children diagnosed with CP. DATA SOURCES Databases used in the search were EBSCOhost, One Search, PubMed, Cloud Source, CINAHL, SPORTDiscus, and Google Scholar. STUDY SELECTION AND DATA COLLECTION Studies published from 2006 to 2021 were included if children had a diagnosis of CP and were age 21 yr or younger, VR was used as an intervention, and measures of UE function and motor performance were used. FINDINGS Twenty-one studies were included, and the results provided promising evidence for improvements in areas of UE function, motor performance, and fine motor skills when VR is used as an intervention. To yield noticeable UE improvements in children with CP, VR should be implemented for 30 to 60 min/session and for at least 360 min over more than 3 wk. Additional areas of improvement include gross motor skills, functional mobility, occupational performance, and intrinsic factors. CONCLUSIONS AND RELEVANCE The use of VR as an intervention for children with CP to improve UE function and motor performance is supported. More randomized controlled trials with larger sample sizes focusing on similar outcomes and intervention frequencies are needed to determine the most effective type of VR for use in clinical occupational therapy. Plain-Language Summary: This systematic review explains how virtual reality (VR) has been used as an intervention with children with cerebral palsy (CP). The review synthesizes the results of 21 research studies of children who had a diagnosis of CP and who were 21 years old or younger. The findings support using VR to improve upper extremity performance, motor performance, and fine motor skills. The findings also show that occupational therapy practitioners should use a VR intervention at a minimum frequency of 30 to 60 minutes per session and for at least 360 minutes over more than 3 weeks to yield noticeable improvements in upper extremity, motor performance, and fine motor skills for children with CP.
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Affiliation(s)
- Juliana Bell
- Juliana Bell, BS, is Occupational Therapy Doctoral Student, Department of Occupational Therapy, Gannon University, Ruskin, FL;
| | - Bonnie Decker
- Bonnie Decker, EdD, OTR/L, FAOTA, is Associate Professor, Department of Occupational Therapy, Gannon University, Ruskin, FL
| | - Alicia Eichmann
- Alicia Eichmann, BS, is Occupational Therapy Doctoral Student, Department of Occupational Therapy, Gannon University, Ruskin, FL
| | - Carly Palkovich
- Carly Palkovich, BS, is Occupational Therapy Doctoral Student, Department of Occupational Therapy, Gannon University, Ruskin, FL
| | - Chelsea Reji
- Chelsea Reji, BA, is Occupational Therapy Doctoral Student, Department of Occupational Therapy, Gannon University, Ruskin, FL
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7
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Burin-Chu S, Baillet H, Leconte P, Lejeune L, Thouvarecq R, Benguigui N. Effectiveness of virtual reality interventions of the upper limb in children and young adults with cerebral palsy: A systematic review with meta-analysis. Clin Rehabil 2024; 38:15-33. [PMID: 37499213 DOI: 10.1177/02692155231187858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To examine the characteristics and the effectiveness of virtual reality systems on upper limb impairments in children and young adults with cerebral palsy. DATA SOURCES An electronic search was conducted on PubMed, PEDro, Web of Science, Central, and EMBASE. METHODS The protocol of this review was prospectively registered in the PROSPERO database (CRD42022302271). Randomized controlled trials that tested the effects of virtual reality-based interventions on the upper limb of participants with cerebral palsy were included. The methodological quality of the studies was measured by the PEDro scale. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation. The data of the studies were analyzed in meta-analysis and presented in forest plots and narrative synthesis. RESULTS Twenty-two studies involving 746 participants were included. Ten different virtual reality systems were used in the interventions, of which six were designed specifically for rehabilitation and four commercial video games. We found an effect in favor of virtual reality when it was used in combination with conventional therapy for upper limb activity (SMD = 0.65; 95% CI (0.19 to 1.11)). However, the certainty of the evidence of the comparisons ranged from very low to low. CONCLUSION Virtual reality seems to be an effective tool for upper limb activity in children and young adults with cerebral palsy. Nevertheless, future studies should present a better methodological quality, a larger sample size, and well-defined rehabilitation programs to reduce the inconsistency of the evidence in this domain.
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Affiliation(s)
| | - Héloïse Baillet
- Normandie Univ, UNICAEN, ENSICAEN, CNRS, GREYC, Caen, France
| | | | - Laure Lejeune
- Normandie Univ, UNICAEN, ENSICAEN, CNRS, GREYC, Caen, France
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Pimentel-Ponce M, Romero-Galisteo RP, Palomo-Carrión R, Pinero-Pinto E, Antonio Merchán-Baeza J, Ruiz-Muñoz M, Oliver-Pece J, González-Sánchez M. Gamification and neurological motor rehabilitation in children and adolescents: a systematic review. Neurologia 2024; 39:63-83. [PMID: 38065433 DOI: 10.1016/j.nrleng.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/07/2021] [Indexed: 12/25/2023] Open
Abstract
INTRODUCTION Gamification consists of the use of games in non-playful contexts. It is widely employed in the motor rehabilitation of neurological diseases, but mainly in adult patients. The objective of this review was to describe the use of gamification in the rehabilitation of children and adolescents with neuromotor impairment. METHODS We performed a systematic review of clinical trials published to date on the MEDLINE (PubMed), Scielo, SCOPUS, Dialnet, CINAHL, and PEDro databases, following the PRISMA protocol. The methodological quality of the studies identified was assessed using the PEDro scale. RESULTS From a total of 469 studies, 11 clinical trials met the inclusion criteria. We analysed the gamification systems used as part of the rehabilitation treatment of different neuromotor conditions in children and adolescents. Cerebral palsy was the most frequently studied condition (6 studies), followed by developmental coordination disorder (3), neurological gait disorders (1), and neurological impairment of balance and coordination (1). CONCLUSION The use of gamification in rehabilitation is helpful in the conventional treatment of neuromotor disorders in children and adolescents, with increased motivation and therapeutic adherence being the benefits with the greatest consensus among authors. While strength, balance, functional status, and coordination also appear to improve, future research should aim to determine an optimal dosage.
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Affiliation(s)
| | - R P Romero-Galisteo
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.
| | - R Palomo-Carrión
- Departamento de Enfermería, Fisioterapia y Terapia Ocupacional, Facultad de Fisioterapia, Universidad de Castilla la Mancha, Toledo, Spain
| | - E Pinero-Pinto
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, Spain
| | - J Antonio Merchán-Baeza
- Grupo de investigación Methodology, Methods, Models and Outcomes of Health and Social Sciences (M30), Facultad de Cienciasde la Salud y Bienestar, Universidad de Vic-Universidad Central de Cataluña (UVIC-UCC), Vic, Barcelona, Spain
| | - M Ruiz-Muñoz
- Departamento de Enfermería y Podología, Facultad de Ciencias de la Salud, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - J Oliver-Pece
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología, Universidad de Málaga, Málaga, Spain
| | - M González-Sánchez
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga. Instituto de Investigación Biomédica deMálaga (IBIMA), Málaga, Spain
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9
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Meriggi P, Mandalà M, Randazzo M, Brazzoli E, Castagna A, Di Giusto V, Cavallini A, Marzegan A, Lencioni T, Olivieri I. Non-immersive virtual reality based treatment for children with unilateral cerebral palsy: Preliminary results. J Pediatr Rehabil Med 2024; 17:107-123. [PMID: 38489200 PMCID: PMC10977369 DOI: 10.3233/prm-230028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 01/09/2024] [Indexed: 03/17/2024] Open
Abstract
PURPOSE Unilateral cerebral palsy (UCP) represents about 30-40% of overall cerebral palsy diagnoses. Upper limb impairment has a significant negative impact on activities of daily living (ADL), and recent studies have shown that the use of virtual reality (VR) can increase motivation and promote an improvement in ADL. This preliminary study was aimed at exploring the acceptability and usability of a VR rehabilitation treatment, using the VITAMIN Platform, for children with UCP. A secondary goal of the study was to compare the results of usual standardized clinical scales and questionnaires with kinematic results as well as with the quantitative measures acquired by the VITAMIN platform in each exercise of the rehabilitation sessions. METHODS Six children with UCP (aged 7-15) were recruited for a preliminary investigation in using a non-immersive VR system. The treatment was composed of 10 weekly sessions of 45 minutes. Each child played five types of exergames, using the impaired upper limb to hit virtual objects projected on a wide screen. Standardized clinical scales, kinematic analysis, and questionnaires were used to extensively assess upper limb function before and at the end of treatment. Five typically-developing children provided a reference for the instrumented kinematic assessment. RESULTS At the end of the treatment, Melbourne Assessment 2 (MA2) scores increased for all the participants (mean increase in range of movement (ROM) + 19.1%, accuracy + 4.6%, dexterity + 13.1%, fluency + 10.3%). Shoulder flexion-extension ROM also improved (mean increase + 10.5°), and according to the kinematic analysis, shoulder movements became more similar to reference profiles. These results were confirmed by a general improvement in performing ADL, assessed by the ABILHAND-Kids questionnaire. Finally, a general agreement among the different measures and indexes emerged from the acquired data. CONCLUSION The results show that VR treatment with the VITAMIN platform could be engaging and functional for rehabilitation of children with UCP. The good agreement among the qualitative and quantitative measures and indexes confirms the potential of such novel treatment. However, due to the limited sample size and small number of sessions, further and larger investigations are required to evaluate the effectiveness and to generalize the results.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ivana Olivieri
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
- Centro Benedetta D’Intino Onlus, Milan, Italy
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10
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Wang Z, He K, Sui X, Yi J, Yang Z, Wang K, Gao Y, Bian L, Jiang J, Zhao L. The Effect of Web-Based Telerehabilitation Programs on Children and Adolescents With Brain Injury: Systematic Review and Meta-Analysis. J Med Internet Res 2023; 25:e46957. [PMID: 38145485 PMCID: PMC10775025 DOI: 10.2196/46957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/02/2023] [Accepted: 10/11/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND Acquired brain injury (ABI) in children and adolescents can lead to motor and executive impairments that often require long-term treatment. The implementation of web-based telerehabilitation therapy at home is a method to improve the functional status of patients. Therefore, we performed a systematic review of the effects of web-based telerehabilitation programs on functional outcomes in children and adolescents with brain injury and supplemented the findings with a meta-analysis. OBJECTIVE This study evaluated the therapeutic effect of web-based telerehabilitation training on children and adolescents with brain injury to determine whether web-based telerehabilitation therapy improved motor function, executive function, physical activity level, lower limb strength, hand and upper limb function, visual processing skills, and occupational functional performance in children and adolescents with brain injury. METHODS PubMed, Embase, Scopus, Web of Science, and the Cochrane Library were searched for randomized controlled trials on web-based telerehabilitation programs in children and adolescents with brain injury until December 2022, and the risk of bias was evaluated using the Cochrane Collaboration Tool. Relevant data were extracted, and a meta-analysis was performed using RevMan5.3 software. RESULTS Overall, 17 studies involving 848 patients were included. Web-based telerehabilitation therapy improved the motor function (standardized mean difference [SMD] 0.29, 95% CI 0.01-0.57; P=.04), physical activity level (SMD 0.42, 95% CI 0.11-0.73; P=.007), lower limb strength (SMD 0.52, 95% CI 0.13-0.90; P=.009), and visual processing skills (SMD 0.26, 95% CI 0.02-0.50; P=.04) of children and adolescents with brain injury. It also improved executive function in letter-number sequencing (SMD 1.26, 95% CI 0.26-2.26; P=.01), attention (SMD 0.38, 95% CI 0.09-0.66; P=.009), and symbol search (SMD 1.18, 95% CI 0.43-1.93, P=.002). CONCLUSIONS Web-based telerehabilitation therapy improved motor function, physical activity level, lower limb strength, letter-number sequencing, attention, and symbol search, which improved the quality of life in children and adolescents with brain injury. Web-based telerehabilitation programs provide great convenience for children and adolescents with ABI who need long-term treatment and allow them to exercise at home for rehabilitation training. The widespread implementation of remote interventions also provides children and adolescents in remote areas with better access to rehabilitation services. This review provides evidence for the effectiveness of web-based telerehabilitation therapy, but there was heterogeneity in some of the results because of different disease types and intervention programs. Future studies can expand the sample size according to disease type and increase follow-up time according to different exercise prescriptions to further refine the long-term effects of this intervention on various functions of children and adolescents with ABI. TRIAL REGISTRATION PROSPERO CRD42023421917; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=421917.
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Affiliation(s)
- Zeyu Wang
- School of Nursing, Jilin University, Changchun, China
| | - Kang He
- School of Nursing, Jilin University, Changchun, China
| | - Xin Sui
- School of Nursing, Jilin University, Changchun, China
| | - Jiang Yi
- The Second Hospital of Jilin University, Jilin University, Changchun City, China
| | - Zhaoyun Yang
- School of Nursing, Jilin University, Changchun, China
| | - Kai Wang
- School of Nursing, Jilin University, Changchun, China
| | - Yan Gao
- School of Nursing, Jilin University, Changchun, China
| | - Linfang Bian
- School of Nursing, Jilin University, Changchun, China
| | - Junjie Jiang
- The Second Hospital of Jilin University, Jilin University, Changchun City, China
| | - Lijing Zhao
- School of Nursing, Jilin University, Changchun, China
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Wang N, Liu N, Liu S, Gao Y. Effects of Nonimmersive Virtual Reality Intervention on Children With Spastic Cerebral Palsy: A Meta-analysis and Systematic Review. Am J Phys Med Rehabil 2023; 102:1130-1138. [PMID: 37535642 DOI: 10.1097/phm.0000000000002321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
ABSTRACT This review aimed to assess the effectiveness of nonimmersive virtual reality intervention compared with traditional rehabilitation in improving the functions of the upper and lower limbs, balance, and social participation among children with spastic cerebral palsy. We used librarian-designed searches of 10 databases to identify research articles on randomized controlled trials that assessed the effectiveness of nonimmersive virtual reality in intervening spastic cerebral palsy patients up to April 15, 2023. Independent evaluation was conducted by two trained investigators using the evaluation criteria of randomized controlled trial quality indicated in the Cochrane Manual of Assessment "risk-of-bias tool." The Physical Therapy Evidence Database scale was used to evaluate the method and quality of the literature. Twenty-one research articles involving 779 patients with spastic cerebral palsy were included. Significant differences between the nonimmersive virtual reality rehabilitation and traditional rehabilitation groups were observed in all indicators, except for the Jebsen-Taylor Hand Function Test. Nonimmersive virtual reality intervention is effective in improving the function of the lower extremity, balance, and social participation in children with spastic cerebral palsy, but its effect on upper limb function is still controversial.
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Affiliation(s)
- Nan Wang
- From the Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China (NW, SL, YG); and Department of Nephrology, Shengjing Hospital of China Medical University, Shenyang, China (NL)
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Tobaiqi MA, Albadawi EA, Fadlalmola HA, Albadrani MS. Application of Virtual Reality-Assisted Exergaming on the Rehabilitation of Children with Cerebral Palsy: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:7091. [PMID: 38002703 PMCID: PMC10672287 DOI: 10.3390/jcm12227091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/15/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Rehabilitation programs for children with cerebral palsy (CP) aim to improve their motor and cognitive skills through repeated and progressively challenging exercises. However, these exercises can be tedious and demotivating, which can affect the effectiveness and feasibility of the programs. To overcome this problem, virtual reality VR-assisted exergaming has emerged as a novel modality of physiotherapy that combines fun and motivation with physical activity. VR exergaming allows children with CP to perform complex movements in a secure and immersive environment, where they can interact with virtual objects and scenarios. This enhances their active engagement and learning, as well as their self-confidence and enjoyment. We aim to provide a comprehensive overview of the current state of research on VR exergaming for CP rehabilitation. The specific objectives are: To identify and describe the existing studies that have investigated the effects of VR exergaming on motor function and participation outcomes in children with CP. In addition, we aim to identify and discuss the main gaps, challenges, and limitations in the current research on VR exergaming for CP rehabilitation. Finally, we aim to provide recommendations and suggestions for future research and practice in this field. METHODS In June 2023, we conducted a systematic search on Scopus, Web of Science, PubMed, Cochrane, and Embase for randomized trials and cohort studies that applied VR-assisted exergaming to rehabilitating patients with CP. The inclusion criteria encompassed the following: (1) Randomized controlled trials (RCTs) and cohort studies involving the rehabilitation of children with CP; (2) the application of VR-based exergaming on the rehabilitation; (3) in comparison with conventional rehabilitation/usual care. The quality of the selected RCTs was evaluated using Cochrane's tool for risk of bias assessment bias includes. Whereas the quality of cohort studies was assessed using the National Institutes of Health (NIH) tool. RESULTS The systematic search of databases retrieved a total of 2576 studies. After removing 863 duplicates, 1713 studies underwent title and abstract screening, and 68 studies were then selected as eligible for full-text screening. Finally, 45 studies were involved in this review (n = 1580), and 24 of those were included in the quantitative analysis. The majority of the included RCTs had a low risk of bias regarding study reporting, participants' attrition, and generating a random sequence. Nearly half of the RCTs ensured good blinding of outcomes assessors. However, almost all the RCTs were unclear regarding the blinding of the participants and the study personnel. The 2020 retrospective cohort study conducted at Samsung Changwon Hospital, investigating the effects of virtual reality-based rehabilitation on upper extremity function in children with cerebral palsy, demonstrated fair quality in its methodology and findings. VR-assisted exergaming was more effective than conventional physiotherapy in improving the Gross Motor Function Measurement (GMFM)-88 score (MD = 0.81; 95% CI [0.15, 1.47], p-value = 0.02) and the GMFM walking and standing dimensions (MD = 1.45; 95% CI [0.48, 2.24], p-value = 0.003 and MD = 3.15; 95% CI [0.87, 5.42], p-value = 0.007), respectively. The mobility and cognitive domains of the Pediatric Evaluation of Disability Inventory score (MD = 1.32; 95% CI [1.11, 1.52], p-value < 0.001) and (MD = 0.81; 95% CI [0.50, 1.13], p-value < 0.0001) were also improved. The Canadian Occupational Performance Measure performance domain (MD = 1.30; 95% CI [1.04, 1.56], p-value < 0.001), the WeeFunctional Independence Measure total score (MD = 6.67; 95% CI [6.36, 6.99], p-value < 0.0001), and the Melbourne Assessment of Unilateral Upper Limb Function-2 score (p-value < 0.001) improved as well. This new intervention is similarly beneficial as conventional therapy in improving other efficacy measures. CONCLUSIONS Our findings suggest that VR-assisted exergaming may have some advantages over conventional rehabilitation in improving CP children's functioning and performance in daily life activities, upper and lower limb mobility, and cognition. VR-assisted exergaming seems to be as effective as conventional physiotherapy in the other studied function measures. With its potential efficacy, better feasibility, no reported side effects, and entertaining experience, VR-assisted exergaming may be a viable complementary approach to conventional physiotherapy in rehabilitating children with CP.
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Affiliation(s)
- Muhammad Abubaker Tobaiqi
- Department of Family and Community Medicine, College of Medicine, Taibah University, Al-Madinah Al-Munawara 42353, Saudi Arabia
| | - Emad Ali Albadawi
- Department of Anatomy, College of Medicine, Taibah University, Al-Madinah Al-Munawara 42353, Saudi Arabia;
| | - Hammad Ali Fadlalmola
- Department of Community Health Nursing, Nursing College, Taibah University, Al-Madinah Al-Munawara 42353, Saudi Arabia;
| | - Muayad Saud Albadrani
- Department of Family and Community Medicine, College of Medicine, Taibah University, Al-Madinah Al-Munawara 42353, Saudi Arabia
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Pinos Cisneros TV, Brons A, Kröse B, Schouten B, Ludden G. Playfulness and New Technologies in Hand Therapy for Children With Cerebral Palsy: Scoping Review. JMIR Serious Games 2023; 11:e44904. [PMID: 37843886 PMCID: PMC10616756 DOI: 10.2196/44904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/23/2023] [Accepted: 07/21/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Innovative technologies such as game consoles and smart toys used with games or playful approaches have proven to be successful and attractive in providing effective and motivating hand therapy for children with cerebral palsy (CP). Thus, there is an increased interest in designing and implementing interventions that can improve the well-being of these children. However, to understand how and why these interventions are motivating children, we need a better understanding of the playful elements of technology-supported hand therapy. OBJECTIVE This scoping review aims to identify the playful elements and the innovative technologies currently used in hand therapy for children with CP. METHODS We included studies that design or evaluate interventions for children with CP that use innovative technologies with game or play strategies. Data were extracted and analyzed based on the type of technology, description of the system, and playful elements according to the Lenses of Play, a play design toolkit. A total of 31 studies were included in the analysis. RESULTS Overall, 54 papers were included in the analysis. The results showed high use of consumer technologies in hand therapy for children with CP. Although several studies have used a combination of consumer technologies with therapeutic-specific technologies, only a few studies focused on the exclusive use of therapeutic-specific technologies. To analyze the playfulness of these interventions that make use of innovative technologies, we focused our review on 3 lenses of play: Open-ended Play, where it was found that the characteristics of ludus, such as a structured form of play and defined goals and rules, were the most common, whereas strategies that relate to paidia were less common. The most commonly used Forms of Play were physical or active form and games with rules. Finally, the most popular Playful experiences were control, challenge, and competition. CONCLUSIONS The inventory and analysis of innovative technology and playful elements provided in this study can be a starting point for new developments of fun and engaging tools to assist hand therapy for children with CP.
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Affiliation(s)
- Tamara Veronica Pinos Cisneros
- Digital Life Centre, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Interaction Design, University of Twente, Enschede, Netherlands
| | - Annette Brons
- Digital Life Centre, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Ben Kröse
- Digital Life Centre, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Ben Schouten
- Play and Civic Media, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Geke Ludden
- Interaction Design, University of Twente, Enschede, Netherlands
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Vibhuti, Kumar N, Kataria C. Efficacy assessment of virtual reality therapy for neuromotor rehabilitation in home environment: a systematic review. Disabil Rehabil Assist Technol 2023; 18:1200-1220. [PMID: 34761705 DOI: 10.1080/17483107.2021.1998674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/16/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Neuromotor impairments can affect any part of the body. It leads to many disorders, injuries, or disabilities, conventional rehabilitation is a long, rigorous, and tedious process. There is a need to inculcate new and innovative techniques in rehabilitation processes, to increase individuals' interest and overall performance with such therapies. Virtual Reality is considered a new technology that has the potential to be a useful aid in overcoming therapeutic problems in clinical and home-based environments. However, providing home-based rehabilitation is more practicable, cost-effective, and even safer than in-hospital rehabilitation. In addition, the need for home-based rehabilitation is growing as the number of neuromotor disorders rises and the capacity of acute inpatient rehabilitation decreases. Therefore, the main objective of this study was to assess the efficacy of a home-based Virtual Reality exercise treatment to identify the areas for future rehabilitation research. MATERIALS AND METHODS Data Extraction of 24,257 articles from seven databases were identified and the review is narrowed down and only 45 studies were focussed on efficacy assessment of Virtual Reality in the home environment. RESULTS The significant outcome of the effective home-based therapy system for the exercise improved functional ability, increasing range of motion, and motivation through Virtual reality-based rehabilitation is inferred. CONCLUSION Unlike clinical settings, a home-based system provides efficacious therapy with a controlled environment. This survey facilitates bettering methods and devices for neuromotor disorders. It is a good living long-term problem-solving approach and investigates awareness, needs, and a preferred component of home-based rehabilitation services.IMPLICATIONS FOR REHABILITATIONVR-based rehabilitation in the home environment has many physical and mental benefits in persons with neuromotor disorders.The most commonly neuromotor disorders considered in the study were Stroke, Spinal Cord Injury, Parkinson's disease, and Cerebral Palsy.Assistive technologies in home environments can compensate for long-term disorders or be used in rehabilitation as an addition to conventional therapy.The study gives an overview of current interventions and how they can be of benefit for a person suffering from neuromotor disorders in the home environment.
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Affiliation(s)
- Vibhuti
- Academy of Scientific and Innovative Research, Ghaziabad, India
- Biomedical Applications, CSIR-Central Scientific Instruments Organisation, Chandigarh, India
| | - Neelesh Kumar
- Academy of Scientific and Innovative Research, Ghaziabad, India
- Biomedical Applications, CSIR-Central Scientific Instruments Organisation, Chandigarh, India
| | - Chitra Kataria
- Department of Rehabilitation Services, Indian Spinal Injuries Center, New Delhi, India
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15
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Bossavit B, Arnedillo-Sánchez I. Motion-based technology to support motor skills screening in developing children: A scoping review. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 240:107715. [PMID: 37517185 DOI: 10.1016/j.cmpb.2023.107715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Acquiring motor skills is fundamental for children's development since it is linked to cognitive development. However, access to early detection of motor development delays is limited. AIM This review explores the use and potential of motion-based technology (MBT) as a complement to support and increase access to motor screening in developing children. METHODS Six databases were searched following the PRISMA guidelines to search, select, and assess relevant works where MBT recognised the execution of children's motor skills. RESULTS 164 studies were analysed to understand the type of MBT used, the motor skills detected, the purpose of using MBT and the age group targeted. CONCLUSIONS There is a gap in the literature aiming to integrate MBT in motor skills development screening and assessment processes. Depth sensors are the prevailing technology offering the largest detection range for children from age 2. Nonetheless, the motor skills detected by MBT represent about half of the motor skills usually observed to screen and assess motor development. Overall, research in this field is underexplored. The use of multimodal approaches, combining various motion-based sensors, may support professionals in the health domain and increase access to early detection programmes.
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Affiliation(s)
- Benoit Bossavit
- School of Computer Science & Statistics, Trinity College Dublin, Ireland; School of Computer Science & Programming Languages, Universidad de Málaga, Spain.
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16
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Kilcioglu S, Schiltz B, Araneda R, Bleyenheuft Y. Short- to Long-Term Effects of Virtual Reality on Motor Skill Learning in Children With Cerebral Palsy: Systematic Review and Meta-Analysis. JMIR Serious Games 2023; 11:e42067. [PMID: 37698895 PMCID: PMC10523212 DOI: 10.2196/42067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 04/24/2023] [Accepted: 07/18/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Many studies have started integrating virtual reality (VR) into neurorehabilitation for children with cerebral palsy (CP). The results of the effects of VR on motor skill learning, including the short- to long-term results of relevant studies, must be pooled in a generic framework. OBJECTIVE This systematic review and meta-analysis aimed to investigate the short- to long-term effects of therapies including VR on motor skill learning in children with CP. METHODS Two examiners followed the inclusion and exclusion criteria of the "Participant, Intervention, Control, and Outcome" framework. Randomized controlled trials (RCTs) and non-RCTs were considered if they compared VR-included interventions with control groups on motor functions and daily life activities in children with CP. PubMed, ScienceDirect, Embase, and IEEE Xplore databases were searched. The modified Downs and Black assessment was used to assess the methodological quality of the included studies. Meta-analyses and subgroup analyses for RCTs were conducted whenever possible. RESULTS A total of 7 RCTs, 2 non-RCTs, and 258 children with CP were included. The priority focus of 78% (7/9) of the studies was upper limb functions. There was a significant short-term effect of adding VR to conventional therapies on upper limb functions when compared with conventional therapies (P=.04; standardized mean difference [SMD]=0.39, 95% CI 0.01-0.76). The overall medium- to long-term effects showed a trend toward favoring the VR group, although the difference was not statistically significant (P=.06; SMD=0.37, 95% CI -0.02 to 0.77). For balance (P=.06; SMD=1.04, 95% CI -0.04 to 2.12), gross motor functions (P=.30; SMD=2.85, 95% CI -2.57 to 8.28), and daily life activities outcomes (P=.21; SMD=0.29, 95% CI -0.16 to 0.74), the overall effect in the short term also showed a trend toward favoring the VR group, but these results were not statistically significant. CONCLUSIONS VR seems to have additional benefits for motor skill learning in children with CP. Studies with follow-up outcomes of VR training focusing on balance and gross motor functions in patients with CP were quite limited. Future research on balance and gross motor function outcomes should target particularly long-term results of therapies including VR on motor skill learning. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021227734; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021227734.
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Affiliation(s)
- Seyma Kilcioglu
- Institute of Neuroscience, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Benoît Schiltz
- Institute of Neuroscience, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Rodrigo Araneda
- Institute of Neuroscience, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
- Exercise and Rehabilitation Science Institute, School of Physical Therapy, Faculty of Rehabilitation Science, Universidad Andrés Bello, Santiago, Chile
| | - Yannick Bleyenheuft
- Institute of Neuroscience, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
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Alrashidi M, Wadey CA, Tomlinson RJ, Buckingham G, Williams CA. The efficacy of virtual reality interventions compared with conventional physiotherapy in improving the upper limb motor function of children with cerebral palsy: a systematic review of randomised controlled trials. Disabil Rehabil 2023; 45:1773-1783. [PMID: 35575755 DOI: 10.1080/09638288.2022.2071484] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/06/2022] [Accepted: 04/24/2022] [Indexed: 01/16/2023]
Abstract
PURPOSE Cerebral palsy (CP) is the commonest motor disability affecting children. This study reviewed the evidence for virtual reality (VR) intervention compared with conventional physiotherapy in upper limb function of children with CP. METHODS Searches were undertaken in MEDLINE, EMBASE, PEDro, CENTRAL, Web of Science, CINAHL, ERIC, ICTRP, EU-CTR, ClinicalTrials.gov and EThOS databases. Only randomised-controlled trials (RCTs) were included. Two reviewers independently screened the search results, assessed full-text articles, extracted data and appraised the methodological quality by using the Cochrane collaboration's risk of bias (RoB2) tool. Albatross plots were used to synthesise the data. RESULTS Seven RCTs, examining motor function in a total of 202 children with CP, included. Four trials used the Quality of Upper Extremity Skills Test (QUEST) as an outcome measure, and three trials used grip strength. These outcome measures were utilised to develop two Albatross plots. Data from the plots showed contradictory findings of the included studies. CONCLUSIONS The effect of VR in the upper limb rehabilitation of children with CP remains unclear. All included studies used commercial non-immersive VR games. Future high-quality clinical research is needed to explore the extent to which non-immersive and immersive VR is feasible and effective with children and adolescents.IMPLICATIONS FOR REHABILITATIONThe current evidence supporting the use of VR as a rehabilitative tool is weak and uncertain.The current use of VR relies only on commercial non-immersive VR (off-shelf) games, which are not adjustable to meet the demands and goals of therapy programmes.Future research is needed to study the therapeutic feasibility of immersive VR with children and adolescents.
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Affiliation(s)
- Mohammed Alrashidi
- Children's Health and Exercise Research Centre, Sport & Health Sciences, University of Exeter, Exeter, UK
- Sport and Health Sciences, University of Exeter, Exeter, UK
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, Taibah University, Madina, KSA
| | - Curtis A Wadey
- Children's Health and Exercise Research Centre, Sport & Health Sciences, University of Exeter, Exeter, UK
| | | | | | - Craig A Williams
- Children's Health and Exercise Research Centre, Sport & Health Sciences, University of Exeter, Exeter, UK
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Crebbin K, Grisbrook T, Elliott C, Thornton A. The Use of Serious Gaming to Improve Sensorimotor Function and Motivation in People with Cerebral Palsy: A Systematic Review. Games Health J 2023; 12:169-197. [PMID: 36161972 DOI: 10.1089/g4h.2022.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this systematic review was to review the evidence for serious gaming interventions in improving sensorimotor function in children and adults with cerebral palsy (CP). Seven databases were searched with terms related to serious gaming and CP. Articles were evaluated according to the Downs and Black rating scale and important principles of serious gaming defined by Whyte et al. Extracted data included the population, intervention, serious gaming elements, outcomes, and authors' conclusions. Fifty-seven articles were identified for inclusion. Participants' ages ranged from 3 to 57 years. Interventions tested included commercial videogames as well as specially designed games. Most interventions had themed content, short-term goals, rewards, feedback, and multiple games. Outcome measures and study designs were inconsistent between studies. Sensorimotor function results of noncomparative studies were positive or neutral overall, but results of comparative studies were more mixed. We concluded that serious gaming interventions may be a useful adjunct to treatment as they are noninvasive, were not associated with deterioration in most cases, and may improve compliance. More comparative studies need to be completed to assess compliance and treatment outcomes. Future games should also aim to adhere more closely to the principles of serious gaming.
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Affiliation(s)
- Kayley Crebbin
- UWA Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Tiffany Grisbrook
- UWA Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Perth Children's Hospital, Perth, Western Australia, Australia
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Catherine Elliott
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Ashleigh Thornton
- UWA Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Perth Children's Hospital, Perth, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
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Choi JY, Yi SH, Shim D, Yoo B, Park ES, Rha DW. Home-based virtual reality-enhanced upper limb training system in children with brain injury: a randomized controlled trial. Front Pediatr 2023; 11:1131573. [PMID: 37274815 PMCID: PMC10233002 DOI: 10.3389/fped.2023.1131573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 04/26/2023] [Indexed: 06/07/2023] Open
Abstract
Background Rehabilitation of upper limb function can be challenging in children with brain lesion. Recent virtual reality (VR) rehabilitation may be an additional treatment option in pediatric rehabilitation. Objectives To assess the feasibility and effectiveness of a home-based VR-enhanced rehabilitation program with wearable multi-inertial measurement unit (IMU) sensors on upper limb functions in children with brain injury. Methods This multicenter single blind randomized controlled trial included 40 children with cerebral palsy (CP) or static brain injury. Subjects were randomized 1:1 to experimental and control group. Both the groups maintained the same therapeutic content and dose of occupational therapy during the intervention period. The experimental group performed additional training at home using the VR-enhanced program for at least 30 min/day, 5 days/week, for 6 weeks. VR training consisted of daily activities or games promoting wrist and forearm articular movements using wearable IMU sensors. The Melbourne Assessment of Unilateral Upper Limb Function-version 2 (MA2), Upper Limb Physician's Rating Scale (ULPRS), Pediatric Evaluation of Disability Inventory-computer adaptive test (PEDI-CAT), computerized 3D motion analysis, and user satisfaction survey were performed. Mann-Whitney U test was used to compare treatment effects between groups, and Friedman and Wilcoxon signed-rank tests were used to compare pre and post intervention. Results Overall 35 children (15 in VR group and 20 in control group) completed the protocol. In the experimental group, an average VR training time was 855 min. The accuracy of motion measured by MA2, segmental movements by ULPRS, daily living capability and social cognitive function by PEDI-CAT, movement time and shoulder movement pattern by motion analysis showed significant improvements. However, there were no significant differences in any of the functional outcome measures compared to the control group. All the children and parents reported positive experiences. Conclusions Home-based VR training though it had limited impact on improving upper limb function, it could help improve social cognitive function, movement pattern, and efficiency in children with brain injury and could be an effective means of extending clinical therapy to the home. Clinical Trial Registration CRIS.nih.go.kr: identifier KCT0003172.
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Affiliation(s)
- Ja Young Choi
- Department of Physical and Rehabilitation Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Sook-hee Yi
- Department of Physical and Rehabilitation Medicine, Seoul Rehabilitation Hospital, Seoul, Republic of Korea
| | - Dain Shim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Beomki Yoo
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Sook Park
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong-wook Rha
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Menekseoglu AK, Capan N, Arman S, Aydin AR. Effect of a Virtual Reality-Mediated Gamified Rehabilitation Program on Upper Limb Functions in Children With Hemiplegic Cerebral Palsy: A Prospective, Randomized Controlled Study. Am J Phys Med Rehabil 2023; 102:198-205. [PMID: 35687751 DOI: 10.1097/phm.0000000000002060] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The aim of the study is to investigate the effects of a virtual reality-mediated gamified rehabilitation program on upper limb functions, skills, range of motion, muscle tone, and quality of life in children with hemiplegic cerebral palsy. DESIGN This prospective, randomized, and controlled study included 36 children with hemiplegic cerebral palsy. Children were randomized into two groups, the virtual reality group ( n = 18) and the control group ( n = 18). Stretching and range-of-motion exercises were performed on the affected upper limb of the children in both groups. In addition to this exercise program, in the virtual reality group, virtual reality-mediated upper limb rehabilitation was performed under supervision. The children were assessed at baseline and 1 and 3 mos after the intervention. RESULTS There was a significant increase in Assisting Hand Assessment, ABILHAND-Kids, Quality of Upper Extremity Skills Test, and KINDL values in the virtual reality group. In addition, there were significant increases in the active joint range of motion of the finger flexion, wrist flexion, pronation, and supination in the virtual reality group. CONCLUSIONS In this study, it was determined that upper limb function, quality of life, and active joint range of motion of the children with hemiplegic cerebral palsy were increased with virtual reality-mediated upper limb rehabilitation.
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Affiliation(s)
- Ahmet Kivanc Menekseoglu
- From the Department of Physical Medicine and Rehabilitation, Ministry of Health, University of Health Science, Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey (AKM); and Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey (NC, SA, ARA)
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Li S, Song Y, Cai Z, Zhang Q. Are active video games useful in the development of gross motor skills among non-typically developing children? A meta-analysis. BMC Sports Sci Med Rehabil 2022; 14:140. [PMID: 35870986 PMCID: PMC9308223 DOI: 10.1186/s13102-022-00532-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/14/2022] [Indexed: 11/10/2022]
Abstract
Background Proficiency in gross motor skills (GMS) lays the foundation for developing more complex motor skills. Improving these motor skills may provide enhanced opportunities for the development of a variety of perceptual, social, and cognitive skills. However, GMS development and intervention effects are not ideal for many non-typically developing children.
Objective To systematically evaluate the effect of active video games on the development of gross motor skills in non-typically developing children and adolescents.
Methods Seven Chinese and English databases were searched for randomized controlled trials, and the risk of bias in included studies were qualitative evaluation according to the revised Cochrane risk of bias tool for randomised trials (RoB 2). Then a meta-analysis was conducted to estimate the overall effect of active video games on the development of gross motor skills in non-typically developing children. Results Twenty papers were included. In the three subordinate concepts of gross motor skills, active video games significantly improved locomotor skills [ SMD = 0.59, 95% CI (0.40, 0.77)] and non-locomotor skills [SMD = 0.51, 95% CI (0.20, 0.81)] in non-typically developing children. However, there was no significant difference compared with the control group [ SMD = 0.32, 95% CI (− 0.17, 0.82)] in object control skills. Conclusions The study shows that active video games can improve locomotor skill and stability skill in non-typically developing children, but the effect on object control skill is uncertain, and more high-quality literature needs to be included in the future. Trial registration The meta-analysis was registered on INPLASY (202,250,124) and is available in full on inplasy.com (https://inplasy.com/inplasy-2022-5-0124/).
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Montoro-Cárdenas D, Cortés-Pérez I, Ibancos-Losada MDR, Zagalaz-Anula N, Obrero-Gaitán E, Osuna-Pérez MC. Nintendo ® Wii Therapy Improves Upper Extremity Motor Function in Children with Cerebral Palsy: A Systematic Review with Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12343. [PMID: 36231643 PMCID: PMC9566093 DOI: 10.3390/ijerph191912343] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Nintendo® Wii-based therapy (NWT) is a non-immersive virtual reality therapy used to recover upper extremity (UE) motor function in children with cerebral palsy (CP). We aimed primarily to elucidate the effectiveness of NWT in improving UE motor and functional impaired abilities in children with CP, compared to conventional therapy or no intervention. The secondary aim was to assess if NWT is more effective when used alone or combined with conventional therapy. METHODS A systematic review with meta-analysis was conducted from a bibliographic search in PubMed, Scopus, PEDro, Web of Science, and CINHAL, ending in October 2021, in accordance with PRISMA guidelines. We included randomized controlled trials that compared NWT vs. conventional therapy or no intervention in terms of their impact on different UE impaired abilities (grip strength, tip grip strength, UE dissociated movements, functional capacity in daily living activities, gross and fine motor dexterity, and grasping ability) in children with CP. Effect size was calculated with standardized mean difference (SMD) and its 95% confidence interval (95% CI). RESULTS Nine studies (276 participants) were included. NWT is more effective than conventional therapy at improving grip strength (SMD = 0.5, 95% CI 0.08, 0.91), tip grip strength (SMD = 0.95, 95% CI 0.3, 1.61), and grasping ability (SMD = 0.72, 95%CI 0.14, 1.3). NWT is more effective than conventional therapy at improving functional capacity in daily living activities (SMD = 0.83, 95% CI 0.07, 1.56). For fine manual dexterity, NWT was better than no intervention (SMD = 3.12, 95% CI 1.5, 4.7). CONCLUSIONS Our results indicate that NWT is effective at improving various UE impaired motor skills in children with CP.
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Abdelhaleem N, El Wahab MSA, Elshennawy S. Effect of virtual reality on motor coordination in children with cerebral palsy: a systematic review and meta-analysis of randomized controlled trials. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2022. [DOI: 10.1186/s43042-022-00258-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Improving motor coordination is an important prerequisite for the functional development of children with cerebral palsy (CP). Virtual reality (VR) may be efficient, interactive, adjustable and motivating physiotherapy choice for children with deficient coordination. This review aimed to identify, evaluate and formulate all the evidence concerning the efficacy of VR on motor coordination in children with CP and to compare the Physiotherapy Evidence Database (PEDro) with Cochrane Risk of Bias (RoB).
Main text
Five databases (PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Science Direct and google scholar) were systemically searched from inception up to 1st January 2019. Studies included VR intervention for children with cerebral palsy with motor incoordination. Studies methodological quality was assessed by Cochrane RoB and PEDro scale. Nineteen studies met the prespecified eligibility criteria. There was a large effect size (SMD 0.75) on fine motor coordination. However, there was a non-significant, small beneficial effect (SMD 0.15) on gross motor coordination. The association between the overall Cochrane RoB and PEDro scores was fair (r = 0.28, P value 0.248). There was a slight agreement between overall and moderate categories PEDro scores and Cochrane RoB (κ = 0.02) and κ = 0.10), respectively. However, high and low categories were moderately agreed with Cochrane RoB (κ = 0.43) and (κ = 0.46).
Conclusion
VR seems to be effective for improving fine motor coordination with questionable effect on gross motor coordination. PEDro scale is fairly correlated with Cochrane RoB, so development and validation of a more compatible quality assessment tools specific to physiotherapy trials are needed.
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Goyal C, Vardhan V, Naqvi W. Virtual Reality-Based Intervention for Enhancing Upper Extremity Function in Children With Hemiplegic Cerebral Palsy: A Literature Review. Cureus 2022; 14:e21693. [PMID: 35237486 PMCID: PMC8882342 DOI: 10.7759/cureus.21693] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 12/25/2022] Open
Abstract
Cerebral palsy (CP) is the most common cause of motor disability in the pediatric population, with hemiplegia as one of the most widely seen subtypes of spastic CP. Although most of the children with hemiplegic CP are independent ambulators, deficits in hand function of the affected side remain a major concern of caregivers and children themselves. Children use the unaffected upper extremity to compensate for the weakness in the affected one, which consequently leads to the disuse of the hemiparetic upper extremity. Interactive virtual environments can enhance the activation of brain areas during training by providing feedback that can catalyze neuroplastic changes for improved function. Although numerous studies have been conducted on the impact of virtual reality (VR)-based rehabilitation in adults with stroke, studies on its use in the pediatric population are scarce. The three broad categories of VR systems based on the type of human-computer interactions are feedback-focused, gesture-based, and haptic-based. Preliminary studies have shown promising results of VR intervention in improving motor function, including upper extremity function, in children with hemiplegic CP. It is an engaging and entertaining intervention that adds an advantage of high compliance due to motivation. The current literature consists of studies with highly heterogeneous groups of participants and small sample sizes. Further investigation on children with a specific type of CP with advanced VR systems technology is warranted.
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Affiliation(s)
- Chanan Goyal
- Pediatric Physiotherapy, Datta Meghe Institute of Medical Sciences, Wardha, IND.,Pediatric Physiotherapy, Government Physiotherapy College, Raipur, IND
| | - Vishnu Vardhan
- Cardiorespiratory Physiotherapy, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Waqar Naqvi
- Community Physiotherapy, N.K.P. Salve Institute of Medical Sciences, Nagpur, IND
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Zhang Y, Li R, Miao X, Cheng LJ, Lau Y. Virtual motor training to improve the activities of daily living, hand grip, and gross motor function among children with cerebral palsy: Meta-regression analysis. Gait Posture 2022; 91:297-305. [PMID: 34798421 DOI: 10.1016/j.gaitpost.2021.10.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Given that cerebral palsy is a lifelong condition, continuous motor training is necessary to correct abnormal posture and patterns to improve functional performance. OBJECTIVE To explore the essential features of virtual motor training and identify its effects on the activities of daily living, hand grip function, and gross motor function among children with cerebral palsy. METHODS Ten databases were systematically searched for randomized controlled trials from inception until October 15, 2019. Studies with a randomized controlled trials design, children with cerebral palsy, comparisons of virtual motor training with other interventions, and activities of daily living, hand grip, and gross motor function outcomes were included. Subgroup analyses and meta-regression were performed. The effect size was assessed using random-effects meta-analysis and evaluated by using Hedges' g. Random effects univariate meta-regression model was used to examine the association of covariates with intervention effectiveness. RESULTS Seventeen randomized controlled trials with 853 participants were included. Meta-analysis indicated that the virtual motor training had significant positive effects on activities of daily living (g = 0.31, 95% confidence interval, CI = 0.10, 0.51), grip (g = 0.40, 95% CI = 0.08, 0.71), and gross motor (g = 0.71, 95% CI = 0.43, 0.99) function. Univariate random-effects meta-regression analysis indicated an increase in activities of daily living scores for motion capture systems that used depth imaging compared with those that used digital imaging. SIGNIFICANCE Our systematic review indicated that virtual motor function may significantly improve ADLs, hand grip, and gross motor functions among children with cerebral palsy.
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Affiliation(s)
- Yanran Zhang
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
| | - Runze Li
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
| | - Xiuxin Miao
- Associate Professor and Director, School of Nursing, Department of Medicine, Qingdao University, Qingdao, Shandong, China.
| | - Ling Jie Cheng
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Parmar ST, Kanitkar A, Sepehri N, Bhairannawar S, Szturm T. Computer Game-Based Telerehabilitation Platform Targeting Manual Dexterity: Exercise Is Fun. "You Are Kidding-Right?". SENSORS (BASEL, SWITZERLAND) 2021; 21:5766. [PMID: 34502656 PMCID: PMC8434447 DOI: 10.3390/s21175766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/12/2021] [Accepted: 08/20/2021] [Indexed: 11/24/2022]
Abstract
There is a need for innovation to improve the engagement and accessibility of rehabilitation programs for children and adults with upper extremity motor impairments due to neurodevelopmental disorders, acquired brain injuries, or spinal cord injuries. For this purpose, a computer game-based telerehabilitation platform (GTP) was developed to address this need. Through the application of a miniature inertial-based computer mouse and the wide variety of commercial computer games, the developed GTP can provide engaging task-specific exercises for the rehabilitation of manual dexterity (object handling and manipulation). A purpose-built repetitive task practice software (RTP) was also developed to gather event data and synchronize it with patient movements during gameplays. This provides automated monitoring and quantification of patients' motor skills, while they practice a range of game-based exercises with their hand and/or arm. The GTP would initially be used in a supervised clinical setting followed by a transition to function at home and be monitored by clinician specialists. Clinical support for home and rural communities, with protocols that can be easily updated, will help increase accessibility to targeted and personalized solutions for patients and achieve the desired training effect.
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Affiliation(s)
| | - Anuprita Kanitkar
- College of Rehabilitation Science, University of Manitoba, Winnipeg, MB R3T 5V6, Canada;
| | - Nariman Sepehri
- Department of Mechanical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB R3T 5V6, Canada;
| | - Satish Bhairannawar
- Department of Electronics and Communication Engineering, SDM College of Engineering and Technology, Dharwad 580009, Karnataka, India;
| | - Tony Szturm
- College of Rehabilitation Science, University of Manitoba, Winnipeg, MB R3T 5V6, Canada;
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Upper extremity rehabilitation using video games in cerebral palsy: a randomized clinical trial. Acta Neurol Belg 2021; 121:1053-1060. [PMID: 32524538 DOI: 10.1007/s13760-020-01400-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 06/02/2020] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The aim of the present study was to compare the effects of neurodevelopmental therapy (NDT)-based upper extremity rehabilitation and video game-based therapy (VGBT) using Nintendo® wii and leap motion controller (LMC) games on upper extremity function in patients with cerebral palsy (CP). The 30 patients included in the present study were randomized to two groups: VGBT group (VGBT using Nintendo® Wii and LMC games) and control group (NDT-based upper extremity rehabilitation). Both groups trained 3 days a week for 8 weeks. Manual dexterity was evaluated using the "Minnesota Manual Dexterity Test (MMDT)", functional ability using the "Childhood Health Assessment Questionnaire (CHAQ)" and the "Duruoz Hand Index (DEI)" and grip and pinch strengths using a dynamometer. Following treatment, significant changes were found, MMDT, grip and pinch strength, CHAQ, and DHI scores in both groups (p < 0.05); however, VGBT group was statistically superior to group II with respect to changes in MMDT (p < 0.05). VGBT using Nintendo®Wii and LMC games had slightly superior effects on manual dexterity in patients with CP while compared with NDT-based upper extremity rehabilitation. Futhermore, the effects of both treatment programs on grip strengths and functional ability were similar beneficial.
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Fandim JV, Saragiotto BT, Porfírio GJM, Santana RF. Effectiveness of virtual reality in children and young adults with cerebral palsy: a systematic review of randomized controlled trial. Braz J Phys Ther 2021; 25:369-386. [PMID: 33358737 PMCID: PMC8353293 DOI: 10.1016/j.bjpt.2020.11.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 07/06/2020] [Accepted: 11/17/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cerebral palsy (CP) is one of the main causes of disability in childhood. Virtual reality (VR) has been used as a treatment option in this population, however its effectiveness is unclear. OBJECTIVE To evaluate the effectiveness of VR in patients with CP. METHODS We conducted electronic searches in EMBASE, MEDLINE, Cochrane library, PEDro, AMED, PsycoINFO, and LILACS databases and trial site registries such as ClinicalTrials.gov and ICTRP. We included randomized controlled trials that tested the use of VR alone or in combination with other interventions compared to more conventional rehabilitation or usual care in individuals with CP. The primary outcomes were upper and lower limb function, postural control, and balance. The secondary outcomes included global motor function, perception, cognition and spatial functions, motivation, motor learning, and adverse events. Two independent reviewers extracted and assessed included articles for risk of bias using the Cochrane risk of bias tool. We use a meta-analysis with random effect model whenever possible. We analyzed the quality of evidence using theGRADE approach. RESULTS We included 38 trials (pooled n = 1233 participants) in this review. There is very low quality of evidence that VR plus conventional rehabilitation is better than conventional rehabilitation for upper limb function. There is also very low quality evidence that VR alone is no better than conventional rehabilitation for upper and lower limb function. No adverse events were observed among the 10 trials that provided information on this outcome. CONCLUSION At present we have very limited to limited confidence in effect estimation for utilization of VR in this population. Future studies may change our confidence in results and effect estimates. PROTOCOL REGISTRATION PROSPERO CRD 42018102759.
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Affiliation(s)
- Junior Vitorino Fandim
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil.
| | - Bruno Tirotti Saragiotto
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
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Kanitkar A, Parmar ST, Szturm TJ, Restall G, Rempel G, Naik N, Gaonkar N, Sepehri N, Ankolekar B. Reliability and validity of a computer game-based tool of upper extremity assessment for object manipulation tasks in children with cerebral palsy. J Rehabil Assist Technol Eng 2021; 8:20556683211014023. [PMID: 34123406 PMCID: PMC8175827 DOI: 10.1177/20556683211014023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 04/13/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction A computer game-based upper extremity (CUE) assessment tool is developed to quantify manual dexterity of children with Cerebral Palsy (CP). The purpose of this study was to determine test-retest reliability of the CUE performance measures (success rate, movement onset time, movement error, and movement variation) and convergent validity with the Peabody Developmental Motor Scale version 2 (PDMS-2) and the Quality of Upper Extremity Skills Test (QUEST). Methods Thirty-five children with CP aged four to ten years were tested on two occasions two weeks apart. Results CUE performance measures of five chosen object manipulation tasks exhibited high to moderate intra-class correlation coefficient (ICC) values. There was no significant difference in the CUE performance measures between test periods. With few exceptions, there was no significant correlation between the CUE performance measures and the PDMS-2 or the QUEST test scores. Conclusions The high to moderate ICC values and lack of systematic errors indicate that the CUE assessment tool has the ability to repeatedly record reliable performance measures of different object manipulation tasks. The lack of a correlation between the CUE and the PDMS-2 or QUEST scores indicates that performance measures of these assessment tools represent distinct attributes of manual dexterity.
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Affiliation(s)
- Anuprita Kanitkar
- Department of Applied Health Sciences, University of Manitoba, Winnipeg, Canada
- Anuprita Kanitkar, University of Manitoba 771 McDermot Avenue, Winnipeg, MB Manitoba R3E 0T6 Canada 204 789-3897.
| | - Sanjay T Parmar
- SDM College of Physiotherapy, Shri Dharamshala Manjunatheshwara University, Dharwad, India
| | - Tony J Szturm
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Gayle Restall
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Gina Rempel
- Pediatrics & Child Health, University of Manitoba, Winnipeg, Canada
| | - Nilashri Naik
- Department of Physiotherapy, Ushas School for Exceptional Children, Hubli, India
| | | | - Nariman Sepehri
- Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
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Kanitkar A, Parmar ST, Szturm TJ, Restall G, Rempel G, Sepehri N. Parents' Perspectives on a Computer Game-Assisted Rehabilitation Program for Manual Dexterity in Children With Cerebral Palsy: Qualitative Analysis of Expectations, Child Engagement, and Benefits. JMIR Rehabil Assist Technol 2021; 8:e24337. [PMID: 34057424 PMCID: PMC8204242 DOI: 10.2196/24337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/20/2020] [Accepted: 04/11/2021] [Indexed: 12/04/2022] Open
Abstract
Background Children with motor impairments affecting the upper extremity benefit from task-specific therapy, such as constraint-induced movement therapy. However, there is a need to improve engagement and compliance with task-specific exercise programs that target manual dexterity for children with cerebral palsy (CP). A computer game–based rehabilitation (GRP) platform was developed that combines fine manipulation and gross movement exercises with engaging game activities appropriate for young children with CP. Objective The objectives of this qualitative analysis were to compare parents’ perspectives and opinions about expectations, challenges, and benefits between 2 interventions. Methods A mixed methods, randomized controlled trial (RCT) was conducted to examine the feasibility and estimate the effect size of 2 exercise programs for rehabilitation of manual dexterity of children with CP using either GRP or conventional therapy. Parents of 26 of the children who completed the GRP program (n=33) and parents of 15 of the children who completed the conventional therapy program (n=27) participated in the interviews. A general conductive approach was used to analyze the data recorded during the parents’ interviews. Results Five themes captured the range of the parent’s experiences, viewpoints, and ideas: (1) parents’ expectations, (2) child’s engagement with therapy, (3) positive effects of the interventions, (4) challenges, and (5) improving the protocol. Conclusions Parents from both groups recognized that their expectations related to improving children’s object handling and manipulation skills including participation in activities of daily life were addressed during the 16-week therapy program. Parents perceived a change in the children’s level of independence in their daily tasks at home, school, and leisure activities. Trial Registration ClinicalTrials.gov NCT02728375; https://clinicaltrials.gov/ct2/show/NCT02728375
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Affiliation(s)
| | | | | | | | - Gina Rempel
- University of Manitoba, Winnipeg, MB, Canada
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Viana RB, de Oliveira VN, Dankel SJ, Loenneke JP, Abe T, da Silva WF, Morais NS, Vancini RL, Andrade MS, de Lira CAB. The effects of exergames on muscle strength: A systematic review and meta-analysis. Scand J Med Sci Sports 2021; 31:1592-1611. [PMID: 33797115 DOI: 10.1111/sms.13964] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 12/17/2022]
Abstract
This systematic review and meta-analysis examined studies on the chronic effects of exergames on muscle strength in humans. PubMed, Scopus, CENTRAL, Web of Science, SciELO, Biblioteca Virtual em Saúde, and Google Scholar were searched, and manual searches of the reference lists of included studies and hand-searches on Physiotherapy Evidence Database and ResearchGate were conducted from inception to August 10, 2020. Randomized and non-randomized exergame intervention studies with or without a non-exercise group and/or a "usual care intervention group" (any other intervention that did not incorporate exergames), which evaluated muscle strength through direct measurements, were included. Forty-seven and 25 studies were included in the qualitative review and meta-analysis, respectively. The between-groups meta-analyses showed no significant differences between exergames and non-exercise control groups for handgrip strength in heathy/unhealthy middle-aged/older adults or knee extension maximum voluntary isometric contraction (MVIC) in healthy older adults. However, exergames provided a greater increase in handgrip strength, knee flexion MVIC, and elbow extension MVIC, but not knee extension MVIC or elbow flexion MVIC, in individuals with different health statuses when compared to usual care interventions. Also, there was a greater increase in handgrip strength in children with hemiplegic cerebral palsy favouring usual care plus exergames compared to usual care interventions. These results suggest that exergames may improve upper and lower limb muscle strength in individuals with different heath statuses compared to usual care interventions, but not muscle strength in middle age/older adults after accounting for random error. Also, exergames appear to be a useful tool for improving handgrip strength in children with hemiplegic cerebral palsy when added to usual care. However, as the exergame interventions were applied in different populations and there currently are many different approaches to perform exergames, future randomized controlled trials with high methodological quality and large sample sizes are needed to provide more compelling evidence in favour of a specific exergame protocol, or to elucidate exergame protocol design principles that appear to strongly influence outcomes.
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Affiliation(s)
- Ricardo Borges Viana
- Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
| | | | - Scott J Dankel
- Department of Health and Exercise Science, Rowan University, Glassboro, NJ, USA
| | - Jeremy P Loenneke
- Kevser Ermin Applied Physiology Laboratory, University of Mississippi, University, MS, USA
| | - Takashi Abe
- Kevser Ermin Applied Physiology Laboratory, University of Mississippi, University, MS, USA
| | | | - Naiane Silva Morais
- Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
| | - Rodrigo Luiz Vancini
- Centro de Educação Física e Desportos, Universidade Federal do Espírito Santo, Vitória, Brazil
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Pimentel-Ponce M, Romero-Galisteo RP, Palomo-Carrión R, Pinero-Pinto E, Merchán-Baeza JA, Ruiz-Muñoz M, Oliver-Pece J, González-Sánchez M. Gamification and neurological motor rehabilitation in children and adolescents: A systematic review. Neurologia 2021; 39:S0213-4853(21)00049-9. [PMID: 33867183 DOI: 10.1016/j.nrl.2021.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/30/2020] [Accepted: 02/07/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Gamification consists of the use of games in non-playful contexts. It is widely employed in the motor rehabilitation of neurological diseases, but mainly in adult patients. The objective of this review was to describe the use of gamification in the rehabilitation of children and adolescents with neuromotor impairment. METHODS We performed a systematic review of clinical trials published to date on the MEDLINE (PubMed), Scielo, SCOPUS, Dialnet, CINAHL, and PEDro databases, following the PRISMA protocol. The methodological quality of the studies identified was assessed using the PEDro scale. RESULTS From a total of 469 studies, 10 clinical trials met the inclusion criteria. We analysed the gamification systems used as part of the rehabilitation treatment of different neuromotor conditions in children and adolescents. Cerebral palsy was the most frequently studied condition (6studies), followed by developmental coordination disorder (3), and neurological impairment of balance and coordination (1). CONCLUSION The use of gamification in rehabilitation is helpful in the conventional treatment of neuromotor disorders in children and adolescents, with increased motivation and therapeutic adherence being the benefits with the greatest consensus among authors. While strength, balance, functional status, and coordination also appear to improve, future research should aim to determine an optimal dosage.
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Affiliation(s)
| | - R P Romero-Galisteo
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España.
| | - R Palomo-Carrión
- Departamento de Enfermería, Fisioterapia y Terapia Ocupacional, Facultad de Fisioterapia, Universidad de Castilla la Mancha, Toledo, España
| | - E Pinero-Pinto
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, España
| | - J A Merchán-Baeza
- Grupo de investigación Methodlogy, Methods, Models and Outcomes of Health and Social Sciences (M30), Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic-Universidad Central de Cataluña (UVIC-UCC), Vic, Barcelona, España
| | - M Ruiz-Muñoz
- Departamento de Enfermería y Podología, Facultad de Ciencias de la Salud, Universidad de Málaga. Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España
| | - J Oliver-Pece
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología, Universidad de Málaga, Málaga, España
| | - M González-Sánchez
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga. Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España
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Cortés-Pérez I, Zagalaz-Anula N, Montoro-Cárdenas D, Lomas-Vega R, Obrero-Gaitán E, Osuna-Pérez MC. Leap Motion Controller Video Game-Based Therapy for Upper Extremity Motor Recovery in Patients with Central Nervous System Diseases. A Systematic Review with Meta-Analysis. SENSORS (BASEL, SWITZERLAND) 2021; 21:2065. [PMID: 33804247 PMCID: PMC7999275 DOI: 10.3390/s21062065] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 12/11/2022]
Abstract
Leap Motion Controller (LMC) is a virtual reality device that can be used in the rehabilitation of central nervous system disease (CNSD) motor impairments. This review aimed to evaluate the effect of video game-based therapy with LMC on the recovery of upper extremity (UE) motor function in patients with CNSD. A systematic review with meta-analysis was performed in PubMed Medline, Web of Science, Scopus, CINAHL, and PEDro. We included five randomized controlled trials (RCTs) of patients with CNSD in which LMC was used as experimental therapy compared to conventional therapy (CT) to restore UE motor function. Pooled effects were estimated with Cohen's standardized mean difference (SMD) and its 95% confidence interval (95% CI). At first, in patients with stroke, LMC showed low-quality evidence of a large effect on UE mobility (SMD = 0.96; 95% CI = 0.47, 1.45). In combination with CT, LMC showed very low-quality evidence of a large effect on UE mobility (SMD = 1.34; 95% CI = 0.49, 2.19) and the UE mobility-oriented task (SMD = 1.26; 95% CI = 0.42, 2.10). Second, in patients with non-acute CNSD (cerebral palsy, multiple sclerosis, and Parkinson's disease), LMC showed low-quality evidence of a medium effect on grip strength (GS) (SMD = 0.47; 95% CI = 0.03, 0.90) and on gross motor dexterity (GMD) (SMD = 0.73; 95% CI = 0.28, 1.17) in the most affected UE. In combination with CT, LMC showed very low-quality evidence of a high effect in the most affected UE on GMD (SMD = 0.80; 95% CI = 0.06, 1.15) and fine motor dexterity (FMD) (SMD = 0.82; 95% CI = 0.07, 1.57). In stroke, LMC improved UE mobility and UE mobility-oriented tasks, and in non-acute CNSD, LMC improved the GS and GMD of the most affected UE and FMD when it was used with CT.
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Affiliation(s)
- Irene Cortés-Pérez
- Centro Médico “Avenida II”, C/Julio Burell 18, 23700 Linares, Spain;
- Department of Health Sciences, University of Jaén, Paraje Las Lagunillas s/n, 23071 Jaén, Spain; (N.Z.-A.); (D.M.-C.); (R.L.-V.); (M.C.O.-P.)
| | - Noelia Zagalaz-Anula
- Department of Health Sciences, University of Jaén, Paraje Las Lagunillas s/n, 23071 Jaén, Spain; (N.Z.-A.); (D.M.-C.); (R.L.-V.); (M.C.O.-P.)
| | - Desirée Montoro-Cárdenas
- Department of Health Sciences, University of Jaén, Paraje Las Lagunillas s/n, 23071 Jaén, Spain; (N.Z.-A.); (D.M.-C.); (R.L.-V.); (M.C.O.-P.)
| | - Rafael Lomas-Vega
- Department of Health Sciences, University of Jaén, Paraje Las Lagunillas s/n, 23071 Jaén, Spain; (N.Z.-A.); (D.M.-C.); (R.L.-V.); (M.C.O.-P.)
| | - Esteban Obrero-Gaitán
- Department of Health Sciences, University of Jaén, Paraje Las Lagunillas s/n, 23071 Jaén, Spain; (N.Z.-A.); (D.M.-C.); (R.L.-V.); (M.C.O.-P.)
| | - María Catalina Osuna-Pérez
- Department of Health Sciences, University of Jaén, Paraje Las Lagunillas s/n, 23071 Jaén, Spain; (N.Z.-A.); (D.M.-C.); (R.L.-V.); (M.C.O.-P.)
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Immersive Virtual Environments and Wearable Haptic Devices in rehabilitation of children with neuromotor impairments: a single-blind randomized controlled crossover pilot study. J Neuroeng Rehabil 2020; 17:144. [PMID: 33115487 PMCID: PMC7594483 DOI: 10.1186/s12984-020-00771-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 10/12/2020] [Indexed: 11/21/2022] Open
Abstract
Background The past decade has seen the emergence of rehabilitation treatments using virtual reality. One of the advantages in using this technology is the potential to create positive motivation, by means of engaging environments and tasks shaped in the form of serious games. The aim of this study is to determine the efficacy of immersive Virtual Environments and weaRable hAptic devices (VERA) for rehabilitation of upper limb in children with Cerebral Palsy (CP) and Developmental Dyspraxia (DD). Methods A two period cross-over design was adopted for determining the differences between the proposed therapy and a conventional treatment. Eight children were randomized into two groups: one group received the VERA treatment in the first period and the manual therapy in the second period, and viceversa for the other group. Children were assessed at the beginning and the end of each period through both the Nine Hole Peg Test (9-HPT, primary outcome) and Kinesiological Measurements obtained during the performing of similar tasks in a real setting scenario (secondary outcomes). Results All subjects, not depending from which group they come from, significantly improved in both the performance of the 9-HPT and in the parameters of the kinesiological measurements (movement error and smoothness). No statistically significant differences have been found between the two groups. Conclusions These findings suggest that immersive VE and wearable haptic devices is a viable alternative to conventional therapy for improving upper extremity function in children with neuromotor impairments. Trial registration ClinicalTrials, NCT03353623. Registered 27 November 2017-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03353623
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Beckers LWME, Geijen MME, Kleijnen J, A A Rameckers E, L A P Schnackers M, J E M Smeets R, Janssen-Potten YJM. Feasibility and effectiveness of home-based therapy programmes for children with cerebral palsy: a systematic review. BMJ Open 2020; 10:e035454. [PMID: 33028544 PMCID: PMC7539606 DOI: 10.1136/bmjopen-2019-035454] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To assess the feasibility and effectiveness of home-based occupational therapy and physiotherapy programmes in children with cerebral palsy (CP), focusing on the upper extremity and reporting on child-related and/or parent-related outcomes. DESIGN Systematic review. DATA SOURCES Electronic searches were performed in MEDLINE, EMBASE, CINAHL, PsycINFO, OTseeker and PEDro, and in ICTRP and CENTRAL trial registers, from inception to 6 June 2019. ELIGIBLE CRITERIA The review included all types of original studies concerning feasibility or effectiveness of home-based therapy in children aged <18 years with any type of CP. No language, publication status or publication date restrictions were applied. DATA EXTRACTION AND SYNTHESIS Study and intervention characteristics and the demographics of participating children and their parents were extracted. Feasibility was assessed by outcomes related to acceptability, demand, implementation, practicality, adaptation, expansion or integration. Regarding effectiveness, child-related outcome measures related to any level of the International Classification of Functioning, Disability and Health, or parent-related outcomes were investigated. Two authors independently extracted the data. Risk of bias was assessed using the Downs and Black checklist and the Joanna Briggs Institute Critical Appraisal Checklist. RESULTS The search resulted in a total of 92 records: 61 studies and 31 conference abstracts. Feasibility studies reported mainly on acceptability and implementation. Overall compliance to home-based training programmes (implementation) was moderate to high, ranging from 56% to 99%. In the effectiveness studies, >40 different child-related outcome measures were found. Overall, an improvement in arm-hand performance within group across time was shown. Only two studies reported on a parent-related outcome measure. No increase in parental stress was found during the intervention. CONCLUSIONS Based on the results of the included studies, home-based training programmes seem to be feasible. However, conclusions about the effectiveness of home programmes cannot be made due to the large variability in the study, patient and intervention characteristics, comparators, and outcome measures used in the included studies. PROSPERO REGISTRATION NUMBER CRD42016043743.
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Affiliation(s)
- Laura W M E Beckers
- Department of Rehabilitation Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Limburg, The Netherlands
- Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, Limburg, The Netherlands
| | - Mellanie M E Geijen
- Department of Rehabilitation Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Limburg, The Netherlands
| | | | - Eugene A A Rameckers
- Department of Rehabilitation Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Limburg, The Netherlands
- Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, Limburg, The Netherlands
- University for Professionals for Pediatric Physical Therapy, AVANSpluc, Breda, The Netherlands
- Faculty of Rehabilitation Science, Pediatric Rehabilitation, Hasselt University, Hasselt, Belgium
| | - Marlous L A P Schnackers
- Behavioral Science Institute, Radboud Universiteit, Nijmegen, Gelderland, The Netherlands
- Department of Rehabilitation, Donders Centre for Brain, Cognition, and Behavior, Radboud University Medical Centre, Nijmegen, Gelderland, The Netherlands
| | - Rob J E M Smeets
- Department of Rehabilitation Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Limburg, The Netherlands
- CIR revalidatie, Eindhoven, Brabant, The Netherlands
| | - Yvonne J M Janssen-Potten
- Department of Rehabilitation Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Limburg, The Netherlands
- Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, Limburg, The Netherlands
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Radwan NL, Ibrahim MM, Mahmoud WS. Effect of Wii-habilitation on spatiotemporal parameters and upper limb function post-burn in children. Burns 2020; 47:828-837. [PMID: 33092897 DOI: 10.1016/j.burns.2020.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/07/2020] [Accepted: 09/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Limb burns can cause different functional disorders that greatly impact one's quality of life. AIM The purpose of the current study was to compare the effect of Nintendo Wii sports intervention, and traditional treatment methods on spatiotemporal parameters and upper limb function post-burn in children. METHODS Thirty children their age ranging from 7-12 years, with dominant side upper limb burn participated in the study.Vicon3-D motion analysis system and Jebsen hand function test were used to evaluate spatiotemporal parameters (movement duration, peak velocity, and time to peak velocity percentage in three functional tasks) and upper limb function respectively. The children were randomly divided into study and control groups. The study group was rehabilitated with Wii training in addition to traditional therapy, while the control group rehabilitated only with the traditional therapy program. For the study group, the games selected were Wii Bowling, Baseball, and Tennis. Both groups were trained for 60 min daily, three times/week for six weeks. The outcomes were measured pre and post the treatment period. RESULTS The whole-time duration and peak velocity improved significantly in the study group across the hand to head task (p = 0.001, p < 0.001, respectively), hand to mouth (p = 0.001), and hand to shoulder (p < 0.001, p = 0.0018, respectively) compared with the control group. The time to peak velocity percentage was enhanced significantly in the study group (p < 0.001) than the control group in all three-measured tasks. Moreover, the Jebsen hand function test improved significantly (p < 0.001) in the study group than in the control group. CONCLUSION Wii-habilitation could be advised as an effective tool in the rehabilitation program of children with post-burn injuries.
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Affiliation(s)
- Nadia L Radwan
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Egypt; Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Kingdom of Saudi Arabia.
| | - Marwa M Ibrahim
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Egypt; Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Kingdom of Saudi Arabia
| | - Waleed S Mahmoud
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Kingdom of Saudi Arabia; Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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MacIntosh A, Desailly E, Vignais N, Vigneron V, Biddiss E. A biofeedback-enhanced therapeutic exercise video game intervention for young people with cerebral palsy: A randomized single-case experimental design feasibility study. PLoS One 2020; 15:e0234767. [PMID: 32569284 PMCID: PMC7307764 DOI: 10.1371/journal.pone.0234767] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 06/01/2020] [Indexed: 11/18/2022] Open
Abstract
Importance/Background Movement-controlled video games have potential to promote home-based practice of therapy activities. The success of therapy gaming interventions depends on the quality of the technology used and the presence of effective support structures. Aim This study assesses the feasibility of a novel intervention that combines a co-created gaming technology integrating evidence-based biofeedback and solution-focused coaching (SFC) strategies to support therapy engagement and efficacy at home. Methods Following feasibility and single-case reporting standards (CONSORT and SCRIBE), this was a non-blind, randomized, multiple-baseline, AB, design. Nineteen (19) young people with cerebral palsy (8–18 years old) completed the 4-week home-based intervention in France and Canada. Participant motivations, personalized practice goals, and relevance of the intervention to daily activities were discussed in a Solution Focused Coaching-style conversation pre-, post-intervention and during weekly check-ins. Participants controlled a video game by completing therapeutic gestures (wrist extension, pinching) detected via electromyography and inertial sensors on the forearm (Myo Armband and custom software). Process feasibility success criteria for recruitment response, completion and adherence rates, and frequency of technical issues were established a priori. Scientific feasibility, effect size estimates and variance were determined for Body Function outcome measures: active wrist extension, grip strength and Box and Blocks Test; and for Activities and Participation measures: Assisting Hand Assessment (AHA), Canadian Occupational Performance Measure (COPM) and Self-Reported Experiences of Activity Settings (SEAS). Results Recruitment response (31%) and assessment completion (84%) rates were good and 74% of participants reached self-identified practice goals. As 17% of technical issues required external support to resolve, the intervention was graded as feasible with modifications. No adverse events were reported. Moderate effects were observed in Body Function measures (active wrist extension: SMD = 1.82, 95%CI = 0.85–2.78; Grip Strength: SMD = 0.63, 95%CI = 0.65–1.91; Box and Blocks: Hedge’s g = 0.58, 95%CI = -0.11–1.27) and small-moderate effects in Activities and Participation measures (AHA: Hedge’s g = 0.29, 95%CI = -0.39–0.97, COPM: r = 0.60, 95%CI = 0.13–0.82, SEAS: r = 0.24, 95%CI = -0.25–0.61). Conclusion A definitive RCT to investigate the effectiveness of this novel intervention is warranted. Combining SFC-style coaching with high-quality biofeedback may positively engage youth in home rehabilitation to complement traditional therapy. Trial registration ClinicalTrials.gov, U.S. National Library of Medicine: NCT03677193.
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Affiliation(s)
- Alexander MacIntosh
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada.,Complexité, Innovation, Activités Motrices et Sportives, Sciences du Sport, de la Motricité et du Mouvement Humain, Université Paris-Saclay, Orsay, France
| | - Eric Desailly
- Recherche et innovation, Fondation Ellen Poidatz, Saint Fargeau-Ponthierry, France
| | - Nicolas Vignais
- Complexité, Innovation, Activités Motrices et Sportives, Sciences du Sport, de la Motricité et du Mouvement Humain, Université Paris-Saclay, Orsay, France.,Complexité, Innovation, Activités Motrices et Sportives, Université d'Orléans, Orléans, France
| | - Vincent Vigneron
- Informatique, Bio-informatique et Systèmes Complexes, l'Université d'Evry Val-d'Essonne, Evry, France
| | - Elaine Biddiss
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
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Fu MJ, Curby A, Suder R, Katholi B, Knutson JS. Home-Based Functional Electrical Stimulation-Assisted Hand Therapy Video Games for Children With Hemiplegia: Development and Proof-of-Concept. IEEE Trans Neural Syst Rehabil Eng 2020; 28:1461-1470. [PMID: 32396095 PMCID: PMC7364443 DOI: 10.1109/tnsre.2020.2992036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We describe the development and three case reports of a home-based intervention for children with hand hemiplegia that integrates custom video games with contralaterally controlled functional electrical stimulation (CCFES). With CCFES, stimulated opening of the more-affected hand is modulated by volitional opening of the less-affected hand. Video games that solicit goal-oriented, skill-requiring movement have shown promise for treating hemiplegia, but they have not previously been combined with electrical stimulation in children. Three children ages 8, 9, and 11 with moderate-to-severe hand hemiplegia were assigned six weeks of therapy in lab and at home. The goal was to determine if children could tolerate 9 lab treatment sessions and administer up to 7.5 hrs/wk of CCFES video game therapy at home. The feasibility of this intervention for home use was assessed by device logs, end-of-treatment interviews, and motor function/impairment assessments. With caregiver help, the children were all able to attend 9 lab sessions and built up to 7.5 hrs/wk of therapy by week 3. They averaged 5-7 hrs/wk of home intervention overall. Motor outcomes improved for all three participants at treatment end, but mostly regressed at 4-weeks follow-up. Individual improvements at treatment end exceeded minimum detectable or clinically important thresholds for Assisting Hands Assessment, Fugl-Meyer Assessment, and Melbourne Motor Assessment 2. We found preliminary indications that CCFES-integrated video game therapy can provide a high dose of hand motor control therapy at home and in the lab. Improvements in motor outcomes were also observed, but more development and study is needed.
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Bostanci H, Emir A, Tarakci D, Tarakci E. Video game-based therapy for the non-dominant hand improves manual skills and grip strength. HAND SURGERY & REHABILITATION 2020; 39:265-269. [PMID: 32247654 DOI: 10.1016/j.hansur.2020.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/13/2020] [Accepted: 02/20/2020] [Indexed: 12/28/2022]
Abstract
The study was designed to investigate the effect of virtual reality-supported training on manual skills and grip strength in the non-dominant hand in healthy participants. Thirty participants were randomized into two groups: ErgoActive group (n=15) and control group (n=15). The ErgoActive study group received 8 weeks of training with leap motion controller-based virtual reality games. The training was done 1 day per week for 30min. The participants' hand function was evaluated using the Jebsen Taylor Hand Function Test (JTHFT), while grip strength was evaluated with a Jamar Hand Dynamometer and Pinchmeter. After 8 weeks, the ErgoActive and control groups had significantly different JTHFT, Jamar and Pinchmeter results (P<0.05). When leap motion controller-based virtual reality applications are used, healthy subjects have increased manual skills and grip strength in their non-dominant hand. These virtual reality games are an effective and fun way of improving patients' hand functions.
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Affiliation(s)
- H Bostanci
- Division of Ergotherapy, Faculty of Health Sciences, Istanbul Medipol University, Kavacik, Ekinciler Cd. No: 19, 34810 Istanbul, Beykoz, Turkey.
| | - A Emir
- Division of Ergotherapy, Faculty of Health Sciences, Istanbul Medipol University, Kavacik, Ekinciler Cd. No: 19, 34810 Istanbul, Beykoz, Turkey
| | - D Tarakci
- Division of Ergotherapy, Faculty of Health Sciences, Istanbul Medipol University, Kavacik, Ekinciler Cd. No: 19, 34810 Istanbul, Beykoz, Turkey
| | - E Tarakci
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Zuhuratbaba, Doktor Tevfik Sağlam Cd. No. 25, 34147 Istanbul, Bakirköy, Turkey
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Rathinam C, Mohan V, Peirson J, Skinner J, Nethaji KS, Kuhn I. Effectiveness of virtual reality in the treatment of hand function in children with cerebral palsy: A systematic review. J Hand Ther 2020; 32:426-434.e1. [PMID: 30017414 DOI: 10.1016/j.jht.2018.01.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 12/08/2017] [Accepted: 01/14/2018] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Systematic review. INTRODUCTION Children with cerebral palsy (CP) may have limited use of their hands for functional activities and for fine motor skills. Virtual reality (VR) is a relatively new and innovative approach to facilitate hand function in children with CP. PURPOSE OF THE STUDY The primary purpose of this study was to determine the effectiveness of VR as an intervention to improve hand function in children with CP compared to either conventional physiotherapy or other therapeutic interventions. The secondary purpose was to classify the outcomes evaluated according to the International Classification of Functioning, Disability and Health (ICF) dimensions. METHODS A International prospective register of systematic reviews (PROSPERO)-registered literature search was carried out in August 2015 in MEDLINE, CINAHL, ERIC, HealthSTAR, AMED, BNI, Embase, PsycINFO, PEDro, Cochrane Central Register, DARE, OTSeeker, REHABDATA, HaPI, CIRRIE, and Scopus. PRISMA guidelines were followed. Only randomized controlled trials (RCTs) were included, and their methodological qualities were examined using the Cochrane collaboration's risk of bias (RoB) tool. A narrative synthesis was performed. RESULTS The 6 RCTs published on this topic provide conflicting results. Four studies reported improved hand function (2 low RoB, 1 high RoB, and 1 unclear RoB), whereas 2 studies reported no improvement. All of the RCTs reported the activity element of ICF, but no study explicitly described the effect of VR intervention based on the ICF model. CONCLUSION The role of VR ti imrpove hand fucntion in children with CP is unclear due to limited evidence; use as an adjunct has some support.
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Affiliation(s)
| | - Vikram Mohan
- Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
| | | | - Jane Skinner
- Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Isla Kuhn
- University of Cambridge Medical Library, University of Cambridge School of Clinical Medicine, Cambridge, UK
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Poteshkin A, Talamova I. Differentiated methodology of coordinating abilities upbringing in children with infantile cerebral paralysis. BIO WEB OF CONFERENCES 2020. [DOI: 10.1051/bioconf/20202600012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In the article the authors give the example of own created methodology of coordinating abilities estimation and upbringing in children with spastic diplegia and hemiparetic forms of infantile cerebral paralysis at the age of 11-12 of the Ist level of functional abilities according to Gross Motor Function Classification Systems. The peculiarity of the methodology is its universal character: the created methodology of estimation helps to estimate within a short time period and in terms of free space deficiency estimate coordinating abilities development. According to the development results estimation of a girl with a hemiparetic form of infantile cerebral paralysis we see the best indices of coordinating abilities development in comparison with the girls with spastic diplegia and the boys of both forms. For coordinating abilities upbringing the authors offer the methodology. It includes two blocks: the 1st block- classical physical exercises; the second block- exercises at stable platform. The authors offer the algorithm of coordinating abilities estimation and upbringing in children with spastic diplegia and hemiparetic forms of infantile cerebral paralysis at the age of 11-12.
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The Rehabilitative Effects of Virtual Reality Games on Balance Performance among Children with Cerebral Palsy: A Meta-Analysis of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214161. [PMID: 31661938 PMCID: PMC6861947 DOI: 10.3390/ijerph16214161] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 02/02/2023]
Abstract
This research aims to evaluate the effect of virtual reality (VR) games on balance recovery of children with cerebral palsy (CP) by quantitatively synthesizing the existing literature, and to further determine the impact of VR game intervention (the duration of each intervention, intervention frequency, intervention cycle, and total intervention time) on the balance recovery of children with CP. To this end, relevant literature up until 3 August 2019 was retrieved from Chinese databases (CNKI and Wanfang Data) and the databases in other languages (Web of Science, Pubmed, EBSCOhost, Informit, Scopus, Science Direct, and ProQuest), and bias analysis was conducted with the PEDro scale in this research. Randomized controlled trials (RCTs) were selected and underwent meta-analysis, and combined effect size was calculated with a random effects model. The results showed that VR games may improve the balance of children with CP (Hedge’s g = 0.29; 95% CI 0.10–0.48), and no significant influence of the intervention on balance of children with CP was shown in the subgroup analysis. In conclusion, VR games played a positive role in the improvement of balance of children with CP, but these results should be viewed with caution owing to current methodological defects (difference in measurement, heterogeneity of control groups, intervention combined with other treatments, etc.).
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Ren Z, Wu J. The Effect of Virtual Reality Games on the Gross Motor Skills of Children with Cerebral Palsy: A Meta-Analysis of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203885. [PMID: 31614990 PMCID: PMC6843701 DOI: 10.3390/ijerph16203885] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/05/2019] [Accepted: 10/12/2019] [Indexed: 12/24/2022]
Abstract
This review aimed to systematically evaluate the rehabilitatitive effect of Virtual Reality Games (VRGs) for gross motor skills of children with cerebral palsy (CP), and to give scientific grounds for the formulation of rehabilitation therapy for these children. To this end, the literature in Chinese databases (CNKI and Wanfang Data) as well as the databases of other countries (Web of Science, PubMed, EBSCOhost, Informit, Scopus, Science Direct and ProQuest) from the establishment dates of these databases to June 3rd 2019 was retrieved in order to collect randomized controlled trials with regard to the intervention effect of VRGs and traditional therapy on gross motor skills of children with CP, and the literature was screened as per inclusion and exclusion criteria. The PEDro scale was then used to evaluate the methodological quality of the included literature, and the software Review Manager 5.3 was employed to analyze the combined effect size. As a result, 7 randomized controlled trials and 234 children with CP were included. Meta-analysis showed that VRGs could improve gross motor skills of children with CP. Combined effect size of gross motor skills SMD = 0.37 [95% CI = (0.06, 0.68), p = 0.02)]. In conclusion, the VRG intervention program can enhance gross motor skills of children with CP to some extent. In view of the limitations regarding methodologies and the quality and quantity of the literature in this research, more quality randomized controlled trials are needed so as to draw convincing conclusions of effect of VRG intervention on gross motor skill development of children with CP in future studies.
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Affiliation(s)
- Zhanbing Ren
- Department of Physical Education, Shenzhen University, Shenzhen 518061, China.
| | - Jinlong Wu
- Department of Physical Education, Shenzhen University, Shenzhen 518061, China.
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Novak I, Honan I. Effectiveness of paediatric occupational therapy for children with disabilities: A systematic review. Aust Occup Ther J 2019; 66:258-273. [PMID: 30968419 PMCID: PMC6850210 DOI: 10.1111/1440-1630.12573] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2019] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Paediatric occupational therapy seeks to improve children's engagement and participation in life roles. A wide variety of intervention approaches exist. Our aim was to summarise the best-available intervention evidence for children with disabilities, to assist families and therapists choose effective care. METHODS We conducted a systematic review (SR) using the Cochrane methodology, and reported findings according to PRISMA. CINAHL, Cochrane Library, MEDLINE, OTSeeker, PEDro, PsycINFO were searched. Two independent reviewers: (i) determined whether studies met inclusion: SR or randomised controlled trial (RCT); an occupational therapy intervention for children with a disability; (ii) categorised interventions based on name, core components and diagnostic population; (iii) rated quality of evidence and determined the strength of recommendation using GRADE criteria; and (iv) made recommendations using the Evidence Alert Traffic Light System. RESULTS 129 articles met inclusion (n = 75 (58%) SRs; n = 54 (42%)) RCTs, measuring the effectiveness of 52 interventions, across 22 diagnoses, enabling analysis of 135 intervention indications. Thirty percent of the indications assessed (n = 40/135) were graded 'do it' (Green Go); 56% (75/135) 'probably do it' (Yellow Measure); 10% (n = 14/135) 'probably don't do it' (Yellow Measure); and 4% (n = 6/135) 'don't do it' (Red Stop). Green lights were: Behavioural Interventions; Bimanual; Coaching; Cognitive Cog-Fun & CAPS; CO-OP; CIMT; CIMT plus Bimanual; Context-Focused; Ditto; Early Intervention (ABA, Developmental Care); Family Centred Care; Feeding interventions; Goal Directed Training; Handwriting Task-Specific Practice; Home Programs; Joint Attention; Mental Health Interventions; occupational therapy after toxin; Kinesiotape; Pain Management; Parent Education; PECS; Positioning; Pressure Care; Social Skills Training; Treadmill Training and Weight Loss 'Mighty Moves'. CONCLUSION Evidence supports 40 intervention indications, with the greatest number at the activities-level of the International Classification of Function. Yellow light interventions should be accompanied by a sensitive outcome measure to monitor progress and red light interventions could be discontinued because effective alternatives existed.
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Affiliation(s)
- Iona Novak
- Cerebral Palsy AllianceDiscipline of Child and Adolescent HealthThe University of SydneyCamperdownNorth South WalesAustralia
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Biddiss E, Chan-Viquez D, Cheung ST, King G. Engaging children with cerebral palsy in interactive computer play-based motor therapies: theoretical perspectives. Disabil Rehabil 2019; 43:133-147. [PMID: 31104517 DOI: 10.1080/09638288.2019.1613681] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To provide a theoretically grounded understanding of engagement in interactive computer play-based motor therapies by children with cerebral palsy in home settings. METHODS A motivational framework for engagement and its relationship with three contemporary theories (self-determination theory, expectancy-value theory, social cognitive theory of self-regulation) was overviewed. A scoping review was conducted to understand how engagement is influenced by features of the technology and intervention design that impact intrinsic and extrinsic motivation, child and parent values and expectancies, and the processes of self-regulation. Multiple reviewers screened and extracted data from 26 articles describing home-based clinical trials of interactive computer play-based motor interventions for children with cerebral palsy. A narrative synthesis framework was used for analysis. RESULTS Features of the technology and the intervention influence feelings of autonomy (e.g., personalization), competence (e.g., calibration), and relatedness (e.g., social play, virtual therapist/coach). There may be multiple and differently valued goals in interactive computer play-based interventions (e.g., game- and therapy-focused) that, if disconnected or unmet, negatively impact engagement. Multiplayer interactions, real-time feedback and progress tracking provide information that influences self-regulation and engagement over time. CONCLUSIONS Optimizing engagement in interactive computer play-based motor interventions requires closer alignment with client-led values/goals; design of technologies and interventions that sustain intrinsic motivation; and feedback that informs/builds self-efficacy. Implications for rehabilitation The decision to prescribe an interactive computer play-based motor intervention should be guided by client-led goals and an informed understanding of the capacity of the interactive computer play-based intervention to meet individual client values/expectancies. Sustaining intrinsic motivation in interactive computer play-based motor therapies is greatly influenced by features of the technology (e.g., calibration, feedback, personalization) and the intervention (e.g., interactions with therapists, social play). Increased effort should be directed towards ensuring that interactive computer play-based interventions and technologies reward and reinforce efforts towards therapy goals.
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Affiliation(s)
- Elaine Biddiss
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Daniela Chan-Viquez
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Stephanie T Cheung
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Gillian King
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
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Hoare BJ, Wallen MA, Thorley MN, Jackman ML, Carey LM, Imms C. Constraint-induced movement therapy in children with unilateral cerebral palsy. Cochrane Database Syst Rev 2019; 4:CD004149. [PMID: 30932166 PMCID: PMC6442500 DOI: 10.1002/14651858.cd004149.pub3] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Unilateral cerebral palsy (CP) is a condition that affects muscle control and function on one side of the body. Children with unilateral CP experience difficulties using their hands together secondary to disturbances that occur in the developing fetal or infant brain. Often, the more affected limb is disregarded. Constraint-induced movement therapy (CIMT) aims to increase use of the more affected upper limb and improve bimanual performance. CIMT is based on two principles: restraining the use of the less affected limb (for example, using a splint, mitt or sling) and intensive therapeutic practice of the more affected limb. OBJECTIVES To evaluate the effect of constraint-induced movement therapy (CIMT) in the treatment of the more affected upper limb in children with unilateral CP. SEARCH METHODS In March 2018 we searched CENTRAL, MEDLINE, Embase, CINAHL, PEDro, OTseeker, five other databases and three trials registers. We also ran citation searches, checked reference lists, contacted experts, handsearched key journals and searched using Google Scholar. SELECTION CRITERIA Randomised controlled trials (RCTs), cluster-RCTs or clinically controlled trials implemented with children with unilateral CP, aged between 0 and 19 years, where CIMT was compared with a different form of CIMT, or a low dose, high-dose or dose-matched alternative form of upper-limb intervention such as bimanual intervention. Primarily, outcomes were bimanual performance, unimanual capacity and manual ability. Secondary outcomes included measures of self-care, body function, participation and quality of life. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts to eliminate ineligible studies. Five review authors were paired to extract data and assess risk of bias in each included study. GRADE assessments were undertaken by two review authors. MAIN RESULTS We included 36 trials (1264 participants), published between 2004 and 2018. Sample sizes ranged from 11 to 105 (mean 35). Mean age was 5.96 years (standard deviation (SD) 1.82), range three months to 19.8 years; 53% male and 47% participants had left hemiplegia. Fifty-seven outcome measures were used across studies. Average length of CIMT programs was four weeks (range one to 10 weeks). Frequency of sessions ranged from twice weekly to seven days per week. Duration of intervention sessions ranged from 0.5 to eight hours per day. The mean total number of hours of CIMT provided was 137 hours (range 20 to 504 hours). The most common constraint devices were a mitt/glove or a sling (11 studies each).We judged the risk of bias as moderate to high across the studies. KEY RESULTS Primary outcomes at primary endpoint (immediately after intervention)CIMT versus low-dose comparison (e.g. occupational therapy)We found low-quality evidence that CIMT was more effective than a low-dose comparison for improving bimanual performance (mean difference (MD) 5.44 Assisting Hand Assessment (AHA) units, 95% confidence interval (CI) 2.37 to 8.51).CIMT was more effective than a low-dose comparison for improving unimanual capacity (Quality of upper extremity skills test (QUEST) - Dissociated movement MD 5.95, 95% CI 2.02 to 9.87; Grasps; MD 7.57, 95% CI 2.10 to 13.05; Weight bearing MD 5.92, 95% CI 2.21 to 9.6; Protective extension MD 12.54, 95% CI 8.60 to 16.47). Three studies reported adverse events, including frustration, constraint refusal and reversible skin irritations from casting.CIMT versus high-dose comparison (e.g. individualised occupational therapy, bimanual therapy)When compared with a high-dose comparison, CIMT was not more effective for improving bimanual performance (MD -0.39 AHA Units, 95% CI -3.14 to 2.36). There was no evidence that CIMT was more effective than a high-dose comparison for improving unimanual capacity in a single study using QUEST (Dissociated movement MD 0.49, 95% CI -10.71 to 11.69; Grasp MD -0.20, 95% CI -11.84 to 11.44). Two studies reported that some children experienced frustration participating in CIMT.CIMT versus dose-matched comparison (e.g. Hand Arm Bimanual Intensive Therapy, bimanual therapy, occupational therapy)There was no evidence of differences in bimanual performance between groups receiving CIMT or a dose-matched comparison (MD 0.80 AHA units, 95% CI -0.78 to 2.38).There was no evidence that CIMT was more effective than a dose-matched comparison for improving unimanual capacity (Box and Blocks Test MD 1.11, 95% CI -0.06 to 2.28; Melbourne Assessment MD 1.48, 95% CI -0.49 to 3.44; QUEST Dissociated movement MD 6.51, 95% CI -0.74 to 13.76; Grasp, MD 6.63, 95% CI -2.38 to 15.65; Weightbearing MD -2.31, 95% CI -8.02 to 3.40) except for the Protective extension domain (MD 6.86, 95% CI 0.14 to 13.58).There was no evidence of differences in manual ability between groups receiving CIMT or a dose-matched comparison (ABILHAND-Kids MD 0.74, 95% CI 0.31 to 1.18). From 15 studies, two children did not tolerate CIMT and three experienced difficulty. AUTHORS' CONCLUSIONS The quality of evidence for all conclusions was low to very low. For children with unilateral CP, there was some evidence that CIMT resulted in improved bimanual performance and unimanual capacity when compared to a low-dose comparison, but not when compared to a high-dose or dose-matched comparison. Based on the evidence available, CIMT appears to be safe for children with CP.
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Affiliation(s)
- Brian J Hoare
- Monash Children's HospitalVictorian Paediatric Rehabilitation Service246 Clayton RdClaytonVictoriaAustralia3168
| | - Margaret A Wallen
- Australian Catholic UniversitySchool of Allied Health, Faculty of Health SciencesNorth SydneyAustralia
| | - Megan N Thorley
- Royal Children's HospitalRehabilitationHerston RoadBrisbaneQueenslandAustralia4006
| | - Michelle L Jackman
- John Hunter Children's HospitalPaediatric Occupational TherapyLambton RoadNew LambtonNew South WalesAustralia2310
| | - Leeanne M Carey
- Florey Institute of Neuroscience and Mental Health, The University of MelbourneNeurorehabilitation and Recovery, Stroke DivisionMelbourneVictoriaAustralia3081
| | - Christine Imms
- Australian Catholic UniversityCentre for Disability & Development ResearchLevel 2, Daniel Mannix Building17 Young StreetMelbourneVictoriaAustralia3065
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Hocking DR, Farhat H, Gavrila R, Caeyenberghs K, Shields N. Do Active Video Games Improve Motor Function in People With Developmental Disabilities? A Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil 2018; 100:769-781. [PMID: 30508504 DOI: 10.1016/j.apmr.2018.10.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 10/30/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To conduct a meta-analysis to examine the effectiveness of active video games (AVGs) interventions on motor function in people with developmental disabilities. DATA SOURCES An electronic search of 7 databases (PubMed, EbscoHost, Informit, Scopus, ScienceDirect, Proquest, PsychInfo) was conducted for randomized controlled trials (RCTs) evaluating AVGs to improve motor function in people with developmental disability, published through to May 2018. STUDY SELECTION Only articles in a peer-reviewed journal in English were selected and screened by 2 independent reviewers for RCTs that compared AVGs to conventional therapy. Twelve RCTs involving 370 people with developmental disabilities met the inclusion criteria for quantitative analysis. DATA EXTRACTION Two independent reviewers assessed risk of bias and study quality using the Egger's R, grading of recommendation, assessment, development and evaluation, and Template for Intervention Description and Replication checklists. DATA SYNTHESIS Three meta-analyses revealed a large effect size for AVGs to improve gross motor skills (Hedges' g=0.833, 95% confidence interval [95% CI]=0.247-1.420), small to medium effects for balance (g=0.458, 95% CI=0.023-0.948), and a small, nonsignificant effect for functional mobility (g=0.425, 95% CI= -0.03 to 0.881). Training frequency (ie, number of sessions per week) moderated the effect of AVGs on motor function in people with developmental disabilities. CONCLUSION We conclude that AVGs show task-specific effectiveness for gross motor skills but the effects are moderated by training intensity. However, because of the low number of trials, diverse diagnoses, variable dosage, and multiple outcome measures of the included trials, these results need to be interpreted with caution.
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Affiliation(s)
- Darren R Hocking
- Developmental Neuromotor and Cognition Lab, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia.
| | - Hassan Farhat
- Developmental Neuromotor and Cognition Lab, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Rebeca Gavrila
- Developmental Neuromotor and Cognition Lab, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Karen Caeyenberghs
- Microstructural Imaging and Rehabilitative Plasticity Program, School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia
| | - Nora Shields
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
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Lopes S, Magalhães P, Pereira A, Martins J, Magalhães C, Chaleta E, Rosário P. Games Used With Serious Purposes: A Systematic Review of Interventions in Patients With Cerebral Palsy. Front Psychol 2018; 9:1712. [PMID: 30283377 PMCID: PMC6156132 DOI: 10.3389/fpsyg.2018.01712] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 08/24/2018] [Indexed: 11/17/2022] Open
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.
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Affiliation(s)
- Sílvia Lopes
- School of Psychology, University of Minho, Braga, Portugal
| | | | | | | | | | - Elisa Chaleta
- School of Psychology and Science Social, University of Évora, Évora, Portugal
| | - Pedro Rosário
- School of Psychology, University of Minho, Braga, Portugal
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Holtz BE, Murray K, Park T. Serious Games for Children with Chronic Diseases: A Systematic Review. Games Health J 2018; 7:291-301. [PMID: 29957082 DOI: 10.1089/g4h.2018.0024] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE The purpose of this study was to systematically review the literature to assess if serious games impact health outcomes for children less than 18 years of age with chronic diseases. Additionally, the impact of self-efficacy, adherence, knowledge, use of theory, parent involvement, and study quality was also examined. MATERIALS AND METHODS Searches were conducted in databases EBSCO, PubMed, and Web of Science between June and August 2016. Randomized controlled trials using a serious game as an intervention, for participants under 18 years of age, to improve their chronic disease were included. RESULTS Data were extracted by two independent researchers, including: Title, author, and publication year; chronic disease; game description; number and age of participants; intervention duration; significant findings; parent involvement; theory; and study quality. Any disagreements were tackled and consensus was achieved. Eighteen studies were included in the review. The areas of health addressed included cerebral palsy, asthma, diabetes, developmental coordination disorders, and vision disorders. In these articles, eight health outcome variables were measured, including: lung function, glycemic control, hospital visits, motor proficiency, and visual acuity. Psychosocial variables that were assessed included self-efficacy and knowledge. Two articles included parents in the intervention, and three articles used theory. Six studies had significant health outcome finding, and four studies found a significant change in one psychosocial variable. CONCLUSION This review demonstrates the potential for games to improve health outcomes of young individuals. However, the mixed results suggest that more serious game interventions need to be better designed and rigorously tested to support their impact on improving health outcomes.
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Affiliation(s)
- Bree E Holtz
- 1 Department of Advertising and Public Relations, Michigan State University , East Lansing, Michigan
| | - Katharine Murray
- 1 Department of Advertising and Public Relations, Michigan State University , East Lansing, Michigan
| | - Taiwoo Park
- 2 Department of Media and Information, Michigan State University , East Lansing, Michigan
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El-Shamy SM, El-Banna MF. Effect of Wii training on hand function in children with hemiplegic cerebral palsy. Physiother Theory Pract 2018; 36:38-44. [DOI: 10.1080/09593985.2018.1479810] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Shamekh Mohamed El-Shamy
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Mohamed Fawzy El-Banna
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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