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Motion interactive games for children with motor disorders: motivation, physical activity, and motor control
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Rörelsestyrda spel i träning av barn med motoriska nedsättningar : motivation, fysisk aktivitet och motorisk kontroll (Swedish)
Abstract [en]

As motion interactive games have become more widespread the interest in using these games in rehabilitation of children with motor disorders has increased among both clinical professionals and the families of these children. The general aim of this thesis was to evaluate the feasibility of using interactive games in rehabilitation of children to promote motivation for practice, physical activity, and motor control. A systematic review of published intervention studies was conducted to obtain an overview of existing research and the current levels of evidence for using interactive games in motor rehabilitation of children. Sixteen studies met the inclusion criteria, out of these three were randomized controlled trials while half were case series or case reports. Thirteen studies presented positive findings, which indicated a promising potential. However, more convincing research is needed.

Commercially available motion interactive games have only been used in a few studies on motor control, and in none of these home based practice was provided. Moreover, no earlier studies have evaluated if these games may increase motivation for training and daily physical activity among children with disabilities. To address these issues a feasibility intervention including 15 children in the ages 6-16 years and with mild to moderate cerebral palsy was conducted. Each child was provided with a Sony PlayStation2â and the EyeToyâ games in Play3, and was recommended to practice with the provided games for at least 20 minutes/day during four weeks. The intervention was evaluated with gaming diaries, physical activity monitors (SenseWear Armband), interviews with the parents, and the clinical motor tests Movement Assessment Battery for Children-2 (mABC-2), Bruininks-Oseretsky Test of Motor Proficiency subtest 5:6, and the 1 Minute Walk Test. In addition, 3D motion analysis was used to evaluate effects on quality of goal-directed arm movements towards virtual and real objects, respectively.

Motivation for practice and compliance of training were high, although declining somewhat during the course of the four weeks. The children’s physical activity increased significantly during the intervention. However, four children were excluded from this analysis due to lack of complete data from the physical activity monitors. According to mABC-2 the children’s motor performance improved, but there were both floor and ceiling effects, indicating a low sensibility of this test. The two additional motor tests showed only non-significant progress. Results from the 3D motion analysis suggest that the children improved movement precision when playing the games, movement smoothness when reaching for real objects, and used a more economic reaching strategy with less trunk involvement. In the interviews the parents expressed the view that motion interactive games promote positive experiences of physical training and add elements of social interaction to the training. They also experienced less urge to take on a coaching role. The training provided by the games was considered unspecific and there was a desire for individualized games to better address the unique rehabilitative need of each child.

In conclusion, it is feasible to use motion interactive games in home rehabilitation for children with cerebral palsy to promote short term motivation for practice and general physical training. Specific effects on motor control need to be further explored and there is also a need for reliable tests that are adequate and sensitive enough to capture changes in movement control. In future development of interactive games for rehabilitation purposes, it is a challenge to preserve the motivational and social features of games while at the same time optimizing an individualized physical training.

Place, publisher, year, edition, pages
Umeå: Umeå university , 2011. , 88 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1419
Keyword [en]
Children, parents, cerebral palsy, physical training, home training, motivation, physical activity, motor control, virtual reality, video games.
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
URN: urn:nbn:se:umu:diva-42792ISBN: 978-91-7459-202-3OAI: oai:DiVA.org:umu-42792DiVA: diva2:411313
Public defence
2011-05-19, Aulan, Vårdvetarhuset, Vårdvetarhuset, Umeå universitet, Umeå, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2011-04-19 Created: 2011-04-13 Last updated: 2015-01-21Bibliographically approved
List of papers
1. Interactive computer play in rehabilitation of children with sensorimotor disorders: a systematic review
Open this publication in new window or tab >>Interactive computer play in rehabilitation of children with sensorimotor disorders: a systematic review
2009 (English)In: Developmental medicine and child neurology, ISSN 1469-8749, Vol. 51, no 3, 173-179 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this review was to examine systematically the evidence for the application of interactive computer play in the rehabilitation of children with sensorimotor disorders. A literature search of 11 electronic databases was conducted to identify articles published between January 1995 and May 2008. The review was restricted to reports of intervention studies evaluating the impact of interactive computer play on motor rehabilitation in children. For each study the quality of the methods and the strength of the evidence were assessed by two independent reviewers using the guidelines of the American Academy for Cerebral Palsy and Developmental Medicine. A total of 74 articles were identified, of which 16 met the inclusion criteria. Three studies were randomized controlled trials (RCTs) and half were case series or case reports. Areas investigated were movement quality, spatial orientation and mobility, and motivational aspects. Thirteen studies presented positive findings. Two of the three RCTs investigating movement quality and one level III study examining spatial orientation showed no significant improvements. Interactive computer play is a potentially promising tool for the motor rehabilitation of children but the level of evidence is too limited to assess its value fully. Further and more convincing research is needed.

National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-22125 (URN)10.1111/j.1469-8749.2008.03184.x (DOI)19191834 (PubMedID)
Available from: 2009-04-23 Created: 2009-04-23 Last updated: 2015-01-21Bibliographically approved
2. Using motion interactive games to promote physical activity and enhance motor performance in children with cerebral palsy
Open this publication in new window or tab >>Using motion interactive games to promote physical activity and enhance motor performance in children with cerebral palsy
2011 (English)In: Developmental Neurorehabilitation, ISSN 1751-8423, E-ISSN 1751-8431, Vol. 14, no 1, 15-21 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To explore the feasibility of using low-cost motion interactive games as a home-based intervention for children with cerebral palsy (CP).

Methods: Fourteen children with CP, 6–16 years old, practiced with the EyeToy for PlayStation2® in their homes during 4 weeks. Outcome measures were physical activity monitors, Movement Assessment Battery for Children-2 (mABC-2), Bruininks-Oseretsky Test of Motor Proficiency (sub-test 5 : 6), 1 Minute Walk Test and gaming diaries.

Results: Motivation for practice and compliance of training were high. The children's physical activity increased during the intervention and activity monitors were feasible to use, although data loss may be a concern. According to mABC-2 the children's motor performance improved, but there were both floor and ceiling effects. The two additional motor tests showed only non-significant progress.

Conclusion: It is highly feasible to use motion interactive games in home rehabilitation for children with CP. Specific motor effects need to be further explored.

Place, publisher, year, edition, pages
Taylor & Francis, 2011
Keyword
Rehabilitation, virtual reality, video-games, paediatric, motivation, motor control, energy expenditure
National Category
Information Systems, Social aspects Physiotherapy
Identifiers
urn:nbn:se:umu:diva-36949 (URN)10.3109/17518423.2010.533329 (DOI)000287565000003 ()
Available from: 2010-10-14 Created: 2010-10-14 Last updated: 2015-12-29Bibliographically approved
3. Motion interactive video games in home training for children with cerebral palsy: parents' perceptions
Open this publication in new window or tab >>Motion interactive video games in home training for children with cerebral palsy: parents' perceptions
2012 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, no 11, 925-933 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: To explore parents' perceptions of using low-cost motion interactive video games as home training for their children with mild/moderate cerebral palsy.

Method: Semi-structured interviews were carried out with parents from 15 families after participation in an intervention where motion interactive games were used daily in home training for their child. A qualitative content analysis approach was applied.

Results: The parents' perception of the training was very positive. They expressed the view that motion interactive video games may promote positive experiences of physical training in rehabilitation, where the social aspects of gaming were especially valued. Further, the parents experienced less need to take on coaching while gaming stimulated independent training. However, there was a desire for more controlled and individualized games to better challenge the specific rehabilitative need of each child.

Conclusions: Low-cost motion interactive games may provide increased motivation and social interaction to home training and promote independent training with reduced coaching efforts for the parents. In future designs of interactive games for rehabilitation purposes, it is important to preserve the motivational and social features of games while optimizing the individualized physical exercise.

Place, publisher, year, edition, pages
Informa Healthcare, 2012
Keyword
Cerebral palsy, children, parents, virtual reality
National Category
Physiotherapy Information Systems, Social aspects
Identifiers
urn:nbn:se:umu:diva-55039 (URN)10.3109/09638288.2011.626489 (DOI)000302369400006 ()
Available from: 2012-05-07 Created: 2012-05-07 Last updated: 2015-08-19Bibliographically approved
4. Effect of practice with motion interactive video games on goal-directed arm movements in children with cerebral palsy: a kinematic evaluation
Open this publication in new window or tab >>Effect of practice with motion interactive video games on goal-directed arm movements in children with cerebral palsy: a kinematic evaluation
Show others...
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objective: The aim of the present study was to evaluate the quality of goal-directed arm movements in children with cerebral palsy after four weeks of daily practice with motion interactive games, and to explore and compare the applicability of various kinematic parameters in a virtual context compared to a situation with real objects.

Methods: Fifteen children with CP, 6-16 years, practiced with the EyeToyâ for PlayStation2â in their homes during four weeks. Before and after the intervention kinematics and kinetics were captured with a five camera motion analysis system (Proreflex, Qualisys AB, Gothenburg, Sweden) and a force plate. The children performed arm movements towards both virtual and real targets.

Results: The children used a more economic reaching strategy with shorter Centre of pressure paths, improved Movement precision, and reduced variability in Maximal shoulder angles during play after practice. Transfer of improved motor control to goal-directed arm movements towards real targets was also indicated by increased Movement smoothness, and while reaching with the non-dominant side, reduced Centre of pressure paths path. The spatiotemporal characteristics proved complex to interpret in terms of improved motor control.

Conclusions: When taking the constraints of the tasks into account the relevant kinematic parameters explored support the conclusion that practice with motion interactive games resulted in an improved motor control. The results of this study illuminate the importance of considering both the nature of the task and the context in which movements are performed when selecting and interpreting kinematic parameters.

Keyword
motor control, kinematics, kinetics, virtual reality, paediatric, cerebral palsy
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-42784 (URN)
Available from: 2011-04-13 Created: 2011-04-13 Last updated: 2015-01-21Bibliographically approved

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