ABSTRACT
The use of video games in rehabilitation is becoming more popular to clinicians. These games are embedded in off-the-shelf commercial entertainment applications or especially-developed for clinical purposes. Treatment of cerebral palsy (CP) children is a challenging task for clinicians. Lack of motivation and progress monitoring are two important factors clinicians need to deal with. The use of serious games (SG), sometimes referred to as Virtual Rehabilitation (VR), could therefore be an interesting adjuvant to conventional treatment for these patients. This is however a new discipline and many scientific issues remain to be solved. The aim of this paper is to describe available conventional treatment for CP children together with the level of evidence of each approach. A systematic review of the use of SG in rehabilitation is then conducted. 31 papers (7 randomized clinical trials, 16 cohort studies and 8 single-cases studies) were selected and analyzed, and their level of evidence compared to the conventional treatment. These studies reported outcomes for 352 patients. In summary, this review shows that it is difficult to compare those studies despite the large amount of patients. This is due to the lack of standardization in patient rehabilitation strategy and to the use of various clinical scales and scores. This non-standardization in patient follow-up between previously-published works make evidence-based conclusions difficult to obtain in order to support these techniques objectively. The use of SG for rehabilitation purposes currently meets similar issues. This paper proposes standardization strategies in order to improve treatment comparison and SG use in rehabilitation.
Subject(s)
Cerebral Palsy/rehabilitation , Games, Experimental , Motor Activity , Movement Disorders/rehabilitation , Video Games , Child , Humans , Randomized Controlled Trials as TopicABSTRACT
Diagnosis and most of all classification of children with cerebral palsy (CP) remain a challenge for clinicians. To help them in this process, clinicians can rely on several clinical testing procedures as well as complementary investigations. The goal of this study was to determine which clinical tests found in the literature are the most frequently used in common practice in Belgium. Forty tests have been found in the literature. They have been sorted into five different categories: quantitative evaluation of motor function, spasticity evaluation, orthopaedic testing, upper limb evaluation and complementary investigations. Seven clinicians (five medical doctors and two physiotherapists) with a mean experience of sixteen years with CP children answered the questionnaire. Concerning the quantitative evaluation of motor function the most used tests are: Gross Motor Function Classification System, Manual Ability Classification System and the Pediatric Evaluation of Disability Inventory (PEDI). As regards spasticity, Ashworth scale is more frequently used than Tardieu test. No trend currently exist for the upper limb evaluation, but it was noted that these tests are rarely used in clinical practice. We observed a significant use of gait analysis at diagnosis and follow-up of CP children. We conclude that there are large differences between clinicians for clinical examination of CP children. This lack of consensus makes patient data comparison difficult between clinical centers. This seems to indicate that a homogenization effort should be organized if one wishes to better stimulate collaborations between centers.
