Is There Evidence That Active Videogames Increase Energy Expenditure and Exercise Intensity for People Poststroke and with Cerebral Palsy?

This article asked and answered the question of whether there was evidence to support the use of videogames for promotion of wellness and fitness for people poststroke and those with cerebral palsy (CP). A literature search of PubMed, CINAHL, and PEDro using a population, intervention, and outcome (PIO) approach and the key words "stroke (or CP) AND video games (and synonyms) AND energy expenditure (EE) (and synonyms)" was conducted. It yielded two relevant references for people poststroke and five references for people with CP. The literature extraction and synthesis by the categories of the PIO indicated that most studies used only the population of interest, except two that compared the EE with that of healthy controls. The main finding is that both people poststroke (moderate severity) and people with CP (mild severity) can achieve moderate EE playing Wii(™) (Nintendo, Kyoto, Japan), PlayStation(®) (Sony, Tokyo, Japan), and Kinect(™) (Microsoft, Redmond, WA) games. Adults with CP of mild severity played the videogames at vigorous levels, whereas those with severe CP played them at low levels. There appears to be an interaction between development and severity that influences the exercise intensity measured by EE. The findings suggests that videogames are a gateway for wellness promotion.

Nintendo wii sports and wii fit game analysis, validation, and application to stroke rehabilitation.

BACKGROUND: Interactive video gaming has become ubiquitous in the practice of rehabilitation. The Nintendo Wii is one such system. Interactive gaming can promote intensive task-based therapy in a manner that is motivating for the user. Widespread enthusiasm for consoles and their games prompted us to analyze the games for their rehabilitation elements related to improving balance and mobility for individuals poststroke. PURPOSE: The purpose of this article is to provide a game analysis for clinical application and evaluation of the game elements for research on interactive video gaming. METHODS: Using a team of game players and raters, 5 tables (1 for the Wii Sports and 4 for the Wii Fit) were developed and validated. The tables consist of 3 categories: game description, impairments targeted (strength, endurance, balance, and coordination), and feedback provided (knowledge of performance [KP] and knowledge of results [KR]). Two domain content experts established face validity. Construct validity was performed by 2 therapist-raters who had more than 15 years' clinical experience and postgraduate training in motor learning. Observations about the games including the fidelity of the interfaces, the nature of the feedback, and some of the challenges to adapting the games for rehabilitation are presented. RESULTS: An 80% agreement between raters set as the criterion for establishing the construct validity was met for feedback evaluation. There was 100% agreement on impairment ratings. Games provide a greater amount of KR compared with KP. CONCLUSION: Given the preponderance of KR, therapists will need to monitor motor performance. Adaptation of interactive video consoles for rehabilitation requires careful evaluation of the games' attributes using relevant rehabilitation construits.

Use of a low-cost, commercially available gaming console (Wii) for rehabilitation of an adolescent with cerebral palsy.

BACKGROUND AND PURPOSE: The purpose of this retrospective and prospective case report is to describe the feasibility and outcomes of using a low-cost, commercially available gaming system (Wii) to augment the rehabilitation of an adolescent with cerebral palsy. PATIENT AND SETTING: The patient was an adolescent with spastic diplegic cerebral palsy classified as GMFCS level III who was treated during a summer session in a school-based setting. INTERVENTION: The patient participated in 11 training sessions, 2 of which included other players. Sessions were between 60 and 90 minutes in duration. Training was performed using the Wii sports games software, including boxing, tennis, bowling, and golf. He trained in both standing and sitting positions. OUTCOMES: Three main outcome measures were used: (1) visual-perceptual processing, using a motor-free perceptual test (Test of Visual Perceptual Skills, third edition); (2) postural control, using weight distribution and sway measures; and (3) functional mobility, using gait distance. Improvements in visual-perceptual processing, postural control, and functional mobility were measured after training. DISCUSSION AND CONCLUSION: The feasibility of using the system in the school-based setting during the summer session was supported. For this patient whose rehabilitation was augmented with the Wii, there were positive outcomes at the impairment and functional levels. Multiple hypotheses were proposed for the findings that may be the springboard for additional research. To the authors' knowledge, this is the first published report on using this particular low-cost, commercially available gaming technology for rehabilitation of a person with cerebral palsy.

The clinical decision-making process of prescribing power mobility for a child with cerebral palsy.

PURPOSE: Powered mobility has been shown to be an effective method for children with disabilities to achieve independent mobility. The purpose of this case report is to describe the physical therapist's clinical decision making related to power mobility for a child with multiple disabilities. CASE DESCRIPTION: Power wheelchair evaluation for a nine-year-old child was conducted using Furumasu's tasks for wheelchair readiness moving through a doorway, maneuvering through three cones, and driving in a hallway. Ongoing team assessment with family consultation informed clinical decision-making. OUTCOMES: A mid-wheel-drive chair afforded improved performance on Furumasu's tasks compared with a rear-wheel-drive chair. SUMMARY: This case describes the clinician's role in prescribing power wheelchairs to affect the user's functional skills, as well as how, in the absence of evidence, clinical experience and patients' needs can guide clinical decision-making.

Form and variability during sit-to-stand transitions: children versus adults.

In performing the sit-to-stand transition, young children (6- to 7-year-olds) were expected to display a movement form similar to that of adults. However, movement consistency was predicted to be poorer in children than in adults because they lack refinement of motor control processes. Kinematic analysis of 10 repetitions of the sit-to-stand movement was carried out for 6 typically developing children and 6 adults. Supporting the authors' prediction of comparable form, no differences were evident between age groups for sequence of joint onsets, proportional duration of segmental motion, or in angle-angle plots of displacement at 2 segments. In contrast, within-participant variability was found to be higher for children: Coefficients of variation for most kinematic measures were twice those seen for adults. The authors interpret the children's lack of movement consistency as a reflection of inadequate stabilization of an internal model of intersegmental dynamics. Whereas adults have attained a skill level associated with refinement of that model, children have not. Children have an additional control problem because changes in body morphology throughout childhood require ongoing updating of the internal model that controls intrinsic dynamics.