Active video game play in children with cerebral palsy: potential for physical activity promotion and rehabilitation therapies.

OBJECTIVE: To evaluate the potential of active video game (AVG) play for physical activity promotion and rehabilitation therapies in children with cerebral palsy (CP) through a quantitative exploration of energy expenditure, muscle activation, and quality of movement. DESIGN: Single-group, experimental study. SETTING: Human movement laboratory in an urban rehabilitation hospital. PARTICIPANTS: Children (N=17; mean age ± SD, 9.43±1.51y) with CP. INTERVENTION: Participants played 4 AVGs (bowling, tennis, boxing, and a dance game). MAIN OUTCOME MEASURES: Energy expenditure via a portable cardiopulmonary testing unit; upper limb muscle activations via single differential surface electrodes; upper limb kinematics via an optical motion capture system; and self-reported enjoyment via the Physical Activity Enjoyment Scale (PACES). RESULTS: Moderate levels of physical activity were achieved during the dance (metabolic equivalent for task [MET]=3.20±1.04) and boxing (MET=3.36±1.50) games. Muscle activations did not exceed maximum voluntary exertions and were greatest for the boxing AVG and for the wrist extensor bundle. Angular velocities and accelerations were significantly larger in the dominant arm than in the hemiplegic arm during bilateral play. A high level of enjoyment was reported on the PACES (4.5±0.3 out of 5). CONCLUSIONS: AVG play via a low-cost, commercially available system can offer an enjoyable opportunity for light to moderate physical activity in children with CP. While all games may encourage motor learning to some extent, AVGs can be strategically selected to address specific therapeutic goals (eg, targeted joints, bilateral limb use). Future research is needed to address the challenge of individual variability in movement patterns/play styles. Likewise, further study exploring home use of AVGs for physical activity promotion and rehabilitation therapies, and its functional outcomes, is warranted.

Reliability and validity of the kinematic dystonia measure for children with upper extremity dystonia.

This study was conducted to determine the test-retest reliability and construct validity of the Kinematic Dystonia Measure, a quantitative measure of upper extremity dystonia. To determine the effectiveness of various treatments, reliable and valid measures of dystonia are required. Test-retest reliability of the Kinematic Dystonia Measure using the intraclass correlation coefficient was excellent for the hand-tapping task (0.95) and substantial for the eye-blinking task (0.74). Construct validity testing for the hand-tapping task revealed that Kinematic Dystonia Measure scores correlated with total Barry-Albright Dystonia Scale scores (Pearson r = 0.79, P = .003), affected arm Barry-Albright Dystonia Scale subscores (Pearson r = 0.76, P = .0.007), and negatively correlated with Quality of Upper Extremity Skills Test scores (Pearson r = -0.60, P = .05). The Kinematic Dystonia Measure has excellent test-retest reliability and good construct validity using the hand-tapping task. When combined with functional outcome measures, the Kinematic Dystonia Measure can effectively measure dystonia in children.