Game-Based Dual-Task Exercise Program for Children with Cerebral Palsy: Blending Balance, Visuomotor and Cognitive Training: Feasibility Randomized Control Trial

Abstract

The objective of this exploratory randomized controlled trial (RCT) was to provide evidence for the feasibility and therapeutic value of a novel game-based dual-task balance exercise program in children with cerebral palsy (CP). Twenty children with CP were recruited and randomized into two groups: (a) the conventional balance training group (CG) and (b) the experimental group (XG), which received a game-based dual-task (DT) balance exercise program. Both groups received their respective therapy programs for 12 weeks at a frequency of three sessions per week. Semi-structured interviews with the parents and children and qualitative analysis were conducted to evaluate the children's experiences with the game-based exercise program. The quantitative analysis included (a) the Pediatric Balance Scale (PBS), (b) Gross Motor Function Measure-88 (GMFM-88), and (c) computerized measures of standing balance performance during various dual-task conditions. Compliance was 100% for all 20 participants. Four themes captured the range of each participant's experiences and opinions: (a) reasons for participation, (b) likes and dislikes with the technologies, (c) positive effects of the program, and (d) future expectations. Children in the XG demonstrated greater improvements in PBS, GMFM, and DT balance measures as compared to children in the CG. The findings demonstrate feasible trial procedures and acceptable DT-oriented training with a high compliance rate and positive outcomes. These findings support further research and development and progression to the next phase of a full-scale RCT to evaluate the clinical effectiveness of the game-based DT balance exercise program for children with CP.

Keywords: balance training; cerebral palsy; dual-task training; telerehabilitation.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that can be construed as a potential conflict of interest.

Figures

Figure 1

CONSORT Flow Diagram.

Figure 2

Illustration of the assessment game setup. As presented in Panel (B), the participant stands while viewing a computer monitor. An inertial-based mouse is secured to the sports cap, and head rotation is used to interact with the visuospatial cognitive games. Panels (A,C) present snapshots of the VMT and VCG modules. Panel (A) (VMT) shows cursors of different shapes appearing on the computer monitor. The target is a circle, and its motion was computer-controlled and moved at a predetermined frequency of 0.5 Hz with an amplitude of 70% of the monitor width. The second cursor is a rectangle, which is slaved to the head-mounted IB mouse. Children were instructed to rotate their heads and overlap the rectangle cursor with the target circle for several cycles (i.e., 30 s). The coordinates of the rectangle and target cursor were recorded at 100 Hz for offline analysis. Panel (D) presents synchronous plots of the target cursor motion and user movement trajectories (head rotation) for a typical VM tracking task. The maximum is the leftmost position, and the minimum is the right-most position. Panel (C) (VCG) objects are categorized as targets or distractors. The game objects appear at random locations at the top of the display every 2 s and move in a diagonal trajectory to the bottom of the display. Children were required to move the paddle to catch the target objects while avoiding the distractors. The coordinates of the game paddle and target objects were recorded (100 Hz) for offline analysis of the success rate (SR). Panel (E) presents the trajectory for one VCG game movement response from target appearance to target disappearance. Panel (F) presents overlay trajectories of all game movement responses for one game session.

Figure 3

Line plots presenting group means and standard errors of means (SEM) pre- and post-intervention.