Potential of the Nintendo Wii™ as a rehabilitation tool for children with cerebral palsy in a developing country: a pilot study
Introduction
Cerebral palsy (CP) is one of the three most common lifelong developmental disabilities, with prevalence rates ranging from 1.5 to 3 per 1000 live births [1], [2], [3]. During the management of children with CP, therapists are constantly being challenged to find a balance between activities that are engaging but also effective. Treatment techniques showing good results have been those that are grounded on motor learning theories, where the main focus is intense practice of functional activities [4], [5], [6], [7], [8].
The integration of virtual reality into neurorehabilitation is an approach to therapy that is currently being explored in both adults and children with promising results. It has been shown that neurons in the adult human brain increase their firing rates when the individual observes movements being performed by another person [9], [10], [11]. Activation of this mirror-neuron system can induce cortical re-organisation and possibly contribute to functional recovery.
Studies using systems ranging from full to partial immersion have reported improvements in both upper and lower extremity function in patients following stroke and children with CP [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24]. Furthermore, case studies investigating cortical re-organisation in a patient following chronic stroke and a child with hemiparetic CP have shown evidence of neuroplastic changes associated with enhanced functional skills when training was undertaken in a virtual environment [23], [24].
Simple virtual reality gaming systems such as the Nintendo Wii™ are affordable, and many physical therapy departments in third world countries, as well as individual therapists, may find that it is well within their budgets. The Nintendo Wii could potentially be a treatment option for physical therapists who have to work in very constrained spaces and with limited equipment to keep the children engaged in the rehabilitation process.
The objectives of this pilot study were to explore the possibility of: (1) using the Nintendo Wii for the rehabilitation of children with CP in a setting with multiple distractions; (2) children with both good and limited grasp function being able to play the selected games; and (3) both wheelchair-dependent and ambulant children being able to train with the gaming system. Additional objectives were to determine: (4) the acceptability of this form of training among children with CP; and (5) whether training with the Nintendo Wii had the potential to impact gross motor function.
Section snippets
Study design
A pilot pre–post-test study was conducted to explore the potential of using the Nintendo Wii as a rehabilitation tool for children with dyskinetic CP in a developing country. Approval to conduct the research was given by the University of the West Indies Ethics Committee (Mona Campus).
Participants
Participants were recruited from three treatment centres located in the parish of St. Andrew, Jamaica. Children between the ages of 6 and 12 years who had adequate cognitive function to understand the requirements
Results
Seven children were recruited for the study with a mean age of 10.6 years. Participant 2 dropped out at Week 4 of the 6-week study period due to a loss of interest by the parent. Data from this participant were not analysed. The participants’ characteristics are shown in Table 1. Three of the six participants who completed the study had impaired grip function, and four were wheelchair dependent.
All six participants who completed the study had 100% attendance for the entire 6-week period. They
Discussion
Results of the study indicate that the Nintendo Wii has potential to be a viable option for use in the rehabilitation of children with CP in developing countries. The Nintendo Wii was developed for able-bodied individuals and requires that the participant holds the remote in the hand while playing. It was noted in this study, however, that by simply securing the remote and nunchuck in the hands of those with limited grasp, using a crepe bandage, they were able to engage fully in Wii Sports
Conclusions
This pilot study indicates that the Nintendo Wii has potential to be a viable tool for use in the rehabilitation of children with CP in developing countries. With minor modifications, children with limited hand function and those who are wheelchair dependent can engage in training on the Nintendo Wii. Clinical trials should be conducted to investigate the effect of this form of training on gross motor function in children with CP.
Ethical approval: The University of the West Indies, Mona Campus,
References (28)
- et al.
Evaluating the responsiveness of 2 versions of the Gross Motor Function Measure for children with cerebral palsy
Arch Phys Med Rehabil
(2006) - et al.
Cerebral palsy – definition, classification, etiology and early diagnosis
Ind J Pediatr
(2005) Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers
Dev Med Child Neurol
(2000)- et al.
Trends in the prevalence of cerebral palsy in a population-based study
Pediatrics
(2002) - et al.
Cerebral palsy: new approaches to therapy
Curr Neurol Neurosci Rep
(2007) - et al.
Efficacy of a child-friendly form of constraint-induced therapy in hemiplegic cerebral palsy: a randomized control trial
Dev Med Child Neurol
(2006) - et al.
Effects of constraint-induced movement therapy in young children with hemiplegic cerebral palsy: an adapted model
Dev Med Child Neurol
(2005) - et al.
Functional therapy for children with cerebral palsy: an ecological approach
Dev Med Child Neurol
(2005) - et al.
Efficacy of hand-arm bimanual intensive therapy (HABIT) in children with hemiplegic cerebral palsy: a randomized control trial
Dev Med Child Neurol
(2007) - et al.
Mirror neurons and their clinical relevance
Nat Clin Pract Neurol
(2009)
Mirror neuron system: basic findings and clinical applications
Ann Neurol
The potential for utilizing the mirror neurone system to enhance recovery of the severely affected upper limb early after stroke: a review and hypothesis
Neurorehabil Neural Repair
The use of virtual reality with children with cerebral palsy: a pilot randomized trial
Ther Recreat J
Feasibility, motivation and selective motor control: virtual reality compared to conventional home exercises in children with cerebral palsy
Cyberpsychol Behav
Cited by (64)
Motion-based technology to support motor skills screening in developing children: A scoping review
2023, Computer Methods and Programs in BiomedicineEffectiveness of virtual reality-based exercise therapy in rehabilitation: A scoping review
2021, Informatics in Medicine UnlockedCitation Excerpt :Some of the reviewed papers focused on Nintendo and Kinect in home-based rehabilitation [7,14,16,43,69,70]. Moreover, Nintendo has been considered a viable device for application in neurological and cognitive rehabilitation [71,72]. In their review study, Santos et al. showed that the combined use of Nintendo and traditional rehabilitation was more effective in balancing rehabilitation and quality of life of patients with Parkinson's disease [73].
Effects of virtual reality in body oscillation and motor performance of children with cerebral palsy: A preliminary randomized controlled clinical trial
2019, Complementary Therapies in Clinical PracticeDo active video games benefit the motor skill development of non-typically developing children and adolescents: A systematic review
2017, Journal of Science and Medicine in SportCitation Excerpt :The exploration of locomotor skills revealed two studies with significant improvements (but no effect size reported).41,45 Another study reported clinically important improvements56; although not statistically significant. Statistical and clinical importance are distinct in that a clinically important difference suggests that intervention improvement was clinically meaningful.31