Elsevier

Physiotherapy

Volume 98, Issue 3, September 2012, Pages 238-242
Physiotherapy

Potential of the Nintendo Wii™ as a rehabilitation tool for children with cerebral palsy in a developing country: a pilot study

https://doi.org/10.1016/j.physio.2012.05.011Get rights and content

Abstract

Objectives

To explore the possibility of using the Nintendo Wii™ as a rehabilitation tool for children with cerebral palsy (CP) in a developing country, and determine whether there is potential for an impact on their gross motor function.

Design

Pilot study with a pre–post-test design.

Setting

Sir John Golding Rehabilitation Center, Jamaica, West Indies.

Participants

Seven children, aged 6 to 12 years, with dyskinetic CP were recruited for the study. One child dropped out at week 4.

Intervention

Training with the Nintendo Wii was conducted twice weekly for 6 weeks. The games used were Wii Sports Boxing, Baseball and Tennis.

Main outcome measures

Percentage attendance over the 6-week period, percentage of sessions for which the full duration of training was completed, and changes in gross motor function using the Gross Motor Function Measure (GMFM).

Results

All six participants who completed the study had 100% attendance, and all were able to complete the full 45 minutes of training at every session. Those who were wheelchair bound participated in two games, whilst those who were ambulant played three games. The mean GMFM score increased from 62.83 [standard deviation (SD) 24.86] to 70.17 (SD 23.67).

Conclusion

The Nintendo Wii has the potential for use as a rehabilitation tool in the management of children with CP. Clinical trials should be conducted in this area to determine whether this could be an effective tool for improving gross motor function.

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)

  • H. Wang et al.

    Evaluating the responsiveness of 2 versions of the Gross Motor Function Measure for children with cerebral palsy

    Arch Phys Med Rehabil

    (2006)
  • C. Sankar et al.

    Cerebral palsy – definition, classification, etiology and early diagnosis

    Ind J Pediatr

    (2005)
  • C. Cans

    Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers

    Dev Med Child Neurol

    (2000)
  • S. Winter et al.

    Trends in the prevalence of cerebral palsy in a population-based study

    Pediatrics

    (2002)
  • M.A. Garvey et al.

    Cerebral palsy: new approaches to therapy

    Curr Neurol Neurosci Rep

    (2007)
  • J.R. Charles 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)
  • A.C. Eliasson et al.

    Effects of constraint-induced movement therapy in young children with hemiplegic cerebral palsy: an adapted model

    Dev Med Child Neurol

    (2005)
  • L.E. Ahl et al.

    Functional therapy for children with cerebral palsy: an ecological approach

    Dev Med Child Neurol

    (2005)
  • A.M. Gordon 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)
  • G. Rizzolatti et al.

    Mirror neurons and their clinical relevance

    Nat Clin Pract Neurol

    (2009)
  • M. Iacoboni et al.

    Mirror neuron system: basic findings and clinical applications

    Ann Neurol

    (2007)
  • V.M. Pomeroy et al.

    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

    (2005)
  • D. Reid et al.

    The use of virtual reality with children with cerebral palsy: a pilot randomized trial

    Ther Recreat J

    (2006)
  • C. Braynton et al.

    Feasibility, motivation and selective motor control: virtual reality compared to conventional home exercises in children with cerebral palsy

    Cyberpsychol Behav

    (2006)
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