title: A crossover randomised and controlled trial of the impact of active video games on motor coordination and perceptions of physical ability in children at risk of Developmental Coordination Disorder. Effects of conventional neurological treatment and a virtual reality training program on eye-hand coordination in children with cerebral palsy Effect of Wii-intervention on balance of children with poor motor performance. Interrater reliability and convergent validity of the American Academy for Cerebral Palsy and Developmental Medicine methodology for conducting systematic reviews. A Low-Cost Video Game Applied for Training of Upper Extremity Function in Children with Cerebral Palsy: A Pilot Study Effects of task-oriented training on mobility function in children with cerebral palsy. Effects of interactive games on motor performance in children with spastic cerebral palsy Can balance in children with cerebral palsy improve through use of an activity promoting computer game? The efficacy of two task-orientated interventions for children with Developmental Coordination Disorder: Neuromotor Task Training and Nintendo Wii Fit Training. Effectiveness of virtual reality using Wii gaming technology in children with Down syndrome. Wii-habilitation as balance therapy for children with acquired brain injury Single‐subject research design: recommendations for levels of evidence and quality rating Effectiveness of a low-cost virtual reality system for children with developmental delay: a preliminary randomised single-blind controlled trial. An investigation of the impact of regular use of the Wii Fit to improve motor and psychosocial outcomes in children with movement difficulties: a pilot study. Upper limb training using Wii Sports Resort™ for children with hemiplegic cerebral palsy: a randomized, single-blind trial
abstract: BACKGROUND Impaired motor development can significantly affect a child 's life and may result in an increased risk of a range of physical and psychological disorders . Active video game ( AVG ) interventions have been demonstrated to enhance motor skills in children with Developmental Coordination Disorder ( DCD ) ; however a home-based intervention has not been assessed . OBJECTIVES The primary aim of this study was to compare the changes in motor coordination between a 16 week period of AVG use , with 16 weeks of normal activities ( NAG ) . The secondary aim was to compare the child and parent perceptions of their physical performance between the AVG and NAG conditions . METHODS Twenty-one 9 - 12 year olds ( 10 males ) were confirmed to be at risk of DCD ( ⩽ 16th percentile Movement Assessment Battery for Children-2nd edition ( MABC-2 ) and ⩽ 15th percentile Developmental Coordination Disorder Question naire ( DCDQ ) ) and participated in this crossover r and omised and controlled trial . Data was collected at study entry , after the first 16 week condition and following the final 16 week condition , including ; ( 1 ) the MABC-2 , ( 2 ) three-dimensional motion analysis of single leg balance and finger-nose tasks , and ( 3 ) parent perception of physical skills . Participant perception of physical skills was collected only after the first and second conditions . RESULTS There was no significant difference between AVG and NAG for any of the primary variables including the MABC-2 , balance centre-of-mass path distance and finger-nose path distance . There was no significant intervention effect for secondary measures of motor coordination ; however the children perceived their motor skills to be significantly enhanced as a result of the AVG intervention in comparison to the period of no intervention . CONCLUSION A 16 week home based AVG intervention did not enhance motor skills in children with DCD , although they perceived their physical skills to be significantly improved . TRIAL REGISTRATION Australia and New Zeal and Clinical trials Registry ( ACTRN 12611000400965 ) [ Purpose ] The purpose of the study was to evaluate the effects of conventional neurological treatment and a virtual reality training program on eye-h and coordination in children with cerebral palsy . [ Subjects ] Sixteen children ( 9 males , 7 females ) with spastic diplegic cerebral palsy were recruited and r and omly assigned to the conventional neurological physical therapy group ( CG ) and virtual reality training group ( VRG ) . [ Methods ] Eight children in the control group performed 45 minutes of therapeutic exercise twice a week for eight weeks . In the experimental group , the other eight children performed 30 minutes of therapeutic exercise and 15 minutes of a training program using virtual reality twice a week during the experimental period . [ Results ] After eight weeks of the training program , there were significant differences in eye-h and coordination and visual motor speed in the comparison of the virtual reality training group with the conventional neurological physical therapy group . [ Conclusion ] We conclude that a well- design ed training program using virtual reality can improve eye-h and coordination in children with cerebral palsy The purpose of this study was to investigate the effects of training with the Wii-balance board on balance and balance-related skills of children with poor motor performance . Twenty-nine children ( 23 boys , 6 girls ; aged 7 - 12 years ) participated in this study and were r and omly assigned to an experimental and control group . All children scored below the 16th percentile on a st and ardized test of motor ability and balance skills ( Movement Assessment Battery for children ( M-ABC-2 ) ) . Before and after a six-week Wii-intervention ( M=8h , 22 min , SD=53 min ) , the balance skills of the experimental group and control group were measured with the  M-ABC-2  and the  Bruininks-Oseretsky test of motor proficiency ( BOT-2  ) . Both groups improved on all tests . The M-ABC-2 and the BOT-2 total balance-scores of the experimental group improved significantly from pre to post intervention , whereas those of the control group showed no significant progress . This result ed in significant interaction-effects , favoring the experimental children . No transfer-effects of the intervention on balance-related skills were demonstrated . Our findings showed that the Wii-balance board is an effective intervention for children with poor balance control . Further development and investigation of the intervention could be directed toward the implementation of the newly acquired balance-skills in daily life AIM The aim of this study was to evaluate the interrater reliability and convergent validity of the American Academy for  Cerebral Palsy and Developmental Medicine  's ( AACPDM ) methodology for conducting systematic review s ( group design studies ) . METHOD Four clinicians independently rated 24 articles for the level of evidence and conduct using AACPDM methodology . Study conduct was also assessed using the Effective Public Health Practice Project scale . Raters were r and omly assigned to one of two pairs to resolve discrepancies . The level of agreement between individual raters and pairs was calculated using kappa ( α=0.05 ) and intraclass correlations ( ICCs ; α=0.05 ) . Spearman 's rank correlation coefficient was calculated to evaluate the relationship between raters ' categorization of quality categories using the two tools . RESULTS There was acceptable agreement between raters ( κ=0.77 ; p<0.001 ; ICC=0.90 ) and between assigned pairs ( κ=0.83 ; p<0.001 ; ICC=0.96 ) for the level of evidence ratings . There was acceptable agreement between pairs for four of the seven conduct questions ( κ=0.53 - 0.87 ) . ICCs ( all raters ) for conduct category ratings ( weak , moderate , and strong ) also indicated good agreement ( ICC=0.76 ) . Spearman 's rho indicated a significant positive correlation for the overall quality category comparisons of the two tools ( 0.52 ; p<0.001 ) . CONCLUSIONS The AACPDM rating system has acceptable interrater reliability . Evaluation of its study quality ratings demonstrated reasonable agreement when compared with a similar tool The aim of the present study was to determine the user satisfaction of the EyeToy for the training of the upper limb in children with cerebral palsy ( CP ) .  User satisfaction was measured in 12 children with CP , using a postexperience question naire , primarily based on a presence question naire . In general , children with CP were satisfied with and motivated by the EyeToy training . In addition , a first evaluation study was performed to determine the effect of this training method on the upper limb function . Ten children with CP were r and omly assigned to the intervention ( mean age 11 years , 9 months ; SD 2,3 ) and the control group ( mean age 12 years , 3 months ; SD 3,2 ) . After a treatment period of 6 weeks , the intervention group completed a  user satisfaction question naire . Functional outcome was measured using the Melbourne Assessment scores . Percentage scores of the Melbourne Assessment of 7 of the 10 children were the same or changed only 1 % to 2 % from baseline to followup . However , in the experimental group , two children improved more , 9 % and 13 % respectively . In conclusion , it can be said that the EyeToy is a motivational training tool for the training of children with CP and has the potential to improve upper extremity function BACKGROUND / PURPOSE Improvement in mobility function has been the primary goal in the rehabilitation of children with cerebral palsy . Few studies have examined the effectiveness of task-oriented strength training for children with cerebral palsy . The purpose of this study was to examine the effects of task-oriented strength training on mobility function in children with cerebral palsy . STUDY DESIGN A single-blind , r and omized controlled trial with pre-training and post-training evaluations . MATERIAL S AND METHODS Ten children with cerebral palsy ( GMFCS levels I-III ) were r and omly assigned to an experimental group ( N = 5 ) or control group ( N = 5 ) . Mobility function was assessed using the Gross Motor Function Measure ( GMFM ) and the Timed " Up and Go " ( TUG ) test . Participants in the control group received conventional physical therapy focused on improving walking and balance through facilitation and normalization of movement patterns . Participants in the experiment group received task-oriented strength training focused on strengthening the lower extremities and practicing functional tasks similar to those the child performs during daily activities . RESULTS After the 5-week training period there were significant improvements in the experimental group for dimension D ( p = 0.009 ) , and dimension E ( p = 0.009 ) of the GMFM . The experimental group significantly reduced the time taken to complete the TUG ( p = 0.017 ) . CONCLUSION / SIGNIFICANCE This study supports the efficacy of task-oriented strength training for improving mobility function in children with cerebral palsy . The findings demonstrate that the application of a task-oriented strength training program is linked to positive functional outcomes . The results suggest that children with cerebral palsy may benefit from a task-oriented strength training program . Further studies with a larger r and omized sample and longer post-intervention follow-up are necessary to document the long-term effects of participation in task-oriented strength training programs in the cerebral palsy population [ Purpose ] Motor control and muscle strength impairments are the prime reasons for motor behavior disorders in children with spastic cerebral palsy . These impairments lead to histological changes in muscle growth and the learning of motor skills . Therefore , such children experience reduced muscle force generation and decreased muscle flexibility . We investigated the effect of training with Nintendo Wii Fit games on motor performance in children with spastic cerebral palsy . [ Subjects and Methods ] Forty children with cerebral palsy spastic diplegia aged 6–10 years diagnosed with level-3 functional capabilities according to the Gross Motor Classification System ( GMFCS ) were enrolled . Participants were divided r and omly into equal groups : group ( A ) that practice d with the Nintendo Wii Fit game for at least 20 minutes/day for 12 weeks and group ( B ) that underwent no training ( control group ) . The Movement Assessment Battery for Children-2 ( mABC-2 ) was used to assess motor performance , because it mainly involves motor tasks very similar to those involved in playing Nintendo Wii Fit games , e.g. , goal -directed arm movements , balancing , and jumping . [ Results ] There were significant improvements in the subscales of the motor performance test of those who practice d with the Nintendo Wii , while the control group showed no significant changes . [ Conclusion ] Using motion interactive games in home rehabilitation is feasible for children with cerebral palsy INTRODUCTION This study aim ed to evaluate if use of an activity promoting computer game , used in the home ( Nintendo Wii Fit ; Nintendo Co Ltd , Japan ) , could influence balance related outcome measures in children with cerebral palsy . METHOD Eighteen children with hemiplegic or diplegic cerebral palsy were recruited for the study . A r and omised cross-over design was used with children tested at baseline , after five weeks of playing Wii Fit games and after five weeks without any intervention . Outcome measures of interest included : performance on the modified sensory organisation test , reactive balance test and rhythmic weight shift test . RESULTS No significant difference was observed between testing occasions for any of the balance measures investigated ( p > 0.05 ) . CONCLUSION Our results suggest that use of a Nintendo Wii balance board and Wii Fit software for a minimum of thirty minutes per day in the patient 's own home , over a five week period , is not effective as a balance training tool in children with cerebral palsy Neuromotor Task Training ( NTT ) and Nintendo Wii Fit Training ( Wii training ) are both task-based interventions used to improve performance in children with motor coordination problems . The aim of this study was to compare the efficacy of these two interventions on the motor performance , isometric strength and cardiorespiratory fitness ( aerobic and anaerobic capacity ) of children with Developmental Coordination Disorder ( DCD ) attending mainstream schools in a low-income setting . A pragmatic , quasi-experimental study design was utilized . Children between the ages of 6 - 10 years , who scored at or below the 16th percentile on the Movement Assessment Battery for Children-2 ( MABC-2 ) and whose teacher reported a functional motor problem , were allocated to either NTT  ( n=37 ) or  Wii training ( n=19 ) groups depending on school of attendance . The MABC-2 , a h and -held dynamometer , the Functional Strength Measure , the Muscle Power Sprint Test and the 20 m Shuttle Run Test were used to assess performance at baseline and after the intervention . The main findings show that the mean motor performance scores of both groups improved over the study period . However , significant differences in improvement were detected between groups , with the NTT group showing greater improvement in motor performance , functional strength and cardiorespiratory fitness . No improvements in isometric strength were seen in either group . The Wii training group showed significant improvement in anaerobic performance . This study provides evidence to support the use of both the Wii Training and NTT for children with DCD . However , in comparison to Wii training , the NTT approach yields superior results across measures of motor proficiency , cardiorespiratory fitness and functional strength . The decision to use either approach may be influenced by re sources and time constraints This quasi-experimental study compared the effect of st and ard occupational therapy ( SOT ) and virtual reality using Wii gaming technology ( VRWii ) on children with Down syndrome ( DS ) . Children ( n = 105 ) were r and omly assigned to intervention with either SOT or VRWii , while another 50 served as controls . All children were assessed with measures of sensorimotor functions . At post-intervention , the treatment groups significantly outperformed the control group on all measures . Participants in the VRWii group had a greater pre-post change on motor proficiency , visual-integrative abilities , and sensory integrative functioning . Virtual reality using Wii gaming technology demonstrated benefit in improving sensorimotor functions among children with DS . It could be used as adjuvant therapy to other proven successful rehabilitative interventions in treating children with DS Purpose : To evaluate the effectiveness of the Nintendo Wii compared to traditional balance therapy in improving balance , motivation , and functional ability in children undergoing acute rehabilitation after brain injury . Methods : A non-concurrent , r and omized multiple baseline single-subject research design was used with three participants . Data were analyzed by visual inspection of trend lines . Results : Daily Wii balance training was equally motivating to traditional balance therapy for two participants and more motivating for one participant . While improvements in dynamic balance were observed , the results for static balance remain inconclusive . All participants demonstrated improvements in functional ability . Conclusion : Wii balance therapy is a safe , feasible , and motivating intervention for children undergoing acute rehabilitation after an acquired brain injury . Further research to examine the effectiveness of Wii balance therapy in this population is warranted The aim of this article is to present a set of evidence levels , accompanied by 14 quality or rigor questions , to foster a critical review of published single‐subject research articles . In developing these guidelines , we review ed levels of evidence and quality /rigor criteria that are in wide use for group research design s , e.g. r and omized controlled trials , such as those developed by the Treatment Outcomes Committee of the American Academy for Cerebral Palsy and Developmental Medicine . We also review ed method ological articles on how to conduct and critically evaluate single‐subject research design s ( SSRDs ) . We then subjected the quality questions to interrater agreement testing and refined them until acceptable agreement was reached . We recommend that these guidelines be implemented by clinical research ers who plan to conduct single‐subject research or who incorporate SSRD studies into systematic review s , and by clinicians who aim to practise evidence ‐based medicine and who wish to critically review pediatric single‐subject research OBJECTIVES Physical and occupational therapists have started to use the Nintendo Wii ™ gaming system with adults and children as part of their regular treatment . Despite the growing use of the Wii and trend towards evidence -based practice , limited evidence is available on the effectiveness of virtual reality using the Wii for children with developmental delay . The purpose of this study was to determine the feasibility and preliminary effectiveness of a low-cost gaming system for young children with developmental delay . STUDY DESIGN Single-blind , r and omised controlled trial . PARTICIPANTS AND SETTING Forty children with developmental delay ( age 39 to 58 months ) who attended a segregated or integrated preschool participated in this study . All children 's parents read and signed an informed consent form approved by the institutional review board . Children were assigned at r and om to an experimental ( Wii ) group ( n=20 ) or a control group ( n=20 ) . INTERVENTION Two weekly sessions for 10 weeks using Nintendo Wii Sports ™ and Nintendo Wii Fit ™ , including balance , strength training and aerobics games . MAIN OUTCOME MEASURES Participants were evaluated 1 week before and 1 week after the programme by a blinded investigator . Primary outcomes were gait speed , timed up and go test , single leg stance test , five-times-sit-to-st and test , timed up and down stairs test , 2-minute walk test and grip strength . The Gross Motor Function Measure ( GMFM ) was used to assess gross motor skills . RESULTS The two groups were homogenous regarding all parameters at baseline . The Wii training was feasible and enjoyable for those in the experimental group . There were no adverse effects or injuries reported over 267 training sessions . Comparison of groups following the intervention indicated that the experimental group showed significant improvements compared with the control group in single leg stance test { mean difference 1.03 [ st and ard deviation ( SD ) 1.7 ] , 95 % confidence interval ( CI ) 0.2 to 1.9 ; P=0.017 } , right grip strength [ mean difference 1.11 ( SD 1.84 ) , 95 % CI 0.15 to 2.06 ; P=0.024 ] and left grip strength [ mean difference 0.90 ( SD 1.67 ) , 95 % CI 0.03 to 1.77 ; P=0.043 ] . Although changes in other outcome measures were not significant between the study groups , there were trends towards greater improvements in the experimental group compared with the control group . CONCLUSION This study supports use of the Wii as a feasible , safe and potentially effective therapeutic tool to augment the rehabilitation of young children with developmental delay . The potential application of the Wii to increase the intensity of therapy or as a rehabilitation tool in children 's homes and rural setting s is an area worthy of investigation . The promising results of this study suggest that further studies are warranted to vali date the potential benefits of a low-cost commercially available gaming system as a treatment strategy to supplement rehabilitation of children with disabilities BACKGROUND Children with Developmental Co-ordination Disorder ( DCD ) experience poor motor and psychosocial outcomes . Interventions are often limited within the healthcare system , and little is known about how technology might be used within schools or homes to promote the motor skills and /or psychosocial development of these children . This study aim ed to evaluate whether short , regular school-based sessions of movement experience using a commercially available home video game console ( Nintendo 's Wii Fit ) would lead to benefits in both motor and psychosocial domains in children with DCD . METHODS A r and omized crossover controlled trial of children with movement difficulties/DCD was conducted . Children were r and omly assigned to an intervention  ( n = 10 ) or comparison ( n = 8) group . The intervention group spent 10 min thrice weekly for 1 month using Wii Fit during the lunch break , while the comparison group took part in their regular Jump Ahead programme . Pre- and post-intervention assessment s considered motor proficiency , self-perceived ability and satisfaction and parental assessment of emotional and behavioural problems . RESULTS Significant gains were seen in motor proficiency , the child 's perception of his/her motor ability and reported emotional well-being for many , but not all children . CONCLUSIONS This study provides preliminary evidence to support the use of the Wii Fit within therapeutic programmes for children with movement difficulties . This simple , popular intervention represents a plausible method to support children 's motor and psychosocial development . It is not possible from our data to say which children are most likely to benefit from such a programme and particularly what the dose and duration should be . Further research is required to inform across these and other questions regarding the implementation of virtual reality technologies in therapeutic services for children with movement difficulties Objective : To investigate whether Wii Sports Resort ™ training is effective and if any benefits are maintained . Design : R and omized , single-blind trial . Participants : Sixty-two hemiplegic children with cerebral palsy ( 6–13 years ) . Intervention : Experimental group undertook six weeks of home-based Wii Sports Resort ™ training plus usual therapy , while the control group received usual therapy . Main measures : Outcomes were coordination , strength , h and function , and carers ’ perception of h and function , measured at baseline , six , and 12 weeks by a blinded assessor . Results : There was a trend of mean difference ( MD ) for the experimental group to have more grip strength by six ( MD 4.0 N , 95 % confidence interval ( CI ) −0.8 to 8.8 , p = 0.10 ) and 12 ( MD 4.1 N , 95 % CI −2.1 to 10.3 , p = 0.19 ) weeks , and to have a higher quantity of h and function according to carers ’ perception by six ( MD 4.5 N , 95 % CI −0.7 to 9.7 , p = 0.09 ) and strengthened by 12 ( MD 6.4 , 95 % CI 0.6 to 12.3 , p = 0.03 ) weeks than the control group . There was no difference between groups in coordination and h and function by six or 12 weeks . Conclusion : Wii ™ training did not improve coordination , strength , or h and function . Beyond the intervention , carers perceived that the children used their h and s more
target: All articles showed improvement in outcomes with AVG , although differences were not consistently significant compared with conventional therapy .
  However , AVG is feasible and shows potential for improving outcomes in this population .
background: AIM To examine current evidence on use of active video gaming ( AVG ) to improve motor function in children with movement disorders including cerebral palsy , developmental coordination disorder , and Down syndrome .