Augmenting pediatric constraint-induced movement therapy and bimanual training with video gaming technology

Issue title: State of the Science for Pediatric Rehabilitation Engineering

Guest editors: Richard Foulds and Sergei Adamovich

Article type: Research Article

Authors: Gordon, Andrew M.^{a; *} | Okita, Sandra Y.^b

Affiliations: [a] Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA | [b] Department of Mathematics, Science, and Technology, Teachers College, Columbia University, New York, NY, USA | Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA

Correspondence: [*] Address for correspondence: Andrew M. Gordon, Ph.D., Department of Biobehavioral Sciences, Box 199, Teachers College, Columbia University, 525 West 120th Street, New York, NY 10027, USA. Tel.: +1 212 678 3326; Fax: +1 212 678 3322; E-mail: ag275@columbia.edu.

Abstract: Cerebral palsy (CP) is the most common cause of physical disability in childhood. Hemiplegia is among the most common forms of CP and the resulting impaired hand function is one of the most disabling symptoms, affecting self-care activities such as feeding, dressing, and grooming. To date, evidence-based treatments are limited. Recent approaches, however, have capitalized on findings that show children with hemiplegia have residual motor capabilities and neuroplastic changes in nervous system function that emerge and improve with practice. Here the etiology and neural basis of hemiplegic CP is first briefly reviewed, followed by a description of the residual motor capabilities in the involved upper extremity and the potential role of intensive practice. Two promising approaches that target residual motor function, constraint-induced movement therapy (CIMT) and bimanual training, are then described. Recent evidence suggests that such task-oriented training approaches to rehabilitation are enhanced when the tasks are meaningful to the performer. Increasingly, this means use of current technology, specifically video gaming, to maintain salience and motivation and target specific motor impairments. Thus a method for using commercially available video gaming, including the Nintendo Wii to augment such intensive treatment approaches is described. It is suggested that with such intensive treatment programs, gaming can be an important compliment to, but not a replacement for, salient task-oriented activities in the real world and that video gaming and virtual reality training will be an important part of future rehabilitation efforts.

Keywords: video game console, Nintendo Wii, computer game, virtual reality, virtual environment, rehabilitation, cerebral palsy, task-oriented training, upper extremity, hand, bimanual training, constraint-induced movement therapy

DOI: 10.3233/TAD-2010-0302

Journal: Technology and Disability, vol. 22, no. 4, pp. 179-191, 2010