Innovative Game-Aided Rehabilitation Platform for Rehabilitation of Balance in Children with Cerebral Palsy.

Abstract

Introduction: Cerebral Palsy (CP) is one of the leading causes of disability globally. Children with CP often develop imbalance and gait abnormality resulting in mobility limitations. Early intervention with intensive, repetitive, task-oriented practice is the key to functional independence. However, often these intensive programs lack motivation and engagement that results in low adherence and discontinuation of physiotherapy. To address this gap, an innovative, computerized game-aided rehabilitation (CGR) platform is designed for dual-task balance training. This platform provides an integrated approach to assess and treat the balance and executive cognitive functions in young children with CP. Methodology: For the known-group validity, 50 participants (25 TD and 25 CP affected children) were recruited. Comparisons were made between the two groups for DTI and task performances to evaluate the group differences. For the pilot intervention study, 16 children with CP were recruited who were randomized into two groups viz. Conventional balance training group (CBG) and Experimental group (XG). Both group received their respective therapy thrice a week for 12 weeks. The primary outcome measures were (Peabody Developmental Motor Scale-2, Gross Motor Function Classification-88, and Pediatric Balance Scale) and CGR assessment measures [COP Analysis, Visuo-Motor (VM) tracking, and Cognitive Game (CG)]. Semi-structured interview were conducted for XG participant’s parents to explore their views regarding the use of CGR. Results: The TD group was engaged in DT whereas the CP group was struggling with balance control. For the intervention study, participants in the XG demonstrated greater improvements in all clinical and CGR outcome measures whereas the CBG demonstrated a decline in VM tracking a CG performance post-intervention. The XG parents conveyed their children’s problems, their expectations, their challenges, and the positive effects of CGR balance training. Conclusion: The CGR assessment was able to differentiate between the TD and CP children’s DT functional performance. The CGR balance training was found to be feasible and engaging for balance training in children with CP. The substantial improvement of balance and gross motor functions in the XG more than the CBG illustrates the effectiveness of the CGR balance training and provides baseline evidence for commencing a full-scale RCT.