Abstract
BackgroundComputer game–based interventions are emerging in pediatric neurorehabilitation, as they can provide two key elements for motor learning—motivating environments that enable long-term compliance, which is particularly relevant for children, and augmented feedback for improving movement performance.ObjectiveThe overall aim of this study is to develop an interactive computer play for children with upper motor neuron lesions to train selective voluntary motor control and give particular attention to motivation and feedback. We also aim to determine features that make games engaging, investigate which sensory feedback modality is noticed the fastest during play, develop an interactive game, and evaluate its feasibility.MethodsWe identified engaging game features by interviewing 19 children and adolescents undergoing rehabilitation. By using a test version of the game, we determined the response times of 10 patients who had to react to visual, auditory, or combined feedback signals. On the basis of the results of these two subprojects, we developed and designed a game environment. Feasibility was studied in terms of the practicability and acceptability of the intervention among 5 children with upper motor neuron lesions.ResultsThe game features deemed the most important by pediatric patients were strategic gameplay (13/29, 45% of answers) and choice (6/29, 21%). While playing the game, an acoustic alarm signal (reaction time: median 2.8 seconds) was detected significantly faster (P=.01) than conditions with other feedback modalities (avatar velocity reduction: median 7.8 seconds; color desaturation: median 5.7 seconds). Most children enjoyed playing the game, despite some technical issues.ConclusionsThe careful identification of game features that increase motivation and feedback modalities that inform children quickly led to the development of an interactive computer play for training selective voluntary motor control in children and adolescents with upper motor neuron lesions.
Highlights
IntroductionBackground Patients with upper motor neuron lesions (ie, due to traumatic brain injury, stroke, or spastic cerebral palsy [cerebral palsy interactive computer play (ICP) (CP)]) exhibit a variety of motor impairments
Patients with upper motor neuron lesions exhibit a variety of motor impairments
We formulated the following specific research questions for the development of an interactive computer play (ICP) to train selective voluntary motor control (SVMC): (1) which features of commercial games do children and adolescents undergoing neuro-orthopedic rehabilitation like, (2) which modality of feedback indicating a negative occurrence is perceived most by these patients while playing an ICP, and (3) is it feasible to use the new ICP as an intervention for children and adolescents with impaired SVMC due to an upper motor neuron lesion?
Summary
Background Patients with upper motor neuron lesions (ie, due to traumatic brain injury, stroke, or spastic cerebral palsy [CP]) exhibit a variety of motor impairments. These symptoms are typically categorized as positive or negative motor signs [1,2]. Negative motor signs describe insufficient (control of) muscle https://games.jmir.org/2021/3/e26028 XSLFO RenderX. Loss of SVMC can clinically manifest as impaired movement control and a multitude of involuntary movements (ie, unintended movements that co-occur with the performance of a voluntary task [3]), such as mass flexion or extension patterns, synergies of muscle activation (ie, obligatory grouped multi-joint movements), or mirror movements (ie, simultaneous, identical movements on the contralateral side) [4,5]. Computer game–based interventions are emerging in pediatric neurorehabilitation, as they can provide two key elements for motor learning—motivating environments that enable long-term compliance, which is relevant for children, and augmented feedback for improving movement performance
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