Active Video Gaming for use in the Home Setting for Children w/ Special Needs
By, James Every MPT
The use of commercially available video game systems in the home environment to supplement physical therapy services delivered in the school and/or outpatient settings is an alternative to a traditional home exercise program. Children frequently lose interest or refuse to participate in many home exercises because the activities are not meaningful to them and are considered boring. Part of the challenge of being a pediatric therapist is the need to incorporate creativity into a proposed intervention plan. In the most simple terms, this means that the PT must find a way to have fun while still addressing the various sensory-motor impairments that a child presents with in order to improve their overall function.
Active video game systems have been found to engage the learner through the use of various forms of sensory feedback. I think that most experienced clinicians would agree that motivation is an important component of motor learning and it can mean the difference between achieving a poor, satisfactory, or a very good outcome. If children are motivated to practice various gross motor skills by playing active video games, then theoretically they should get more repetitions in throughout the day and have a higher probability of acquiring a novel skill or re-learning a lost skill. Based on my clinical experience, use of an active video game system as part of a physical therapy home treatment plan generates much excitement among the pediatric population!
Findings from numerous studies I have included in my EBP table demonstrate improved balance, coordination, function, increased energy expenditure, and enjoyment following an active video game intervention. In addition, because many children with special needs and disabilities are unable to participate in typical childhood games and sport-related activities, the use of an active video game system may be a satisfactory substitute for these missed opportunities, from a psychosocial standpoint.
Initially, my plan was to conduct a 6 week pilot study with several students on my caseload using commercially available video game systems to play various virtual games/sports in a small group setting, one day per week after school. In essence, the idea was to develop a “video game club” for children with special needs in order to provide them with the opportunity to participate in an extra-curricular activity similar to their typically developing peers.
One important goal of the proposed pilot study above was to determine which type of system the children preferred (Nintendo Wii vs. Xbox Kinect). In addition to the goal above and determining the feasibility of actually implementing an after school video game club, another objective was to examine each student’s postural control/balance by incorporating several pre/post measurements using a common clinical test such as the Pediatric Berg Balance Scale, plus the actual Wii Balance Board. Unfortunately, my initial proposal did not get approved primarily because of liability concerns and time constraints. Therefore, I decided I would provide a presentation to interested parents, including an interactive lab component which would assist them in considering the use of an active video game system in their home setting. My presentation is scheduled for Thursday, April 18th at one of the elementary schools I serve in N. Raleigh.
CapstonePowerPointPDF Capstonereferencesparents CapstoneEvaluation
The objectives of my Capstone project are to:
1. Provide a rationale briefly discussing some of the recent evidence to support using a commercially available video game system as an adjunct to PT services delivered in the school and/or outpatient clinic.
2. Discuss possible positive outcomes as a result of a home based intervention.
3. Describe the differences in technology that a Haptic-based gaming system utilizes (Nintendo Wii) vs. a Gesture-based (Xbox Kinect).
4. Illustrate that each system has advantages/disadvantages and selecting the most appropriate device depends on the childs’ abilities and limitations.
5. Encourage a healthy collaboration between the child’s physical therapist and family to help choose individual games that student may benefit from most to address impairments found in the initial evaluation.
6. Emphasize that this technology is not meant to replace traditional physical therapy and that additional research is needed in the future with studies specifically designed to examine the transfer of motor skills into the real world.
I would like to thank Dr. Karen McCulloch for her guidance in helping me define my Capstone project and for having the patience to assist a digital immigrant like myself when technical problems arose during these past two years. I am also grateful to my fantastic and devoted committee members and co-workers, Jane Mac Neela & Briane Perry, and to Dr. Carol Giuliani for the valuable mentorship she provided to me in October 2012, regarding the preparation/planning aspect of my first lecture presented in her PHYT 727 Motor Learning class.
Lastly, additional thanks to Dr Giuliani for her suggestions regarding how to improve the content and organization of my PowerPoint slides for future presentations, and for reminding me to always strive to keep my learners engaged!
James
5 Responses to “Video Gaming for Home Use for Children with Special Needs”
Karen McCulloch
HI James,
I would love to hear how the presentation went that you offered to parents and your thoughts on how you might modify if you were to do a similar thing again. Did you offer people a chance to try the systems and think about how it might work for their child? I would think that offering some specific ideas about games that would be best to start with might be useful. Any suggestions?
kmac
Andrea Hartzell
Hi James,
I was excited to read about your project because I remember from last semester reading about the research you were doing and was very interested in being able to use this with the children I treat. I agree that motivating children is key for a pediatric PT and it seems that in today’s world of technology, this is definitely something that motivates and keeps their interest.
I appreciated the information you provided about the different systems and how they work. I agree with you about the use of the balance board – I have used this with some of the children I used to work with that had issues with weight shifting, timing, and motor planning, and I definitely saw improvements from week to week.
I also encourage the patients I see at the Healthy Lifestyles Program to use this as a way to be more active and am familiar with some of the studies you had mentioned regarding energy expenditure. I think this is very motivating for this population of patients and also the parents get involved with their children more with this type of activity as well.
You did a great job on the PP project! I would love to be able to share some of this information with the PT’s/OT’s I work with. Let me know if you are willing to come for a lunch and learn sometime! We have a Wii with a balance board and do use it, but more information and guidance would be great!
Great job and Congrats!
Andrea
clshort
Hey James!!
First of all, GREAT work! I loved reading about your project, especially because video games are a some what new addition to the PT field. My only experience thus far with gaming in PT is from my inpatient neuro rotation, specifically with patients post-stroke. There was a Wii for use with recreational therapy, which the older patients really had fun with! I was also surprised how many games there are that focus on a variety of tasks, for example sitting vs standing dynamic balance. I saw that you mentioned this balance board in your PPT and I have to say I loved it too. It was especially great for learning to weight shift in sitting for patients with severe hemiplegia.
I LOVE your idea of the term “video game club!” I think that especially in the home setting, kids are playing these games with siblings or alone. I think that this is a great idea to incorporate them in extracurricular activities with other kids their age! It would also give them something to look forward to.
Additionally, I think that the Xbox Kinect would be better for higher level individuals, otherwise, like you mentioned, it may be difficult for some children to perform required positions for the system. I think the Wii has its disadvantages in other ways, but it is more versatile because it is controlled by tactile information (the Wiimote by hand, or balance board for example).
After reviewing your research and PPT info, my vote goes to the Wii!
Great job!
Cassie
Chritina Aluri
Hi James, I loved all of your materials! I will be doing my last rotation this summer at the inpatient pediatric rehabilitation department at CMC Levine’s in Charlotte this summer. I am so glad that they have a Wii there (maybe they’ll get a kinect too!) and was wondering how you would suggest I incorporate its use in this setting? Thanks and great job!
Christina
tjbritt
Hi James,
I thoroughly enjoyed learning about your capstone and to see how it has formulated since the last time we talked! I must say your background information on VR and the different video gaming system was very informative. I never considered myself to be a “video game nut”, but I felt fairly competent in my knowledge. However you easily relate how these systems impact the sensory system, providing a solid foundation for the support of video games in rehab.
I used two video gaming studies for my capstone that focused on the use static balance to promote dynamic balance and decrease postural sway. This was used for cerebellar ataxia in children. The Wii balance board seemed similar to the force plate used by Betker (it was a large square and required the children to forward or side→side weight shift to complete the video game task). For this reason, I think transfer of balance can be used on the Wii Balance board (which you also suggested fairs well against the gold standard force plates)! I also like the picture of the elephant on the ball ( I used the same one in my ppt)!
I think finding activities that motivate children is extremely important. However it can be extremely difficult to find motivating activities that promote long term compliance. I think of myself in instances as my “motivators” have changed as I have aged. Likewise, even activities I used to enjoy, too much can cause burn out. With video games you can utilize your same basic “therapy” principles, but there are always new video games being developed. Likewise for children who may not be able to afford video game system such as the Wii or X-box, library’s sometimes offer them (to use AT THE LIBRARY). The games may be older, but non-the-less this could be used as a resource to get some “gaming time in”.
Holly Holland hosts a constraint induced movement therapy camp every summer for hemi’s. One of the sensory rooms has a Wii and literally there is always a line to play because the kids enjoy it so much – case in point!
Therapeutic + Fun = SUCCESS
GREAT JOB!
Britt