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. An active video game intervention does not improve physical activity and sedentary time of children at-risk for developmental coordination disorder: a crossover randomized trial. Effects of interactive games on motor performance in children with spastic cerebral palsy “Not just another Wii training”: a graded Wii protocol to increase physical fitness in adolescent girls with probable developmental coordination disorder-a pilot study Video-game based therapy performed by children with cerebral palsy: a cross-over randomized controlled trial and a cross-sectional quantitative measure of physical activity. Optimising motor learning in infants at high risk of cerebral palsy: a pilot study Modified Constraint-Induced Movement Therapy combined with Bimanual Training (mCIMT-BiT) in children with unilateral spastic cerebral palsy: how are improvements in arm-hand use established? Variable training does not lead to better motor learning compared to repetitive training in children with and without DCD when exposed to active video games. Effects of Nintendo Wii-Fit® video games on balance in children with mild cerebral palsy. Effect of therapist-based constraint-induced therapy at home on motor control, motor performance and daily function in children with cerebral palsy: a randomized controlled study The effectiveness of exercise intervention on inhibitory control in children with developmental coordination disorder: using a visuospatial attention paradigm as a model. The efficacy of two task-orientated interventions for children with Developmental Coordination Disorder: Neuromotor Task Training and Nintendo Wii Fit Training. The Oxford-Durham Study: A Randomized, Controlled Trial of Dietary Supplementation With Fatty Acids in Children With Developmental Coordination Disorder 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. Intrathecal baclofen treatment in dystonic cerebral palsy: a randomized clinical trial: the IDYS trial Sitting playfully: does the use of a centre of gravity computer game controller influence the sitting ability of young people with cerebral palsy? Single blind randomised controlled trial of GAME (Goals - Activity - Motor Enrichment) in infants at high risk of cerebral palsy. Effect of treatment environment on modified constraint-induced movement therapy results in children with spastic hemiplegic cerebral palsy: a randomized controlled trial Motor Imagery Training Ameliorates Motor Clumsiness in Children Deliberate Play and Preparation Jointly Benefit Motor and Cognitive Development: Mediated and Moderated Effects A modified constraint-induced movement therapy (CIT) program improves paretic arm use and function in children with cerebral palsy. Feasibility, Motivation, and Selective Motor Control: Virtual Reality Compared to Conventional Home Exercise in Children with Cerebral Palsy Behavior During Tethered Kicking in Infants With Periventricular Brain Injury
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 ) BACKGROUND Children with developmental coordination disorder ( DCD ) are highly inactive and sedentary . The purpose of this study was to assess the impact of a home-based active video game intervention on objective ly measured physical activity and sedentary behaviour in children at risk for DCD . METHODS In a crossover r and omized clinical trial , 21 children ( mean age 11.0 , SD 1.0 ; n = 11 girls ) in Perth , Western Australia participated in two 16-week periods : no active video games ( AVGs ) control period and AVGs intervention period . Two active input consoles were provided to participants along with a selection of non-violent AVGs for participants to play at home . Participants wore accelerometers at baseline and following each period to determine minutes of sedentary , light , moderate and vigorous times in addition to self-reported types of activities in a diary . Linear mixed models , adjusted for the order of periods , compared physical activity and sedentary time during the last week of each period . RESULTS There were no significant differences between the intervention and control periods in time spent in sedentary ( decrease of -1.0 min/day during the intervention period , 95%CI -12.1 , 10.1 ) , light ( increase of 2.2 min/day , 95%CI -8.8 , 13.2 ) , moderate ( decrease of 0.7 min/day , 95%CI -4.6 , 3.3 ) or vigorous ( decrease of -0.6 min/day , 95%CI -1.6 , 0.4 ) . CONCLUSIONS Among children at risk for DCD , participating in this AVG intervention did not improve objective ly measured physical activity and sedentary time [ 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 Background Adolescents with low motor competence participate less in physical activity and tend to exhibit decreased physical fitness compared to their peers with high motor competence . It is therefore essential to identify new methods of enhancing physical fitness in this population . Active video games ( AVG ) have been shown to improve motor performance , yet investigations of its impact on physical fitness are limited . The objective of this study was to examine the impact of the grade d Wii protocol in adolescent girls with probable Developmental Coordination Disorder ( p-DCD ) . Methods A single-group pre-post design was conducted to assess the impact of a newly developed Wii protocol in adolescent girls attending school in a low income community of Cape Town , South Africa . Sixteen participants ( aged 13 - 16 years ) with p-DCD ( ≤16th percentile on the MABC-2 test ) were recruited . Participants received 45 min Wii training for 14 weeks . Outcome measures included the six-minute walk distance and repeated sprint ability . Information on heart rate , enjoyment and perceived exertion ratings were also collected . Results Significant improvements in aerobic and anaerobic fitness were observed . The participants reported high enjoyment scores and low perceived exertion ratings . The grade d Wii protocol was easily adaptable and required little re sources ( space , equipment and expertise ) to administer . Conclusions The findings provide preliminary evidence to support the use of the grade d Wii protocol for promoting physical fitness in adolescent girls with p-DCD . Further studies are needed to confirm these results and to vali date the clinical efficacy of the protocol in a larger sample with a more robust design BACKGROUND Previous studies reported controversial results about the efficacy of video-game based therapy ( VGT ) in improving neurorehabilitation outcomes in children with cerebral palsy ( CP ) . AIM Primary aim was to investigate the effectiveness of VGT with respect to conventional therapy ( CT ) in improving upper limb motor outcomes in a group of children with CP . Secondary aim was to quantify if VGT leads children to perform a higher number of movements . DESIGN A cross-over r and omized controlled trial ( RCT ) for investigating the primary aim and a cross-sectional study for investigating the secondary aim of this study . SETTING S Out patients . POPULATION INCLUSION CRITERIA clinical diagnosis of CP , age between 4 and 14 years , level of GMFC between I and IV . EXCLUSION CRITERIA QI<35 , severe comorbidities , incapacity to st and even with an external support . METHODS Twenty-two children with CP ( 6.89±1.91-year old ) were enrolled in a cross-over RCT with 16 sessions of VGT ( using Xbox with Kinect device ) and then 16 of CT or vice versa . Upper limb functioning was assessed using the Quality of Upper Extremities Skills Test ( QUEST ) and h and abilities using Abilh and -kids score . According to the secondary aim of this study a secondary cross-sectional study has been performed . Eight children with CP ( 6.50±1.60-year old ) were enrolled into a trial in which five wireless triaxial accelerometers were positioned on their forearms , legs and trunk for quantifying the physical activity during VGT vs. CT .  RESULTS QUEST scores significantly improved only after VGT ( P=0.003 ) , and not after CT ( P=0.056 ) . The reverse occurred for Abilh and -kids scores ( P=0.165 vs. P=0.013 , respectively ) . Quantity of performed movements was three times higher in VGT than in CT ( + 198 % , P=0.027 ) . CONCLUSION VGT result ed effective in improving the motor functions of upper limb extremities in children with CP , conceivably for the increased quantity of limb movements , but failed in improving the manual abilities for performing activities of daily living which benefited more from CT . CLINICAL REHABILITATION IMPACT VGT performed using the X-Box with Kinect device could enhance the number of upper limb movements in children with CP during rehabilitation and in turn improving upper limb motor skills , but CT remained superior for improving performances in manual activities of daily living Background The average age for the diagnosis of cerebral palsy ( CP ) is 19 months . Recent neuroplasticity literature suggests that intensive , task-specific intervention ought to commence as early as possible and in an enriched environment , during the critical period of neural development . Active motor interventions are effective in some population s , however the effects of active motor interventions on the motor outcomes of infants with CP have not been research ed thoroughly , but pilot work is promising . The aim of this study was to determine the short- term effects of “ GAME ” ; a new and novel goal -oriented activity-based , environmental enrichment therapy programme on the motor development of infants at high risk of CP and test study procedures for a r and omized controlled trial ( RCT ) . Methods Pragmatic 2-group pilot RCT to assess motor outcomes , goal attainment , parent well-being and home environment quality , after 12-weeks of GAME intervention versus st and ard care . GAME included : creation of movement environments to elicit motor behaviours ; parent training in motor learning and task analysis ; frequent practice of motor tasks using a programme that was individualised to the child , was varied and focused on self-initiated movement . Data were analyzed using multiple regression . Results Thirteen infants were consented , r and omised , treated and completed the study . At study conclusion , the GAME group ( n = 6 ) demonstrated an advantage in Total Motor Quotient of 8.05 points on the Peabody Developmental Motor Scale-2 ( PDMS-2 ) compared to the st and ard care group ( n = 7 ) ( p < .001 ) . No significant differences existed between groups on any other measure . Conclusions GAME appears to offer a promising and feasible new motor intervention for CP , with favourable short-term motor outcomes . A pressing need exists for an adequately powered RCT with long-term end points , to determine if GAME may advance these children ’s motor trajectory A recent r and omized controlled trial indicated that modified Constraint-Induced Movement Therapy followed by Bimanual Training ( mCIMT-BiT ) is an effective intervention to improve spontaneous use of the affected upper limb in children with unilateral spastic cerebral palsy ( CP ) . The present study aim ed to investigate how the above-mentioned improvements as a result of 8 weeks mCIMT-BiT were established . 52 children with unilateral spastic CP with Manual Ability Classification System ( MACS ) scores I , II or III and aged 2.5 - 8 years were r and omly allocated to either mCIMT-BiT ( n = 28 ) or Usual Care ( UC ) ( n = 24 ) . Developmental disregard ( ' learned non-use ' ) and upper limb capacity and performance scores were derived from the Video Observations Aarts and Aarts , module Determine Developmental Disregard . Active and passive range of motion at the affected wrist and elbow were assessed using goniometry during isolated movements . Upper limb capacity and performance demonstrated significantly greater improvements after mCIMT-BiT compared to UC , which lasted up to 8 weeks follow-up , whereas developmental disregard and passive and active range of motion did not show differential effects . The results support the notion that improvement of capacity and performance of the upper limb through mCIMT-BiT in children with unilateral spastic CP is based on a better utilization of existing motor functions of the affected arm and h and . However , enhancement of the overall amount of use ( or the reduction of learned non-use ) may still be suboptimal leaving room for improvement of this treatment BACKGROUND Little is known about the influence of practice schedules on motor learning and skills transfer in children with and without developmental coordination disorder ( DCD ) . Underst and ing how practice schedules affect motor learning is necessary for motor skills development and rehabilitation . AIMS The study investigated whether active video games ( exergames ) training delivered under variable practice led to better learning and transfer than repetitive practice . METHODS AND PROCEDURES 111 children aged 6 - 10 years ( M=8.0 , SD=1.0 ) with no active exergaming experience were r and omized to receive exergames training delivered under variable ( Variable Game Group ( VGG ) , n=56 ) or repetitive practice schedule ( Repetitive Game Group ( RGG ) , n=55 ) . Half the participants were identified as DCD using the DSM-5 criteria , while the rest were typically developing ( TD ) , age-matched children . Both groups participated in two 20min sessions per week for 5 weeks . OUTCOMES AND RESULTS Both participant groups ( TD and DCD ) improved equally well on game performance . There was no significant difference in positive transfer to balance tasks between practice schedules ( Repetitive and Variable ) and participant groups ( TD and DCD ) . CONCLUSIONS AND IMPLICATION S Children with and without DCD learn balance skills quite well when exposed to exergames . Gains in learning and transfer are similar regardless of the form of practice schedule employed . WHAT THIS PAPER ADDS This is the first paper to compare the effect of practice schedules on learning in children with DCD and those with typical development . No differences in motor learning were found between repetitive and variable practice schedules . When children with and without DCD spend the same amount of time on exergames , they do not show any differences in acquisition of motor skills . Transfer of motor skills is similar in children with and without DCD regardless of differences in practice schedules BACKGROUND This study compared the effects of Nintendo Wii-Fit ® balance-based video games and conventional balance training in children with mild cerebral palsy ( CP ) . METHODS This r and omized controlled trial involved 30 ambulatory pediatric patients ( aged 5 - 18 years ) with CP . Participants were r and omized to either conventional balance training ( control group ) or to  Wii-Fit balance-based video games training ( Wii group ) . Both group received neuro-developmental treatment ( NDT ) during 24 sessions . In addition , while the control group received conventional balance training in each session , the Wii group played Nintendo Wii Fit games such as ski slalom , tightrope walk and soccer heading on balance board . Primary outcomes were Functional Reach Test ( forward and sideways ) , Sit-to-St and Test and Timed Get up and Go Test . Nintendo Wii Fit balance , age and game scores , 10 m walk test , 10-step climbing test and Wee-Functional Independence Measure ( Wee FIM ) were secondary outcomes . RESULTS After the treatment , changes in balance scores and independence level in activities of daily living were significant ( P < 0.05 ) in both groups . Statistically significant improvements were found in the Wii-based game group compared with the control group in all balance tests and total Wee FIM score ( P < 0.05 ) . CONCLUSION Wii-fit balance-based video games are better at improving both static and performance-related balance parameters when combined with NDT treatment in children with mild CP Objective : To determine the effect of therapist-based constraint-induced therapy at home on motor performance , daily function and reaching control for children with cerebral palsy . Design : A single-blinded , r and omized controlled trial . Subjects : Forty-seven children ( 23 boys ; 24 girls ) with unilateral cerebral palsy , aged 6–12 years , were r and omized to constraint-induced therapy ( n = 24 ) or traditional rehabilitation ( n = 23 ) . Interventions : Constraint-induced therapy involved intensive functional training of the more affected arm while the less affected arm was restrained . Traditional rehabilitation involved functional unilateral and bilateral arm training . Both groups received individualized therapist-based interventions at home for 3.5–4 hours/day , two days a week for four weeks . Main measures : Motor performance and daily function were measured by the Peabody Developmental Motor Scale , Second Edition and the Pediatric Motor Activity Log . Reaching control was assessed by the kinematics of reaction time , movement time , movement unit and peak velocity . Results : There were larger effects in favour of constraint-induced therapy  on motor performance , daily function , and some aspects of reaching control compared with traditional rehabilitation .  Children  receiving constraint-induced therapy demonstrated higher scores for Peabody Developmental Motor Scale , Second Edition – Grasping ( pretest mean ± SD , 39.9 ± 3.1 ; posttest , 44.1 ± 2.8 ; P < 0.001 ) , Pediatric Motor Activity Log ( pretest , 1.8 ± 0.3 ; posttest , 2.5 ± 0.3 ; P < 0.001 ) and shorter reaction time , normalized movement time ( P < 0.001 ) and higher peak velocity ( P = 0.004 ) of reaching movement . Conclusions : Constraint-induced therapy induced better grasping performance , daily function , and temporal and spatiotemporal control of reaching in children with unilateral cerebral palsy than traditional rehabilitation Children with developmental coordination disorder ( DCD ) have been demonstrated to show a deficit of inhibitory control in volitional shifts of attention . The aim of this study was to use ecological intervention to investigate the efficacy of table-tennis training on treating both problems with attentional networks and motor disorder in children with DCD . Forty-three children aged 9 - 10 years old were screened using the Movement Assessment Battery for Children and divided into DCD ( n=27 ) and typically developing ( TD , n=16 ) groups . Children with DCD were then quasi-r and omly assigned to either a DCD-training group who underwent a ten-week table-tennis training program with a frequency of 3 times a week or a DCD non-training group . Before and after training , the capacity of inhibitory control was examined with the endogenous Posner paradigm task for DCD and TD groups . Table-tennis training result ed in significant improvement of cognitive and motor functions for the children with DCD . The study demonstrated that exercise intervention employed within the school setting can benefit the inhibitory control and motor performance in children with DCD . However , future research efforts should continue to clarify whether the performance gains could be maintained over time 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 Background . Developmental coordination disorder ( DCD ) affects ∼5 % of school-aged children . In addition to the core deficits in motor function , this condition is associated commonly with difficulties in learning , behavior , and psychosocial adjustment that persist into adulthood . Mounting evidence suggests that a relative lack of certain polyunsaturated fatty acids may contribute to related neurodevelopmental and psychiatric disorders such as dyslexia and attention-deficit/hyperactivity disorder . Given the current lack of effective , evidence -based treatment options for DCD , the use of fatty acid supplements merits investigation . Methods . A r and omized , controlled trial of dietary supplementation with ω-3 and ω-6 fatty acids , compared with placebo , was conducted with 117 children with DCD ( 5–12 years of age ) . Treatment for 3 months in parallel groups was followed by a 1-way crossover from placebo to active treatment for an additional 3 months . Results . No effect of treatment on motor skills was apparent , but significant improvements for active treatment versus placebo were found in reading , spelling , and behavior over 3 months of treatment in parallel groups . After the crossover , similar changes were seen in the placebo-active group , whereas children continuing with active treatment maintained or improved their progress . Conclusions . Fatty acid supplementation may offer a safe efficacious treatment option for educational and behavioral problems among children with DCD . Additional work is needed to investigate whether our inability to detect any improvement in motor skills reflects the measures used and to assess the durability of treatment effects on behavior and academic progress 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 Background Dystonic cerebral palsy is primarily caused by damage to the basal ganglia and central cortex . The daily care of these patients can be difficult due to dystonic movements . Intrathecal baclofen treatment is a potential treatment option for dystonia and has become common practice . Despite this widespread adoption , high quality evidence on the effects of intrathecal baclofen treatment on daily activities is lacking and prospect i ve data are needed to judge the usefulness and indications for dystonic cerebral palsy . The primary aim of this study is to provide level one clinical evidence for the effects of intrathecal baclofen treatment on the level of activities and participation in dystonic cerebral palsy patients . Furthermore , we hope to identify clinical characteristics that will predict a beneficial effect of intrathecal baclofen in an individual patient . Methods / Design A double blind placebo-controlled multi-center r and omized clinical trial will be performed in 30 children with dystonic cerebral palsy . Patients aged between 4 and 25 years old with a confirmed diagnosis of dystonic cerebral palsy , Gross Motor Functioning Classification System level IV or V , with lesions in the cerebral white matter , basal ganglia or central cortex and who are eligible for intrathecal baclofen treatment will be included . Group A will receive three months of continuous intrathecal baclofen treatment and group B will receive three months of placebo treatment , both via an implanted pump . After this three month period , all patients will receive intrathecal baclofen treatment , with a follow-up after nine months . The primary outcome measurement will be the effect on activities of and participation in daily life measured by Goal Attainment Scaling . Secondary outcome measurements on the level of body functions include dystonia , spasticity , pain , comfort and sleep-related breathing disorders . Side effects will be monitored and we will study whether patient characteristics influence outcome . Discussion The results of this study will provide data for evidence -based use of intrathecal baclofen in dystonic cerebral palsy . Trial registration Nederl and s Trial Register , Purpose : An investigative study to examine whether sitting ability could be improved through the use of a suite of computer games operated by leaning in one of four directions in a seated position . Method : Young people with cerebral palsy played with a suite of computer games controlled using a sitting platform that can detect changes in the distribution of pressure . A r and omized cross-over trial with two periods of three months involving intervention or no intervention was used . Sitting ability was measured at the beginning and end of each period with participants acting as their own controls . Results : Statistically significant improvements were seen in two elements of box sitting using the Chailey levels ( shoulder girdle position and spinal profile ) and in five elements of the Sitting Assessment for Children with Neuromotor Dysfunction across both reach and rest phases of the assessment . Conclusions : The study provides evidence to suggest that a meaningful and engaging therapeutic activity , such as using computer games controlled by leaning the upper body , can help to improve sitting ability in children with neuromotor dysfunction . Further work is required to underst and fully what effects such activities have on the various components of sitting ability . Implication s for Rehabilitation Children with a neuromotor dysfunction such as Cerebral Palsy have less opportunities to play and have difficulty using st and ard computer based gaming equipment . Games consoles that require body movement such as the Nintendo Wii and Kinect are being purchased by Schools , Rehabilitation Centres and by Families with a number of aims . In a small sample this study indicates that using such equipment may improve some aspects of sitting ability BACKGROUND Cerebral palsy ( CP ) is caused by a lesion in the developing infant brain . Recent neuroplasticity literature suggests that intensive , task-specific intervention ought to commence early , during the critical period of neural development . AIMS To determine whether " GAME " ( Goals - Activity - Motor Enrichment ) , a motor learning , environmental enrichment intervention , is effective for improving motor skills in infants at high risk of CP . METHODS AND PROCEDURES Single blind r and omised controlled trial of GAME versus st and ard care . Primary outcome was motor skills on the Peabody Developmental Motor Scales-2 ( PDMS-2 ) . Secondary outcomes included Canadian Occupational Performance Measure ( COPM ) , Bayley Scales of Infant and Toddler Development ( BSID-III ) and Gross Motor Function Measure-66 ( GMFM-66 ) . Outcome assessors were masked to group allocation and data analyzed with multiple regression . OUTCOMES AND RESULTS All n=30 infants enrolled received the assigned intervention until 16 weeks post enrolment . At 12 months of age , n=26 completed assessment s. Significant between group differences were found in raw scores on the PDMS-2 in favour of GAME ( B=20.71 , 95%CI 1.66 - 39.76 , p=0 . 03 ) and at 12 months on the total motor quotient ( B=8.29 , 95%CI 0.13 - 16.45,p = 0.05 ) . Significant between group differences favored GAME participants at 12 months on the cognitive scale of the BSID-III and satisfaction scores on the COPM . CONCLUSION GAME intervention result ed in advanced motor and cognitive outcomes when compared with st and ard care Purpose : To determine the effects of treatment environment ( home and clinic ) on results of modified constraint-induced movement therapy ( modified CIMT ) in children with spastic hemiplegic cerebral palsy . Method : In a single-blinded , r and omized , controlled trial , 14 children with spastic hemiplegic cerebral palsy ( 5 females , 9 males ; mean age : 74 months ) received 15 hours of modified CIMT , occurring three times/week for 10 sessions every other day in two r and omly assigned groups . Each session lasts one and half hours . Treatment environment for intervention group ( n = 7 ) was home and for control group ( n = 7 ) was clinic . Measures were conducted pre , post and 3 months after treatment period by pediatrics motor activity log and subtests 5 ( upper limb coordination ) and 8 ( upper limb speed and dexterity ) of Bruininks – Oseretsky test of motor proficiency . Sample r and omization and data analysis by analysis of variance with repeated measures were conducted by SPSS-16 software in α level set at p < 0.05 . Results : All subjects showed significant improvement ( p < 0.01 ) in post-test measures except subtest 5 of Bruininks – Oseretsky test of motor proficiency . In contrast to clinic group , subjects in home showed significantly continued improvement at follow-up session in all measures . Conclusions : Modified CIMT is effective in improving upper limb function in children with spastic hemiplegic cerebral palsy . In addition , more improved performance in home group places the practice in natural context as the preferred method for treatment of these children . Implication s for Rehabilitation In hemiplegic cerebral palsy , one side of the body is more affected , which is a consequence of non-progressive impairments in the brain . Constraint-induced movement therapy tries to improve upper limb function of hemiparetic children by restraint of the less-affected h and and intensive training of the more-affected h and . This study shows more improvement of h and function through implementing constraint-induced movement therapy in home than clinic . In a r and omized , controlled trial , our study shows the positive effects of practice in natural environments compared to simulated environments such as clinic Children with impaired motor coordination ( or developmental coordination disorder ) have difficulty representing internally the visuospatial coordinates of intended movements . We have proposed that this deficit reflects impairment in the generation of forward models of the efference copy of intended movements―the efference-copy-deficit hypothesis . In this study , we challenged this hypothesis by examining the efficacy of an imagery intervention design ed specifically to train the forward modeling of purposive actions . A pre-post design was adopted . Fifty-four children referred with motor coordination problems were assigned r and omly to one of three groups : imagery training , traditional perceptual-motor training , and wait-list control . The imagery protocol ―delivered by an interactive CD―ROM―was shown to be equally effective to  perceptual-motor training  in facilitating the development of motor skill in the referred children . These results support the efference-copy-deficit hypothesis in explaining the cause of motor clumsiness in most children . Directions for future intervention studies and remediation in the field of developmental clumsiness are discussed . ( J Child Neurol 2002;17:491 - 498 ) In light of the interrelation between motor and cognitive development and the predictive value of the former for the latter , the secular decline observed in motor coordination ability as early as preschool urges identification of interventions that may jointly impact motor and cognitive efficiency . The aim of this study was twofold . It ( 1 ) explored the outcomes of enriched physical education ( PE ) , centered on deliberate play and cognitively challenging variability of practice , on motor coordination and cognitive processing ; ( 2 ) examined whether motor coordination outcomes mediate intervention effects on children ’s cognition , while controlling for moderation by lifestyle factors as outdoor play habits and weight status . Four hundred and sixty children aged 5–10 years participated in a 6-month group r and omized intervention in PE , with or without playful coordinative and cognitive enrichment . The weight status and spontaneous outdoor play habits of children ( parental report of outdoor play ) were evaluated at baseline . Before and after the intervention , motor developmental level ( Movement Assessment Battery for Children ) was evaluated in all children , who were then assessed either with a test of working memory ( R and om Number Generation task ) , or with a test of attention ( from the Cognitive Assessment System ) . Children assigned to the ‘ enriched ’ intervention showed more pronounced improvements in all motor coordination assessment s ( manual dexterity , ball skills , static/dynamic balance ) . The beneficial effect on ball skills was amplified by the level of spontaneous outdoor play and weight status . Among indices of executive function and attention , only that of inhibition showed a differential effect of intervention type . Moderated mediation showed that the better outcome of the enriched PE on ball skills mediated the better inhibition outcome , but only when the enrichment intervention was paralleled by a medium-to-high level of outdoor play . Results suggest that specifically tailored physical activity ( PA ) games provide a unique form of enrichment that impacts  children ’s cognitive development through motor coordination improvement , particularly object control skills , which are linked to children ’s PA habits later in life . Outdoor play appears to offer the natural ground for the stimulation by design ed PA games to take root in children ’s mind AIM Constraint-induced movement therapy ( CIT ) is a rehabilitation intervention put forward by Taub and colleagues for sensorimotor disorders in children with hemiparesis , comprising consisting of the restraint of the unaffected arm and concurrent intensive training of the affected arm for six hours/day for two weeks . The aim of this study was to evaluate the effectiveness of a modified CIT program ( mCIT ) characterized by restraining the unaffected h and with a cotton mitten during daily activities and a reduced intensity training program for two h/week for five weeks . METHODS Ten children ( age : 1 - 9 years ) with hemiparetic cerebral palsy were enrolled in a r and omized , cross-over study in which the effects of a mCIT and a conventional physiotherapy program were compared . The amount of use and the functional performance of the affected arm were evaluated by means of two specifically devised tests ( Use and Function Test ) . A further test evaluated functional performance during bimanual tasks . These measures showed a good inter-rater and inter-session reliability . All tests were administered before , at the end and four weeks after treatment . RESULTS Significant differences between the two therapeutic approaches were evidence d in both affected arm use ( P=0.008 ) and function ( P=0.018 ) . These improvements maintained at the follow-up ( Use Test P=0.07 ; paretic arm function P=0.012 ) . Bimanual function performance showed a trend towards improvement in both post-treatment and follow-up testing . The conventional physiotherapy group did not show any improvement in any outcome measure . CONCLUSIONS The mCIT program proposed in the present study showed to be a promising rehabilitative procedure in children with congenital arm paresis after cerebral palsy Children with cerebral palsy ( CP ) have difficulty controlling and coordinating voluntary muscle , which results in poor selective control of muscle activity . Children with spastic CP completed ankle selective motor control exercises using a virtual reality ( VR ) exercise system and conventional ( Conv ) exercises . Ankle movements were recorded with an electrogoniometer .  Children and their parents were asked to comment on their interest in the exercise programs . Greater fun and enjoyment were expressed during the VR exercises .  Children completed more repetitions of the Conv exercises , but the range of motion and hold time in the stretched position were greater during VR exercises . These data suggest that using VR to elicit or guide exercise may improve exercise compliance and enhance exercise effectiveness Purpose : To describe behavior of children with periventricular brain injury ( PBI ) in a tethered-kicking intervention . Methods : Sixteen infants with PBI were r and omly assigned to exercise or no-training in a longitudinal pilot study . Frequencies of leg movements and interlimb coordination were described from videos at 2 and 4 months ' corrected age ( CA ) . Results : Eight of the 13 children ( 62 % ) with longitudinal data increased the frequency of leg movements while tethered to a mobile between 2 and 4 months ' CA . Movement frequency was correlated with scores on the Test of Infant Motor Performance , but no differences between experimental groups were found . Children with typical development at 12 months ' CA increased the proportion of leg movements that were synchronous between 2 and 4 months , as did a child with cerebral palsy in the experimental group . Conclusions : The tethered-kicking intervention facilitates movement in infants with PBI , but effects on development remain to be demonstrated
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 .
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 .