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

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.