Influence of Centre of Gravity Computer Game Controller on Sitting Ability in Children with Neuromotor Dysfunction

1. School of Health and Social Care Sitting Playfully: Does the use of a centre of gravity computer game controller influence the sitting and functional ability of children with neuromotor dysfunction? Will Wade & David Porter

2. Background • Basic organisation of postural adjustments intact in CP. However lack capacity to modulate adjustments to task specific constraints (van der Heide, et al. 2004) – possibly due to impaired motor co-ordination and deficits in sensory integration. • Improved sitting ability can in turn lead to improved comfort, functional ability and independence and also a reduction on the risk of contractures, deformity and pressure ulcers. • Quality of movement and ROM increases when purposeful tasks given (van der Weel 1991) • Play is the main occupation of children. Authors have postulated that the play form of therapy is essential in children whom have potential to improve motor function (Mayston 2000, O’Brien 2000) School of Health and Social Care

3. Objective • Does the regular use of computer game(s), requiring adjustment of the players centre of gravity to control the game, have an effect on the development of sitting ability for children with neuromotor dysfunction? • To what degree is this fun or motivational for the children involved? School of Health and Social Care

4. Participants • Aged between 5 and 16 years of age at the start of the study • Group 3, 4 or 5 on the GMFCS • Level 3 or higher on the Chailey levels of sitting ability • Cerebral Palsy or similar • Sufficient vision and cognitive ability to play simple computer games. School of Health and Social Care

5. Intervention • From previous study by Janet Cockburn • Modified Logitech Dual action Joystick • Air activated pressure switches • Wobble And Move Balance Learning Environment (WAMBLE) School of Health and Social Care

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7. Method • Randomised cross over trial • 3 months intervention: WAMBLE Board, Games. Assess sitting ability. • 3 months non-intervention: Record sitting activities that don’t require movement. Assess sitting ability. • After 6 months informal interview School of Health and Social Care

8. Outcomes • Chailey Levels of Ability • Prone lying • Supine lying • Box sitting • Sitting Assesment for Children with Neuromotor Dysfunction (SACND) • Rest • Reach • Test of Playfulness. School of Health and Social Care

9. Results (1) • Participants: • 19 participants initially • 13 participants included in analysis • 6 females, 7 males • Across the South of England • Schools and children’s homes School of Health and Social Care

10. Results (2) School of Health and Social Care

11. Results (3) • Test of Playfulness • Involved & Engaged • Qualitative information • Was fun! • Staff/Parents felt it helped • Interactions with siblings / others • Was tricky to set-up School of Health and Social Care

12. Discussion • Some potential limitations. Sample size. Blinding. • Use of the WAMBLE tends to suggest an improvement in some elements of sitting ability. • Agrees with Reid 2005 (Virtual Reality) • Supports Mayston (2000) and Hadders-Algra (2005) - providing activities that children want to do is key School of Health and Social Care

13. Acknowledgements • Cerebra • Chailey Heritage Clinical Services (Donna Cowan, Ladan Najafi, Martin Langner) • Reading University • Oxford Brookes University School of Health and Social Care

14. Thank you for your attention School of Health and Social Care