Exergaming improves balance in children with spastic cerebral palsy with low balance performance: results from a multicenter controlled trial

Abstract

Purpose Previous studies investigating the effectiveness of exergame balance-training (using video-games) in children with cerebral palsy (CP) yielded inconsistent results that could be related to underpowered studies. Therefore, in this multicenter intervention study, we investigated whether exergaming improves balance clinically in spastic CP. Materials and methods In total, 35 children with unilateral or bilateral spastic CP (GMFCS-level I-II) were included (age-range: 7-16 years); 16 at VUMC (trial: NTR6034), 19 at UHG (trial: NCT03219112). All participants received care as usual. The intervention group (n = 24) additionally performed exergame-training; 6-8 weeks home-based X-box One Kinect training focused on balance. Balance performance was assessed with the pediatric balance scale (PBS) and two subscales of the Bruininks-Oseretsky Test of Motor Proficiency-2nd edition ("balance" [BOTbal] and "running speed and agility" [BOTrsa]). Mixed model ANOVAs with between and within factors were used to test differences between and within groups. Results On group level, no post-intervention differences were found between the intervention and control group (PBS: p = 0.248, eta(2)(p) = 0.040; BOTbal: p = 0.374, eta(2)(p) = 0.024; BOTrsa: p = 0.841, eta(2)(p) = 0.001). Distribution of CP-symptoms (unilateral versus bilateral) did not affect training (PBS: p = 0.373, eta(2)(p) = 0.036; BOTbal: p = 0.127, eta(2)(p) = 0.103; BOTrsa: p = 0.474, eta(2)(p) = 0.024). Children with low baseline balance performance (based on PBS) in the intervention group showed improvements in balance performance after training (PBS: p = 0.003, eta(2)(p) = 0.304; BOTbal: p = 0.008, eta(2)(p) = 0.258), whereas children with high baseline balance performance did not. Conclusions This exergame-training resulted in balance improvements for the current population of CP that had a low baseline function.