Transcript Slide 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
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 coordination 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
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
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
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
School of Health and Social Care
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
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
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
Results (2)
Chailey
Levels
of Ability
SACND
Supine
Lying
No statistically significant differences.
Prone Lying
No statistically significant differences.
Box Sitting
Shoulder Girdle Position
p<0.05
Spinal Profile
p<0.05
Abnormal Postural Reactions
p<0.01
Non-purposeful and/or uncontrolled
gross body movements
p<0.05
Proximal Stability
p<0.05
Overall Quality of Reach movement
p<0.05
Involuntarily Leg Extension
p<0.05
Rest
Reach
School of Health and Social Care
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
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 HaddersAlgra (2005) - providing activities that
children want to do is key
School of Health and Social Care
Acknowledgements
 Cerebra
 Chailey Heritage Clinical Services (Donna
Cowan, Ladan Najafi, Martin Langner)
 Reading University
 Oxford Brookes University
School of Health and Social Care
Thank you for your attention
School of Health and Social Care