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Nintendo Wii Versus Resistance Training to Improve Upper-Limb Function in Children Ages 7 to 12 with Spastic Hemiplegic Cerebral Palsy: a Home-Based Pilot Study

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Nintendo Wii Versus Resistance Training to Improve Upper-Limb Function in Children Ages 7 to 12 with Spastic Hemiplegic Cerebral Palsy: a Home-Based Pilot Study Nintendo Wii versus Resistance Training to Improve Upper-Limb Function in Children Ages 7 to 12 with Spastic Hemiplegic Cerebral Palsy: A Home-Based Pilot Study By Caroline Kassee A Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of Master of Health Sciences In The Faculty of Health Sciences Kinesiology University of Ontario Institute of Technology July 2015 © Caroline Kassee, 2015 ii CERTIFICATE OF APPROVAL Caroline Kassee (2015) iii Nintendo Wii versus Resistance Training to Improve Upper- Limb Function in Children Ages 7 to 12 with Spastic Hemiplegic Cerebral Palsy: A Home-Based Pilot Study Chairperson of the Supervisory Committee: Dr. Meghann Lloyd Faculty of Health Sciences Abstract This pilot, home-based study compared a Nintendo Wii intervention to a single-joint upper-limb resistance training of a similar intensity, in n=6 children ages of 7 to 12 with spastic hemiplegic CP with respect to upper limb function, compliance and motivation levels. The main results of this study found that all participants in the Wii intervention group (n=3) experienced positive changes in more than one assessment from pre-test to follow-up, and these changes were on average greater than those experienced by the resistance training group (n=3). Also, the Nintendo Wii group was found to have a higher compliance rate with the study’s protocols, and higher parent-reported motivation levels throughout the study, as compared to the resistance-training group. This suggests that Nintendo Wii interventions for the upper limbs may be a more effective home-based rehabilitation strategy than the single-joint upper limb resistance training program used in this study for this population, primarily due to greater participant motivation to comply with Nintendo Wii training. These findings warrant further research with larger sample sizes. Keywords: spastic hemiplegic cerebral palsy, upper-limb function, Nintendo Wii, resistance training, home study Caroline Kassee (2015) iv STATEMENT OF ORIGINALITY I, Caroline Kassee, hereby declare that this thesis is, to the best of my knowledge, original, except as acknowledged in the text. I further declare that the material contained in this thesis has not been previously submitted, either in whole or in part, for a degree at this, or any other university. Caroline Kassee (2015) v ACKNOWLEDGEMENTS Thank you to my supervisor, Dr. Meghann Lloyd, for your clear and consistent guidance in every step of this research project. You have been invaluable in helping me to develop as researcher, and have provided me with all of the advice and assistance I needed in order to complete this degree. I am eternally grateful for all you have done for me over these past two years. Thank you to Dr. Carolyn Hunt, for your assistance with the recruitment process at Grandview Children’s Centre for this project. Also, thank you for your constant guidance over all the years I have known you. Your understanding, encouragement and advocacy on my behalf has really made an immense personal difference to me, and continually motivates me to keep moving forward. Thank you to Dr. Michael Holmes, for your help in the design of this study. Your thoughtful and relevant feedback on any questions I had throughout these two years was much needed, and absolutely crucial in helping me complete this project. Thank you to my research assistants, particularly Emma DePasquale, but also Leanne Elliot, Kristin Dobranowski, and Keri-Ellen Walcer. I could not have managed this project without you. You are all wonderful people, with many great things ahead of you. Thank you to my parents and brothers, for your unwavering love and support. My love and gratitude for you all is boundless and far surpasses what mere words can express. Finally, I would like to dedicate this project to my little brother Rafi, who has CP, and who really is the true inspiration behind all my academic pursuits in this area. This thesis was partially funded by a research grant from Grandview Children’s Centre in Oshawa Ontario Caroline Kassee (2015) vi LIST OF ABBREVIATIONS USED AVG Active Video Games boNT-A Botulinum neurotoxin-A CP Cerebral Palsy GMFCS Gross Motor Function Classification System HIE Hypoxic Ischemic Encephalopathy MA2 Melbourne Assessment of Unilateral Upper Limb Function-2 MACS Manual Ability Classification System PVL Periventricular Leukomalacia ROM Range of Motion SD Standard Deviation SDT Self-Determination Theory VR Virtual Reality Caroline Kassee (2015) vii TABLE OF CONTENTS CERTIFICATE OF APPROVAL .................................................................................. II ABSTRACT ..................................................................................................................... III STATEMENT OF ORIGINALITY .............................................................................. IV ACKNOWLEDGEMENTS ............................................................................................ V LIST OF ABBREVIATIONS USED ............................................................................. VI TABLE OF CONTENTS ............................................................................................. VII LIST OF TABLES ........................................................................................................ XII LIST OF FIGURES ....................................................................................................... XV OVERVIEW ............................................................................................................... XVII SECTION 1: INTRODUCTION ..................................................................................... 1 INTRODUCTION TO THESIS ............................................................................................... 2! Overview of Cerebral Palsy ........................................................................................ 2! Spastic Hemiplegic Cerebral Palsy ............................................................................. 3! Management of Upper Limb Spastic Hemiplegic Cerebral Palsy .............................. 4! Motivation and Rehabilitation .................................................................................... 5! Nintendo Wii Training in Pediatric Cerebral Palsy .................................................... 6! Resistance Training in Pediatric Cerebral Palsy ......................................................... 7! Summary ..................................................................................................................... 8 PROPOSED RESEARCH FRAMEWORK: DYNAMIC SYSTEMS THEORY ................................. 9! Dynamic Systems Theory and Therapeutic Interventions .......................................... 9! Control Parameters in Nintendo Wii and Resistance Training ................................. 10! Summary ................................................................................................................... 12 SIGNIFICANCE OF THE RESEARCH .................................................................................. 13! Justification of Methodology .................................................................................... 13! Purpose and Overall Contribution ............................................................................ 16 Caroline Kassee (2015) viii OBJECTIVES AND HYPOTHESES ...................................................................................... 16! Objectives of the Research ........................................................................................ 16! Specific Hypotheses of the Research ........................................................................ 18 REFERENCES .................................................................................................................. 19 SECTION 2: LITERATURE REVIEW ....................................................................... 25 CEREBRAL PALSY .......................................................................................................... 26! Overview ................................................................................................................... 26! Causes of Cerebral Palsy .......................................................................................... 27! Associated Impairments in Cerebral Palsy ............................................................... 30! Spastic Cerebral Palsy ............................................................................................... 32! Spastic Hemiplegic Cerebral Palsy ........................................................................... 34! Motor Impairments in Spastic Hemiplegic Cerebral Palsy ....................................... 35! Upper-Limb Impairments and Functionality in Spastic Hemiplegic Cerebral Palsy 37 REHABILITATION IN PEDIATRIC CEREBRAL PALSY ........................................................ 39! Management of Upper Limb Spastic Cerebral Palsy ................................................ 39! Motivation and Rehabilitation in Pediatric Cerebral Palsy ....................................... 41 EXPERIMENTAL GROUP: NINTENDO WII REHABILITATION AND CEREBRAL PALSY ....... 42! Introduction to Virtual Reality and Rehabilitation ................................................... 42! Nintendo Wii Technology ......................................................................................... 44! Overview of Nintendo Wii Rehabilitation Studies in Pediatric Cerebral Palsy ....... 46! Wii Rehabilitation
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