Maha F. Algabbani
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Action Video Games Enhance Executive Function in Typically Developing Children and Children with Hemiplegic Cerebral Palsy MAHA F. ALGABBANI Thesis submitted in partial fulfilment of the requirements of the regulation for the degree of Doctor of Philosophy Newcastle University Faculty of Medical Sciences Institute of Neuroscience September 2016 Abstract Hypotheses: 1) Executive Function (EF) in children can be improved by action video games training. 2) Improvement of EF can enhance hand motor function. Aims: 1) To determine whether children who play Video Games (AVGPs) exhibit similar enhancement of EF as has been reported in adults; 2) To study the effect of action video game genre training on EF and hand motor function for Typically Developing (TD) children; 3) To study the effect of AVG training on EF and hand motor function for children with Hemiplegic Cerebral Palsy (HCP). Methods: Aim1:154 TD children aged 6-12 years participated in a cross-sectional study; Aim 2: 40 Non-Action Video Game players (NAVGPs) aged 8-12 years were randomized to training with AVG or NAVG, in a double blinded study of the effect of AVG training on EF; Aim 3:9 children with HCP aged 8-12 participated in a pilot study, open intervention study of the effect of AVG training on EF and hand function. EF was assessed using Cambridge Neuropsychological Test Automated Battery (CANTAB) and hand motor function was assessed using Tyneside 9 holes pegboard. In addition, Assisting Hand Assessment (AHA), Melbourne Assessment 2 (MA2), and Chedoke Arm and Hand Activity Inventory (CAHAI) were used for children with HCP. Results: EF and hand motor functions were superior in children playing AVGs compared to children who play NAVGs only. Action video game training for 50 hours over 8 weeks significantly improved EF in TD children compared to those training with NAVGs. AVG training was associated with significant improvement in EF in children with HCP. Hand motor function did not show significant improvement after training. Conclusion: Action video game training can enhance EF in TD and should be investigated further to assess if it has a therapeutic role in improving EF and dexterity in children with HCP. i Dedication This thesis is dedicated to my family ii Acknowledgements I would like to express my sincere appreciation to my supervisor Prof. Janet Eyre for the continuous support of my Ph.D. study and related research, for her patience, motivation, and immense knowledge. Her guidance helped me in all the time of research and writing of this thesis. I would like to thank the members of my annual progress review panel Dr. Graham Morgan, and Dr. Thomas Kelly, for their insightful comments and engagement. My sincere thanks also go to my co-supervisor Dr. Hana Al-Sobayel for her help and support. My appreciation extends to all people in schools, hospitals and rehabilitation departments, where I recruited the participants and collect data, for their support and help. I would especially like to thank the children and their parents for participating in this research. Thanks to Janice Pearse, Kim, Lindsey, Kholood, Lesego, Martin and William for their help and support. Finally, I must express my very deep gratitude to my family: my husband and my children, my mother, my brothers and sisters, and my sister-in-law for providing me with unfailing support and continuous encouragement throughout my years of process of researching and writing this thesis. This accomplishment would not have been possible without them. Thank you. iii iv Table of Contents Chapter 1. Introduction .............................................................................................. 1 1.1 Executive Function ...................................................................................................... 1 1.1.1 Model of EF .......................................................................................................... 1 1.1.2 Development of EF in children ............................................................................ 6 1.1.3 Assessment of EF ................................................................................................. 9 1.1.4 Interventions for EF ............................................................................................ 10 1.1.5 Action Video Games and EF .............................................................................. 11 1.2 Impairment of Executive function in children with hemiplegic cerebral palsy ......... 11 1.2.1 Hemiplegic Cerebral Palsy ................................................................................. 11 1.2.2 Hand motor function of HCP ............................................................................. 13 1.2.3 Interventional management ................................................................................ 13 1.3 Executive Function of children with HCP ................................................................. 15 1.4 Summary .................................................................................................................... 15 1.5 Thesis aims ................................................................................................................ 16 Chapter 2. Methods ................................................................................................... 17 2.1 Ethical approval ......................................................................................................... 17 2.2 Recruitment ................................................................................................................ 17 2.2.1 Typically Developing Children .......................................................................... 17 2.2.2 Children with Hemiplegic Cerebral Palsy .......................................................... 17 2.3 Consent ...................................................................................................................... 17 2.4 Environment ............................................................................................................... 17 2.5 Assessment procedure ................................................................................................ 18 2.5.1 Video Games play Questionnaire ....................................................................... 18 2.5.2 Tests of Executive Function ............................................................................... 18 2.5.3 Assessment of Upper Limbs Motor Function..................................................... 25 v Chapter 3. Positive Relationship between Duration of AVG play and Visuospatial Executive Function in Typically Developing Children .............................................. 37 3.1 Introduction ............................................................................................................... 37 3.2 Method....................................................................................................................... 39 3.2.1 Participants ......................................................................................................... 39 3.2.2 Study design ....................................................................................................... 39 3.2.3 Outcomes ........................................................................................................... 39 3.2.4 Statistical analysis .............................................................................................. 40 3.3 Results ....................................................................................................................... 40 3.3.1 Subjects .............................................................................................................. 40 3.3.2 Duration of Video game Play............................................................................. 41 3.3.3 Executive Function Assessments ....................................................................... 41 3.3.4 The Relationship between duration of video-game and executive function ...... 44 3.4 Discussion ................................................................................................................. 46 3.4.1 Effect of AVGs on executive function tasks ...................................................... 49 3.4.2 Positive Relationship between Duration of AVG Play and Visuospatial Executive Function in Children ....................................................................................... 52 3.4.3 Effects of age on executive function and visual attention skills ........................ 53 3.5 Summary ................................................................................................................... 53 Chapter 4. The Effect of Video Game Training on Executive Function and Hand Motor Function in Typically Developing Children: Double Blinded Randomized Trial 54 4.1 Introduction ............................................................................................................... 54 4.2 Method....................................................................................................................... 54 4.2.1 Participants ......................................................................................................... 54 4.2.2 Study design ....................................................................................................... 56 4.2.3 Apparatus ........................................................................................................... 56 4.2.4 Randomization and Blinding ............................................................................