Videogaming for Home Rehabilitation: A Family-Centered Approach for Children with Cerebral Palsy
Bibliographic record
Abstract
Bootle Blast (BB) is a movement-tracking videogame designed to encourage upper limb (UL) functional movements tailored to each child's therapy goals. This dissertation presents the findings of three studies exploring different aspects of feasibility of using BB as a home-based, UL rehabilitation intervention among children with cerebral palsy (CP) from two countries. The first study was a mixed methods case series involving four children with hemiplegic CP and their parents in Toronto, Canada. Participants played BB at home for 12 weeks. Adherence to self-directed playtime goals (PTGs), changes in UL motor outcomes, and participants' experiences with BB were explored. Three children completed the intervention and achieved their PTGs, with improvements observed in UL function. Participants experienced intrinsic motivation, real-world UL functional gains, and the convenience of doing therapy at home. The second study explored the expectations and demand for BB among Costa Rican children with CP. Three main interview themes were identified: 1) socio-cultural factors heighten demand, 2) feelings of hope prevail for the intervention, and 3) collaborative goal setting supports realistic expectations for BB. Results from these interviews provided valuable insights on how to tailor the intervention for each of the 15 participating dyads, using a family-centered approach. In the last study, participants (dyads from study 2) established weekly PTGs and played BB at home for 8 weeks. Thirteen children completed the intervention, but only three achieved their PTG on six out of eight weeks, establishing partial feasibility of implementation. Yet, all 13 children improved in at least one of two primary UL motor performance measures of, providing evidence in support of the effectiveness of the BB intervention. This dissertation contributes to the evidence on how to improve the real-world feasibility of movement tracking videogames, like BB, as a home-based rehabilitation tool for children with CP. The intervention was associated with positive outcomes, such as improved UL motor function and increased access to motor therapy care. The findings support the potential of this intervention to address the pressing issue of limited access to UL therapies for children with CP, offering a promising avenue for future research and clinical applications. Bootle Blast (BB) es un videojuego con sensor de movimiento diseñado para fomentar los movimientos funcionales de las extremidades superiores (MMSS) adaptados a los objetivos terapéuticos de cada niño. Esta tesis presenta los hallazgos de tres estudios que exploran diferentes aspectos de la viabilidad del uso de BB como una intervención de rehabilitación para el MMSS en el hogar para niños con parálisis cerebral (PC) en dos países. El primer estudio fue una serie de casos de métodos mixtos que involucró a cuatro niños con PC hemipléjica y sus padres en Toronto, Canadá. Los participantes jugaron BB en casa durante 12 semanas. Se exploró la adherencia al tiempo de juego meta (TJM) elegido previamente por cada participante, los cambios en los movimientos funcionales del MMSS afectado, y las experiencias de los participantes al usar BB. Tres niños completaron la intervención y alcanzaron sus TMJ, observándose mejoras en la función del MMSS. Los participantes experimentaron motivación intrínseca, ganancias funcionales de los MMSS en actividades de la vida diaria, y la conveniencia de hacer terapia en casa. El segundo estudio exploró las expectativas y la demanda de BB en niños costarricenses con parálisis cerebral. Se identificaron tres temas principales derivados de entrevistas: 1) los factores socioculturales aumentan la demanda por BB, 2) prevalecen los sentimientos de esperanza para una posible intervención con BB y 3) el establecimiento colaborativo de metas (padre, niñe y terapeuta) apoya el tener expectativas realistas para el uso de BB. Los resultados de estas entrevistas proporcionaron información valiosa sobre cómo adaptar la intervención para cada una de las 15 díadas participantes, utilizando un enfoque centrado en la familia. En el último estudio, los participantes (díadas del estudio 2) establecieron TMJ semanales y jugaron BB en casa durante ocho semanas. Trece niñes completaron la intervención, pero solo tres lograron su TMJ en seis de las ocho semanas, lo que establece una viabilidad parcial de la implementación. Sin embargo, los 13 niñes mejoraron en al menos una de las dos mediciones primarias sobre la funcionalidad motora de los MMSS, lo que proporciona evidencia de la efectividad de la intervención con BB. Esta tesis contribuye a la evidencia sobre cómo mejorar la viabilidad en condiciones de "mundo real" (i.e., fuera de ensayos clinicos) con videojuegos con sensor de movimientos como BB, como una herramienta de rehabilitación domiciliaria para niñes con PC. La intervención se asoció con resultados positivos, como una mejor función motora de los MMSS y un mayor acceso a la atención en rehabilitación motora. Los hallazgos respaldan el potencial de esta intervención para abordar la apremiante problemática del acceso limitado a las terapias de MMSS para los niñes con PC, lo que ofrece una vía prometedora para futuras investigaciones y aplicaciones clínicas.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".