Integration of exergames and virtual reality in the treatment of cerebral palsy children

How to motivate children (patients) to perform their exercises during rehabilitation or at home? This is the challenge met by physical therapists in their daily professional practice with disabled patients. Indeed, a lack of motivation is one of the most frequent reasons for patients to drop out. Commercial video games have significantly evolved over the last decade. Today computer performance and play experience allow new perspectives for rehabilitation. Thanks to new gaming controllers (Nintendo Wii Fit™, Microsoft Xbox Kinect™, etc.) video game playing has changed from a passive (i.e. the player is seated on a sofa) to an active experience: players have to move in order to interact with games. Clinicians are now prospecting the new potential use of these games in rehabilitation mainly through testing available commercial games with patients suffering from various pathologies (e.g. cerebral palsy, brain stroke, Parkinson disease, elderly.). Physical rehabilitation must be based on active exercises, and new gaming strategy allows it. Furthermore, the game environment is obviously a major advantage to increase patient motivation to perform their rehabilitation schemes. Today challenge is to use games as rehabilitation. However, results of these first clinical tests using commercial video games are not as good as first expected. Several limitations appeared when using commercial video games in rehabilitation. Such games are designed for entertainment purpose and obviously do not include any therapeutically know-how and strategies. Further, the architecture of the games (i.e. tasks to achieve, visual background, etc) is not adapted for patients showing various kinds of disabilities like motor or visual disorders. For example, most games are based on scenario fast movements to succeed while such quick execution is often contraindicated during many physical rehabilitation schemes related to neurological disorders. Also, player motion accuracy requested by the player during the games is low while most therapists will aim to improve patient joint control and coordination. In short, commercial video games are not adapted for rehabilitation; contrariwise the different gaming controllers used offer interesting new perspectives for rehabilitation. The current challenge for therapists is to help the game industry to develop specific games well- adapted for specific pathologies. Since a few years specific solutions have been developed and tested with cerebral palsy children. This chapter presents an overview of the different works that have been done in the field both using commercial games as well as games specifically developed for the target group. Advantages and limits of each approach will be then discussed. Finally, the last part of this chapter will focus on global trends for future work and perspectives will be provided on how to integrate rehabilitation aspects (physiotherapy, occupational therapy) in game scenarios.SCOPUS: ch.b