Interactive computer play – what happens when the game is over?

Abstract

This commentary is on the original article by James et al. on pages 530-538 in this issue.Children and young people living with cerebral palsy (CP) who experience difficulties with their motor capacity, may benefit from physical and occupational therapy throughout their life. It is often a challenge for therapists, as well as parents, to find a variety of engaging practice tools and exercise environments that both provide a means of repetition and are highly motivating for the individual child or young person. 1The main aims of interventions for individuals living with CP are to reduce impairments, increase functional ability, and facilitate greater participation. In order to be able to perform desired movements, there is a requirement to integrate attention, motivation, and emotional processes with sensorimotor transformation.2 Interactive computer play (ICP) is a novel way of combining these factors into therapy interventions. ICP can be defined as 'any kind of computer game or virtual-reality technique where the child can interact and play with virtual objects in a computer generated environment '. 3 With the advantage of being able to provide ample opportunities to individualize and create fun and engaging exercise environments, an online-based training concept 'Move it to improve it' (Mitii) was investigated by James et al. 4 James et al.'s study is important and timely with interactive computer games being popular amongst children in general. The use of ICP in therapy is a relatively new research field. Previously reported methodological issues include underpowered studies and limitations of case studies and small samples of participants.3 Recognizing this, James et al. conducted an adequately powered randomized control trial to investigate the effectiveness of Mitii on occupational performance, upper limb function, and visual perception in children and young people with unilateral CP.Although James et al. did not report clinically significant differences of ICP translating into functional skills, the study suggests that this form of ICP may be used to increase therapy dose and complement other training. However, when ICP is used as a training modality for children and young people with CP, the challenge for therapists and parents is how to keep the child engaged when the novelty of the game has passed. When routine and therapy requirements dominate, the child's internal drive and sense of play tend to subside.1 Like other children and young people who enjoy this type of leisure activity, to remain motivated to continue to play they will most likely demand continuously challenging new games. In addition, the ability to customize the settings to meet individual needs will be imperative.James et al.'s study provides valuable information for implementation and uptake of ICP into clinical practice and research. However, the challenge remains of using ICP interventions that do not translate to functional skills. It poses the question of whether an individualized ICP is more suitable as an accessible leisur...