Ability-Based Balancing Using The Gross Motor Function Measure In Exergaming For Youth With Cerebral Palsy

Objective: To test if the gross motor function measure (GMFM) could be used to improve game balancing allowing youth with cerebral palsy (CP) with different physical abilities to play a cycling-based exercise videogame together. Our secondary objective determined if exergaming with the GMFM Ability-Based algorithm was enjoyable.Materials and Methods: Eight youth with CP, 8-14 years of age, GMFM scores between 25.2% and 87.4% (evenly distributed between Gross Motor Function Classification System levels II and III), competed against each other in head-to-head races, totaling 28 unique race dyads. Dyads raced three times, each with a different method of minimizing the distance between participants (three balancing algorithms). This was a prospective repeated measures intervention trial with randomized and blinded algorithm assignment. The GMFM Ability-Based algorithm was developed using a least squares linear regression between the players' GMFM score and cycling cadence. Our primary outcome was dyad spread or average distance between players. The GMFM Ability-based algorithm was compared with a control algorithm (No-Balancing), and an idealized algorithm (one-speed-for-all [OSFA]). After each race, participants were asked Was that game fun? and Was that game fair? using a five-point Likert scale.Results: Participants pedaled quickly enough to elevate their heart rate to an average of 1208 beats per minute while playing. Dyad spread was lower when using GMFM Ability-Based balancing (4.6 +/- 4.2) compared with No-Balancing (11.9 +/- 6.8) (P<0.001). When using OSFA balancing, dyad spread was (1.6 +/- 0.9), lower than both GMFM Ability-Based (P=0.006) and No-Balancing (P<0.001). Cycling cadence positively correlated to GMFM, equal to 0.58 (GMFM) +33.29 (R-adj(2)= 0.662, P=0.004). Participants rated the games a median score 4/5 for both questions: was that game fun? and was that game fair?.Conclusion: The GMFM Ability-Based balancing decreased dyad spread while requiring participants to pedal quickly, facilitating interaction and physical activity.