Purpose: Previous studies investigating the effectiveness of exergame balance-training (using video-games) in children with cerebral palsy (CP) yielded inconsistent results that could be related to underpowered studies. Therefore, in this multicenter intervention study, we investigated whether exergaming improves balance clinically in spastic CP. Materials and methods: In total, 35 children with unilateral or bilateral spastic CP (GMFCS-level I–II) were included (age-range: 7–16 years); 16 at VUMC (trial: NTR6034), 19 at UHG (trial: NCT03219112). All participants received care as usual. The intervention group (n = 24) additionally performed exergame-training; 6–8 weeks home-based X-box One Kinect training focused on balance. Balance performance was assessed with the pediatric balance scale (PBS) and two subscales of the Bruininks–Oseretsky Test of Motor Proficiency-2nd edition (“balance” [BOTbal] and “running speed and agility” [BOTrsa]). Mixed model ANOVAs with between and within factors were used to test differences between and within groups. Results: On group level, no post-intervention differences were found between the intervention and control group (PBS: p = 0.248, η_p² = 0.040; BOTbal: p = 0.374, η_p² = 0.024; BOTrsa: p = 0.841, η_p² = 0.001). Distribution of CP-symptoms (unilateral versus bilateral) did not affect training (PBS: p = 0.373, η_p² = 0.036; BOTbal: p = 0.127, η_p² = 0.103; BOTrsa: p = 0.474, η_p² = 0.024). Children with low baseline balance performance (based on PBS) in the intervention group showed improvements in balance performance after training (PBS: p = 0.003, η_p² = 0.304; BOTbal: p = 0.008, η_p² = 0.258), whereas children with high baseline balance performance did not. Conclusions: This exergame-training resulted in balance improvements for the current population of CP that had a low baseline function.IMPLICATIONS FOR REHABILITATION Exergame-training (training using video-games) shows mixed results in children with cerebral palsy (CP). Children with spastic CP (GMFCS level I–II) with a high baseline balance-level did not show functional balance improvements after this home-based exergame-training, suggesting that these children should not be enrolled in this type of exergame-training protocol. Children with spastic CP (GMFCS level I–II) with a low baseline balance-level showed clinically relevant functional balance improvements after this home-based exergame-training, suggesting that these children can benefit from enrolment in this type of exergame-training protocol to improve their balance. The distribution of CP-symptoms did not affect the effectiveness of this balance exergame-training in children with spastic CP with GMFCS-level I and II.

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In children with cerebral palsy (CP), rigid ventral shell ankle-foot orthoses (vAFOs) are often prescribed to reduce excessive knee flexion in stance and lower the energy cost of walking (ECW). However, how vAFOs affect ECW is a complex issue, as vAFOs may have an impact on lower limb biomechanics, upper body movements, and balance. Besides, the vAFO's biomechanical effect have been shown to be dependent on its stiffness around the ankle joint. We examined whether vAFO stiffness influences trunk movements and gait stability in CP, and whether there is a relationship between these factors and ECW. Fifteen children with spastic CP were prescribed vAFOs. Stiffness was varied into a rigid, stiff and flexible configuration. At baseline (shoes-only) and for each vAFO stiffness configuration, 3D-gait analyses and ECW-tests were performed. From the gait analyses, we derived trunk tilt, lateroflexion, and rotation range of motion (RoM) and the mediolateral and anteroposterior Margins of Stability (MoS) and their variability as measures of gait stability. With the ECW-test we determined the netEC. We found that wearing vAFOs significantly increased trunk lateroflexion (Wald χ2 = 33.7, p < 0.001), rotation RoM (Wald χ2 = 20.5, p < 0.001) and mediolateral gait instability (Wald χ2 = 10.4, p = 0.016). The extent of these effects partly depended on the stiffness of the vAFO. Significant relations between trunk movements, gait stability and ECW were found r = 0.57–0.81, p < 0.05), which indicates that trunk movements and gait stability should be taken into account when prescribing vAFOs to improve gait in children with CP walking with excessive knee flexion.

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Due to their sensorimotor disorders, children with cerebral palsy (CP) typically experience poor balance control during standing and walking [1]. Virtual Reality (VR) is increasingly used in balance rehabilitation since literature has indicated some promising effects on for instance motivation [2] and functional outcomes [3] in several patient populations. Some preliminary studies have investigated the effect of VR training on balance in children with CP, however, they describe mixed results [4,5]. The contradictory findings could be the result of insufficient power due to small sample size and use of different measures of balance.@en