FIT THROUGH FUN - Games in Upper Motor Rehab for Children with Cerebral Palsy, Navigating the Challenges and Benefit: a Scoping Review
Main Article Content
Abstract
Background and Objective: Children with cerebral palsy (CP) experience significant limitations in daily activities, particularly due to motor impairments affecting upper limb function. While traditional physiotherapy is essential, its repetitive nature may reduce motivation and engagement. Emerging video game-based therapy (VGBT) offers potential to improve motor outcomes and adherence through interactive tasks. This review explores the role of video games in improving upper motor function in children with CP, focusing on their benefits, challenges, and accessibility. Method: This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Literature was sourced from PubMed, ProQuest, and Scopus. Studies were appraised for quality using the McMaster Critical Review Form for quantitative studies. Results: Twenty-one articles were selected based on inclusion criteria, with an average McMaster score of 13.33. Video game-based therapies (VGBT), particularly exergames and virtual reality (VR), show promise in improving upper limb function in children with CP. Studies report improvements in hand function, coordination, and motor dexterity, alongside increased engagement and adherence. These interventions help address issues in traditional therapy, such as monotony and low participation. Adaptive feedback and biofeedback-enhanced games also offer potential for individualized therapy. However, challenges such as limited technology access, personalization, and long-term efficacy remain. Conclusion: This review demonstrates the effectiveness of VGBT in improving upper limb function and overcoming limitations of conventional therapies. Addressing barriers, such as technology access and the need for personalized interventions, is critical for maximizing VGBT's benefits. Further research into adaptable, accessible, and personalized interventions is essential to ensure equitable rehabilitation outcomes for all children with CP.
Article Details
How to Cite
Herliv, S. A., Khairunnisa Zahra, A., Hardiyanti, L., Hardiyanti, L., Pratitapraya, A., & Azmiarrizqi, F. (2025). FIT THROUGH FUN - Games in Upper Motor Rehab for Children with Cerebral Palsy, Navigating the Challenges and Benefit: a Scoping Review. Indonesian Journal of Physical Medicine and Rehabilitation, 14(1), 148 - 160. https://doi.org/10.36803/indojpmr.v14i1.450
Section
Scoping Review

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References
References
1. Shahane V, Kumavor P, Morgan K, Friel KM, Srinivasan SM. A protocol for a single-Arm interventional study assessing the effects of a home-based joystick-operated ride-on-Toy navigation training programme to improve affected upper extremity function and spontaneous use in children with unilateral cerebral palsy (UCP). BMJ Open. 2023;13(5). doi:10.1136/bmjopen-2023-071742
2. Hosseini P, Kobravi HR, Tahami E, et al. A New Training Protocol Based on Bimanual Playing a Computer Game for Motion-Cognitive Rehabilitation in Children with Spastic Hemiparetic Cerebral Palsy. Iran J Pediatr. 2023;33(5). doi:10.5812/ijp-136889
3. Yildirim Y, Budak M, Tarakci D, Algun ZC. The Effect of Video-Based Games on Hand Functions and Cognitive Functions in Cerebral Palsy. Games Health J. 2021;10(3):180-189. doi:10.1089/g4h.2020.0182
4. Saussez G, Bailly R, Araneda R, et al. Efficacy of integrating a semi-immersive virtual device in the HABIT-ILE intervention for children with unilateral cerebral palsy: a non-inferiority randomized controlled trial. J Neuroeng Rehabil. 2023;20(1):1-15. doi:10.1186/s12984-023-01218-4
5. Cuccurullo, Sara J. Physical Medicine and Rehabilitation Board Review Third Edition.
6. MacIntosh A, Desailly E, Vignais N, Vigneron V, Biddiss E. A biofeedback-enhanced therapeutic exercise video game intervention for young people with cerebral palsy: A randomized single-case experimental design feasibility study. PLoS One. 2020;15(6 June):1-23. doi:10.1371/journal.pone.0234767
7. Abd-Elfattah HM, Galal DOSM, Abdelmageed SM, et al. Effect of touch screen tablet use on fine motor functions in children with hemiparetic cerebral palsy: A randomized controlled trial. NeuroRehabilitation. 2024;55(1):137-146. doi:10.3233/NRE-240134
8. Meriggi P, Mandalà M, Randazzo M, et al. Non-immersive virtual reality based treatment for children with unilateral cerebral palsy: Preliminary results. J Pediatr Rehabil Med. 2024;17(1):107-123. doi:10.3233/PRM-230028
9. Alrashidi M, Wadey CA, Tomlinson RJ, Buckingham G, Williams CA. The efficacy of virtual reality interventions compared with conventional physiotherapy in improving the upper limb motor function of children with cerebral palsy: a systematic review of randomised controlled trials. Disabil Rehabil. 2023;45(11):1773-1783. doi:10.1080/09638288.2022.2071484
10. Mirich R, Kyvelidou A, Greiner BS. The Effects of Virtual Reality Based Rehabilitation on Upper Extremity Function in a Child with Cerebral Palsy: A Case Report. Phys Occup Ther Pediatr. 2021;41(6):620-636. doi:10.1080/01942638.2021.1909688
11. Daliri M, Moradi A, Fatorehchy S, Bakhshi E, Moradi E, Sabbaghi S. Investigating the Effect of Leap Motion on Upper Extremity Rehabilitation in Children with Cerebral Palsy: A Randomized Controlled Trial. Dev Neurorehabil. 2023;26(4):244-252. doi:10.1080/17518423.2023.2203210
12. Cortes-Perez I, Zagalaz-Anula N, Montoro-Cárdenas D, Lomas-Vega R, Obrero-Gaitán E, Osuna-Pérez M. Leap Motion Controller Video Game-Based Therapy for Upper. Sensors. 2021;21:2065.
13. Ren Z, Wu J. The effect of virtual reality games on the gross motor skills of children with cerebral palsy: A meta-analysis of randomized controlled trials. Int J Environ Res Public Health. 2019;16(20). doi:10.3390/ijerph16203885
14. Kanitkar A, Parmar ST, Szturm TJ, et al. Evaluation of a computer game-assisted rehabilitation program for manual dexterity of children with cerebral palsy: Feasibility randomized control trial. PM R. 2023;15(10):1280-1291. doi:10.1002/pmrj.12947
15. Parmar ST, Kanitkar A, Sepehri N, Bhairannawar S, Szturm T. Computer game-based telerehabilitation platform targeting manual dexterity: Exercise is fun. “you are kidding—right?” Sensors. 2021;21(17):1-16. doi:10.3390/s21175766
16. Bautista JD, Perales FJ, Ramis S, Montoya P, Riquelme I. Adaptation and Validation of a Serious Game for Motor Learning Training in Children with Cerebral Palsy. Games Health J. 2023;12(6):480-488. doi:10.1089/g4h.2023.0082
17. Gözaçan Karabulut D, Maden Ç, Karabulut Y, Aslan M. Effects of Video-Based Exercises and Conventional Physiotherapy on Upper Extremity Functionality, Selective Motor Control, and Proprioception in Unilateral Cerebral Palsy: A Randomized Controlled Trial. Games Health J. 2024;13(4):305-312. doi:10.1089/g4h.2024.0044
18. Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med. 2018;169(7):467-473. doi:10.7326/M18-0850
19. Srinivasan S, Kumavor P, Morgan K. A Training Program Using Modified Joystick-Operated Ride-on Toys to Complement Conventional Upper Extremity Rehabilitation in Children with Cerebral Palsy: Results from a Pilot Study. Bioengineering. 2024;11(4). doi:10.3390/bioengineering11040304
20. Shahane V, Kumavor PD, Morgan K, Srinivasan S. Fast and Fun: A Pilot Feasibility Study Using Dual Joystick-Operated Ride-on Toys for Upper Extremity Rehabilitation in Children with Hemiplegia. Phys Occup Ther Pediatr. 2024;44(6):844-864. doi:10.1080/01942638.2024.2360462
21. Martins FPA, Massetti T, Crocetta TB, et al. Analysis of motor performance in individuals with cerebral palsy using a non-immersive virtual reality task – A pilot study. Neuropsychiatr Dis Treat. 2019;15:417-428. doi:10.2147/NDT.S184510
22. Chan-Víquez D, Khan A, Munce S, Fehlings D, Wright FV, Biddiss E. Understanding a videogame home intervention for children with hemiplegia: a mixed methods multi-case study. Front Med Technol. 2023;5(July):1-16. doi:10.3389/fmedt.2023.1217797
23. Avcil E, Tarakci D, Arman N, Tarakci E. Upper extremity rehabilitation using video games in cerebral palsy: a randomized clinical trial. Acta Neurol Belg. 2021;121(4):1053-1060. doi:10.1007/s13760-020-01400-8
24. Chang HJ, Ku KH, Park YS, et al. Effects of virtual reality-based rehabilitation on upper extremity function among children with cerebral palsy. Healthc. 2020;8(4). doi:10.3390/healthcare8040391
25. Nguyen T, Choromanski L, Kreuzer T, Stroppini J. Exploring the Feasibility of a Virtual, Home-Based MusicGlove® Protocol for Children with Hemiparetic Cerebral Palsy. Open J Occup Ther. 2022;10(1):1-15. doi:10.15453/2168-6408.1836
26. Chan-Víquez D, Fernández-Huertas H, Montserrat-Gonzalez C, et al. Feasibility of a home-based home videogaming intervention with a family-centered approach for children with cerebral palsy: a randomized multiple baseline single-case experimental design. J Neuroeng Rehabil. 2024;21(1). doi:10.1186/s12984-024-01446-2
27. Gehringer JE, Jameson AW, Boyer H, et al. Feasibility of At-Home Hand Arm Bimanual Intensive Training in Virtual Reality: Case Study. JMIR Form Res. 2024;8:1-14. doi:10.2196/57588
28. Srinivasan S, Amonkar N, Kumavor P, Morgan K, Bubela D. Outcomes Associated with a Single Joystick-Operated Ride-on-Toy Navigation Training Incorporated into a Constraint-Induced Movement Therapy Program: A Pilot Feasibility Study. Behav Sci (Basel). 2023;13(5). doi:10.3390/bs13050413
29. Demers M, Fung K, Subramanian SK, Lemay M, Robert MT. Integration of motor learning principles into virtual reality interventions for individuals with cerebral palsy: Systematic review. JMIR Serious Games. 2021;9(2). doi:10.2196/23822
30. Srinivasan S, Kumavor PD, Morgan K. A Pilot Feasibility Study on the Use of Dual-Joystick-Operated Ride-on Toys in Upper Extremity Rehabilitation for Children with Unilateral Cerebral Palsy. Children. 2024;11(4). doi:10.3390/children11040408
31. Ahn SN. A Scoping Review of the Serious Game-Based Rehabilitation of People with Cerebral Palsy. Int J Environ Res Public Health. 2023;20(21). doi:10.3390/ijerph20217006
32. Goyal C, Vardhan V, Naqvi W. Virtual Reality-Based Intervention for Enhancing Upper Extremity Function in Children With Hemiplegic Cerebral Palsy: A Literature Review. Cureus. 2022;14(1):1-8. doi:10.7759/cureus.21693
33. Tresser S, Kuflik T, Levin I, Weiss PL. Personalisation of a virtual gaming system for children with motor impairments: performance and usability. Disabil Rehabil Assist Technol. 2023;18(6):876-882. doi:10.1080/17483107.2021.1936222
34. Chen HL, Lin SY, Yeh CF, et al. Development and Feasibility of a Kinect-Based Constraint-Induced Therapy Program in the Home Setting for Children With Unilateral Cerebral Palsy. Front Bioeng Biotechnol. 2021;9(October):1-11. doi:10.3389/fbioe.2021.755506
35. Kilcioglu S, Schiltz B, Araneda R, Bleyenheuft Y. Short- to Long-Term Effects of Virtual Reality on Motor Skill Learning in Children With Cerebral Palsy: Systematic Review and Meta-Analysis. JMIR Serious Games. 2023;11(1):1-17. doi:10.2196/42067
36. Tresser S, Kuflik T, Levin I, Weiss PL. Personalized Rehabilitation for Children with Cerebral Palsy. Vol 31. Springer Netherlands; 2021. doi:10.1007/s11257-021-09296-6
37. Vieira C, Da Silva Pais-Vieira CF, Novais J, Perrotta A. Serious Game Design and Clinical Improvement in Physical Rehabilitation: Systematic Review. JMIR Serious Games. 2021;9(3):1-13. doi:10.2196/20066
38. Voinescu A, Sui J, Stanton Fraser D. Virtual reality in neurorehabilitation: An umbrella review of meta-analyses. J Clin Med. 2021;10(7). doi:10.3390/jcm10071478
1. Shahane V, Kumavor P, Morgan K, Friel KM, Srinivasan SM. A protocol for a single-Arm interventional study assessing the effects of a home-based joystick-operated ride-on-Toy navigation training programme to improve affected upper extremity function and spontaneous use in children with unilateral cerebral palsy (UCP). BMJ Open. 2023;13(5). doi:10.1136/bmjopen-2023-071742
2. Hosseini P, Kobravi HR, Tahami E, et al. A New Training Protocol Based on Bimanual Playing a Computer Game for Motion-Cognitive Rehabilitation in Children with Spastic Hemiparetic Cerebral Palsy. Iran J Pediatr. 2023;33(5). doi:10.5812/ijp-136889
3. Yildirim Y, Budak M, Tarakci D, Algun ZC. The Effect of Video-Based Games on Hand Functions and Cognitive Functions in Cerebral Palsy. Games Health J. 2021;10(3):180-189. doi:10.1089/g4h.2020.0182
4. Saussez G, Bailly R, Araneda R, et al. Efficacy of integrating a semi-immersive virtual device in the HABIT-ILE intervention for children with unilateral cerebral palsy: a non-inferiority randomized controlled trial. J Neuroeng Rehabil. 2023;20(1):1-15. doi:10.1186/s12984-023-01218-4
5. Cuccurullo, Sara J. Physical Medicine and Rehabilitation Board Review Third Edition.
6. MacIntosh A, Desailly E, Vignais N, Vigneron V, Biddiss E. A biofeedback-enhanced therapeutic exercise video game intervention for young people with cerebral palsy: A randomized single-case experimental design feasibility study. PLoS One. 2020;15(6 June):1-23. doi:10.1371/journal.pone.0234767
7. Abd-Elfattah HM, Galal DOSM, Abdelmageed SM, et al. Effect of touch screen tablet use on fine motor functions in children with hemiparetic cerebral palsy: A randomized controlled trial. NeuroRehabilitation. 2024;55(1):137-146. doi:10.3233/NRE-240134
8. Meriggi P, Mandalà M, Randazzo M, et al. Non-immersive virtual reality based treatment for children with unilateral cerebral palsy: Preliminary results. J Pediatr Rehabil Med. 2024;17(1):107-123. doi:10.3233/PRM-230028
9. Alrashidi M, Wadey CA, Tomlinson RJ, Buckingham G, Williams CA. The efficacy of virtual reality interventions compared with conventional physiotherapy in improving the upper limb motor function of children with cerebral palsy: a systematic review of randomised controlled trials. Disabil Rehabil. 2023;45(11):1773-1783. doi:10.1080/09638288.2022.2071484
10. Mirich R, Kyvelidou A, Greiner BS. The Effects of Virtual Reality Based Rehabilitation on Upper Extremity Function in a Child with Cerebral Palsy: A Case Report. Phys Occup Ther Pediatr. 2021;41(6):620-636. doi:10.1080/01942638.2021.1909688
11. Daliri M, Moradi A, Fatorehchy S, Bakhshi E, Moradi E, Sabbaghi S. Investigating the Effect of Leap Motion on Upper Extremity Rehabilitation in Children with Cerebral Palsy: A Randomized Controlled Trial. Dev Neurorehabil. 2023;26(4):244-252. doi:10.1080/17518423.2023.2203210
12. Cortes-Perez I, Zagalaz-Anula N, Montoro-Cárdenas D, Lomas-Vega R, Obrero-Gaitán E, Osuna-Pérez M. Leap Motion Controller Video Game-Based Therapy for Upper. Sensors. 2021;21:2065.
13. Ren Z, Wu J. The effect of virtual reality games on the gross motor skills of children with cerebral palsy: A meta-analysis of randomized controlled trials. Int J Environ Res Public Health. 2019;16(20). doi:10.3390/ijerph16203885
14. Kanitkar A, Parmar ST, Szturm TJ, et al. Evaluation of a computer game-assisted rehabilitation program for manual dexterity of children with cerebral palsy: Feasibility randomized control trial. PM R. 2023;15(10):1280-1291. doi:10.1002/pmrj.12947
15. Parmar ST, Kanitkar A, Sepehri N, Bhairannawar S, Szturm T. Computer game-based telerehabilitation platform targeting manual dexterity: Exercise is fun. “you are kidding—right?” Sensors. 2021;21(17):1-16. doi:10.3390/s21175766
16. Bautista JD, Perales FJ, Ramis S, Montoya P, Riquelme I. Adaptation and Validation of a Serious Game for Motor Learning Training in Children with Cerebral Palsy. Games Health J. 2023;12(6):480-488. doi:10.1089/g4h.2023.0082
17. Gözaçan Karabulut D, Maden Ç, Karabulut Y, Aslan M. Effects of Video-Based Exercises and Conventional Physiotherapy on Upper Extremity Functionality, Selective Motor Control, and Proprioception in Unilateral Cerebral Palsy: A Randomized Controlled Trial. Games Health J. 2024;13(4):305-312. doi:10.1089/g4h.2024.0044
18. Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med. 2018;169(7):467-473. doi:10.7326/M18-0850
19. Srinivasan S, Kumavor P, Morgan K. A Training Program Using Modified Joystick-Operated Ride-on Toys to Complement Conventional Upper Extremity Rehabilitation in Children with Cerebral Palsy: Results from a Pilot Study. Bioengineering. 2024;11(4). doi:10.3390/bioengineering11040304
20. Shahane V, Kumavor PD, Morgan K, Srinivasan S. Fast and Fun: A Pilot Feasibility Study Using Dual Joystick-Operated Ride-on Toys for Upper Extremity Rehabilitation in Children with Hemiplegia. Phys Occup Ther Pediatr. 2024;44(6):844-864. doi:10.1080/01942638.2024.2360462
21. Martins FPA, Massetti T, Crocetta TB, et al. Analysis of motor performance in individuals with cerebral palsy using a non-immersive virtual reality task – A pilot study. Neuropsychiatr Dis Treat. 2019;15:417-428. doi:10.2147/NDT.S184510
22. Chan-Víquez D, Khan A, Munce S, Fehlings D, Wright FV, Biddiss E. Understanding a videogame home intervention for children with hemiplegia: a mixed methods multi-case study. Front Med Technol. 2023;5(July):1-16. doi:10.3389/fmedt.2023.1217797
23. Avcil E, Tarakci D, Arman N, Tarakci E. Upper extremity rehabilitation using video games in cerebral palsy: a randomized clinical trial. Acta Neurol Belg. 2021;121(4):1053-1060. doi:10.1007/s13760-020-01400-8
24. Chang HJ, Ku KH, Park YS, et al. Effects of virtual reality-based rehabilitation on upper extremity function among children with cerebral palsy. Healthc. 2020;8(4). doi:10.3390/healthcare8040391
25. Nguyen T, Choromanski L, Kreuzer T, Stroppini J. Exploring the Feasibility of a Virtual, Home-Based MusicGlove® Protocol for Children with Hemiparetic Cerebral Palsy. Open J Occup Ther. 2022;10(1):1-15. doi:10.15453/2168-6408.1836
26. Chan-Víquez D, Fernández-Huertas H, Montserrat-Gonzalez C, et al. Feasibility of a home-based home videogaming intervention with a family-centered approach for children with cerebral palsy: a randomized multiple baseline single-case experimental design. J Neuroeng Rehabil. 2024;21(1). doi:10.1186/s12984-024-01446-2
27. Gehringer JE, Jameson AW, Boyer H, et al. Feasibility of At-Home Hand Arm Bimanual Intensive Training in Virtual Reality: Case Study. JMIR Form Res. 2024;8:1-14. doi:10.2196/57588
28. Srinivasan S, Amonkar N, Kumavor P, Morgan K, Bubela D. Outcomes Associated with a Single Joystick-Operated Ride-on-Toy Navigation Training Incorporated into a Constraint-Induced Movement Therapy Program: A Pilot Feasibility Study. Behav Sci (Basel). 2023;13(5). doi:10.3390/bs13050413
29. Demers M, Fung K, Subramanian SK, Lemay M, Robert MT. Integration of motor learning principles into virtual reality interventions for individuals with cerebral palsy: Systematic review. JMIR Serious Games. 2021;9(2). doi:10.2196/23822
30. Srinivasan S, Kumavor PD, Morgan K. A Pilot Feasibility Study on the Use of Dual-Joystick-Operated Ride-on Toys in Upper Extremity Rehabilitation for Children with Unilateral Cerebral Palsy. Children. 2024;11(4). doi:10.3390/children11040408
31. Ahn SN. A Scoping Review of the Serious Game-Based Rehabilitation of People with Cerebral Palsy. Int J Environ Res Public Health. 2023;20(21). doi:10.3390/ijerph20217006
32. Goyal C, Vardhan V, Naqvi W. Virtual Reality-Based Intervention for Enhancing Upper Extremity Function in Children With Hemiplegic Cerebral Palsy: A Literature Review. Cureus. 2022;14(1):1-8. doi:10.7759/cureus.21693
33. Tresser S, Kuflik T, Levin I, Weiss PL. Personalisation of a virtual gaming system for children with motor impairments: performance and usability. Disabil Rehabil Assist Technol. 2023;18(6):876-882. doi:10.1080/17483107.2021.1936222
34. Chen HL, Lin SY, Yeh CF, et al. Development and Feasibility of a Kinect-Based Constraint-Induced Therapy Program in the Home Setting for Children With Unilateral Cerebral Palsy. Front Bioeng Biotechnol. 2021;9(October):1-11. doi:10.3389/fbioe.2021.755506
35. Kilcioglu S, Schiltz B, Araneda R, Bleyenheuft Y. Short- to Long-Term Effects of Virtual Reality on Motor Skill Learning in Children With Cerebral Palsy: Systematic Review and Meta-Analysis. JMIR Serious Games. 2023;11(1):1-17. doi:10.2196/42067
36. Tresser S, Kuflik T, Levin I, Weiss PL. Personalized Rehabilitation for Children with Cerebral Palsy. Vol 31. Springer Netherlands; 2021. doi:10.1007/s11257-021-09296-6
37. Vieira C, Da Silva Pais-Vieira CF, Novais J, Perrotta A. Serious Game Design and Clinical Improvement in Physical Rehabilitation: Systematic Review. JMIR Serious Games. 2021;9(3):1-13. doi:10.2196/20066
38. Voinescu A, Sui J, Stanton Fraser D. Virtual reality in neurorehabilitation: An umbrella review of meta-analyses. J Clin Med. 2021;10(7). doi:10.3390/jcm10071478