From left, Cheryl Peters, Jillian, 7, and Lauren, 9, play a game being developed for kids with cerebral palsy while the game’s developer, Elaine Biddiss, looks on.Deborah Baic/The Globe and Mail
Very little in life slows Jillian Peters down. If you catch her in a hallway, the spunky seven-year-old is likely to race you in her hot-pink wheelchair. Cerebral palsy doesn't define her.
"Life for Jillian is fun and exciting and challenging and emotional, sometimes," said Cheryl Peters, Jillian's mom, "but mostly energetic."
Her condition does require extra work, though. She does stretches at home to help with her mobility. Now, she's testing a new therapy at the Holland Bloorview Kids Rehabilitation Hospital in Toronto. Unlike Jillian's other treatments, this one doesn't feel like homework
What is cerebral palsy and how is it traditionally treated?
Generally, cerebral palsy is the result of a brain injury or malformation during gestation or right after birth. Depending on which part of the brain is affected, the effects of cerebral palsy can be wide-ranging. But most people with cerebral palsy have challenges with motor control.
Jillian was 13 months old when she was diagnosed with spastic diplegic cerebral palsy, which means two of her limbs are affected most of the time. In her case, it's her legs. But her right arm carries extra tone, though it's not clear if that's a direct result of her cerebral palsy.
"Walking is not fun," Jillian said. "Walking is not supposed to be fun. Running and sitting is supposed to be fun.
"And sleeping," she adds with a giggle.
Jillian practises walking with a walker and, to build her arm strength, she's encouraged to use the arm she is less comfortable with whenever possible. But it's not a choice she naturally makes. So, traditionally, when one limb is weaker, doctors will put kids through constraint therapy.
"Say if the child is having difficulty using their right hand, we would constrain their left hand with something like a splint or a cast to force them to use their right hand," explained Dr. Darcy Fehlings, one of Jillian's main physicians and a senior clinician scientist at the Bloorview Research Institute.
Making therapy fun with video games
The problem with constraint and other therapies is that they're not very fun. So Elaine Biddiss, an engineering scientist at Bloorview, started to look at how interactive video games could be used to accomplish rehabilitation goals.
Her games use existing motion-tracking video game technology, such as the Microsoft Kinect, to game-ify physical therapy. For example, in one of the games – Bootle Band, which was inspired by the popular game Rock Band – Jillian is required to use her weaker arm to shake a lemon-shaped maraca at specific intervals and at different intensities to defeat the "Rust Monster" bad guy. This task has her practising her grip, range of movement and arm strength.
Ultimately, the hope is that kids will play these games a lot and, by repeating these actions over and over again, they may help facilitate new neural pathways into the injured parts of the brain. This concept is called neuroplasticity.
"You may get an enhancement in stem cells that are able to go and recreate nerve-cell elements that are missing," Dr. Fehlings said. "Or we may be stimulating more synaptic connections and axonal growth."
Socializing while strengthening
The games are also designed with multi-player settings, so kids who are using them for treatment can also play with their able-bodied siblings and friends.
"One of the challenges with mainstream games is that, oftentimes, they're too difficult, too fast or require complex movements," Dr. Biddiss said.
In Bootle Band, there can be multiple users, each getting his or her own instrument. Together they rattle, tap and clap their way to victory against the evil "Rust Monster." Dr. Biddiss designed the game so that the difficulty (aka the vigour of the noise-making) can be adjusted to the user.
By being customizable, it promotes a social element to these games. Suddenly, kids with cerebral palsy don't have to do their exercises alone. And the social aspect builds competition and co-operation and keeps the players hooked.
"Engagement is hypothesized to prime the brain for learning and for neuroplasticity to occur," Dr. Biddiss said.
Why video games show promise
Even before Bootle Band, Jillian was a video-game enthusiast, playing games such as Disney's Castle of Illusion Starring Mickey Mouse with her nine-year-old sister Lauren, on their Playstation at home.
The reality is that video games are a natural habitat for many kids. And because of this, Dr. Biddiss believes the potential uptake for her therapeutic games is promising.
Currently, her video games are still in the development phase, but Dr. Biddiss dreams of a day when she can get games such as these into the homes of kids with cerebral palsy. She hopes that will be within five to 10 years.
Once on the market, kids such as Jillian could have an affordable, engaging and fun supplement to their other treatments.
"It's the right of kids to play, and these kids [at Holland Bloorview] are so inspirational," Dr. Biddiss said. "At the end of the day, I feel an obligation to make these therapies as fun and effective as possible."