Exer-game developed through GRAND-NeuroDevNet partnership offers effective therapy for children with cerebral palsy
Research extended through CHRP award joins expertise from two NCEs to explore video games as a viable treatment for children with disabilities.
Posted by GRAND NCE, February 20, 2013

Dubbed "Liberi", the multiplayer exer-game allows children with cerebral palsy to socialize, exercise and engage in collaborative games.
Called "Liberi", the multiplayer exer-game allows children with cerebral palsy to socialize, exercise and engage in collaborative games. PHOTO: Darcy Fehlings.

Results of a new therapy collaboratively developed by researchers in the GRAND and NeuroDevNet NCEs show that exercise video games (or “exer-games”) can greatly improve the lives of children with cerebral palsy. Harnessing the appeal of gaming to motivate beneficial exercise, medical researchers and computer scientists at Queen’s University and the University of Toronto have developed a multiplayer virtual reality game that contributes to both physical fitness and fun social interaction among players.

Cerebral palsy (CP) is the most common physical disability in childhood. As children with CP reach mid- to late-adolescence, their muscle strength fails to increase in proportion to their body growth; some teens lose the ability to walk with a walker and transition to a wheelchair. Poor physical fitness and social isolation that result from their reduced mobility can impact on their quality of life.

During regular play sessions with the cycle-based exer-game, participants get a vigorous cardiovascular and muscle strengthening workout. Players pedal a stationary bicycle to power a video game character they maneuver using a uniquely designed controller. Interacting in real time with up to eight friends, the young players are challenged with activities like building, racing, and fighting enemies. The unit is also equipped with a linked microphone that allows for live chat during the game.

Perhaps what has most impressed researchers and parents about the project has been the enthusiasm and engagement of the teen participants:

“It’s something tremendously rewarding: not just having the kids themselves playing the games - [hearing] their whoops of delight and excitement to get to come out and play - but even having their parents come back and say how exciting it has been for them, to have their kids being able to do this,” said Dr. Nicholas Graham, a Professor of Computer Science at Queen's University and Director of the EQUIS Lab (Engineering Interactive Systems) at Queen’s University. As project leader of GRAND’s Gaming for Physical Fitness (GAMFIT) project, Graham and fellow researchers at EQUIS are exploring fun collaborative games that motivate people to become and remain physically active.

Project part of unique NCE partnership

Graham’s NeuroDevNet counterpart, Dr. Darcy Fehlings (University of Toronto), is the Physician Director of the Child Development Program at the Holland Bloorview Kids Rehabilitation Hospital in Toronto. Also a Senior Scientist at the Bloorview Research Institute, Fehlings is leading research into new rehabilitation treatments for children and youth with cerebral palsy.

Graham and Fehling’s two-year pilot CP Fit n’ Fun Project was one of four innovative projects launched as part of the $500,000 NEUROGAM initiative co-funded by both NCEs. Early in their existence, the two research networks realized the tremendous potential of emerging computer and gaming technologies as novel therapeutics for neurodevelopmental disorders. NEUROGAM was the result of an initial 2010 workshop that connected like-minded investigators and trainees to explore existing and new research collaborations. NEUROGAM was completed in 2012, but thanks to a Collaborative Health Research Projects (CHRP) award funded through the Natural Sciences and Engineering Research Council of Canada (NSERC) and the Canadian Institutes of Health Research (CIHR) the research was extended last fall for another three years.

“[The workshop] was a key linkage because [otherwise] we wouldn’t have come together – since we’re in such diverse fields,” Fehlings noted. “It’s such a nice complement of skills being brought together in this particular project. It’s one of my most enjoyable research studies.”

Novel design ups engagement and motivation

During the pilot, medical professionals, game designers, computer scientists, kinesiologists, physical therapists, and eight children with CP helped co-develop the successful game prototype.

“We were able to combine all of the expertise from Darcy’s group on how to design physical devices that people could use, while bringing in our gaming expertise on how to design interfaces,” said Graham. “It meant everything had to be designed from the ground up for people with CP, from the controllers, to the handle attachments, to the support from the cycling device, all the way to the play of the games themselves.”

According to Graham, conventional game design guidelines for players with motor disabilities have yielded slow-paced, simplistic and consequently boring games. Graham wanted to revise these design standards to match the interests and abilities of the players and help make exer-games fun and engaging.

“What was learned from the kids is that they like action-oriented games. They like to play NHL and FIFA and Call of Duty – games that have a lot of action and are fast-paced. We tried to find ways of making the games fast-paced and action-packed, despite the fact that conventional wisdom said we can’t do that,” said Graham. “Exer-games should be exciting because you want people to get their heart-rates going, you want people to get motivated to keep trying a little harder.”

Some studies of exer-game systems in the home have questioned their effectiveness in improving players’ physical fitness. But without the proper support or coaching, Graham points out, over a six to eight week period people’s motivation drops off entirely. In contrast, Fehlings’ group is given a support system that provides continual encouragement. The design team is also careful to periodically roll out new games to maintain interest.

However, the biggest motivational factor has been the ability to play and socialize with other players. Children with CP often find it difficult to get together with other kids their own age, and exer-games offer a platform to do this. For participants, the ability to play with friends was one of the game's top features. When asked what made the game fun, one young player responded "The fact that we all were together and talk to each other while we were doing it." Another added: "It keeps you connected to people." Kids also felt they worked harder at the game when played as a group, as one put it: "I was pedaling a bit more when I was playing with the others."

“The fact they could play together as friends was an important part of the findings. It was a big motivator," said Fehlings. “They [also] want to play with friends who don’t have CP.”

“The families the kids and the parents are really keen on the exer-games – it’s something that really resonates with them,” she added. “We have some families who can hardly wait to start the next trial so that their kids can start to get back on the bikes and exer-gaming again.”

“It’s a very beneficial thing to do, and it’s just awesome and fun,” said participant Lara Wong, 15, of the exer-game study in an interview for the Toronto Star. For Lara, who has known Fehlings since she started going to Holland Bloorview in kindergarten. “The people in the group are my friends, and I’ve noticed a difference in them, too.”

Researchers aim to broaden therapeutic use and application of games

The current prototype is designed for a Gross Motor Function Classification System (GMFCS) rating of three (on a scale of five): players can walk but use a mobility aid like a walker. Graham and Fehlings are looking at techniques to include players with very different physical abilities, including those who require wheelchairs. The goal is to create an adaptable system that gives everyone a good workout, while also being challenged by the game. Plans are also underway to develop an inexpensive home-based version that can include more than eight players.

If long-term benefits for youth with cerebral palsy are found, Fehling sees the research findings as generalizable to individuals with other disabilities. As a highly motivating and effective rehabilitation treatment for promoting fitness, health, and social integration, exer-games may help treat childhood obesity and social isolation experienced by those with neurological disorders. Exer-games also improve attention, focus, and mood that could address some of the symptoms of FASD.


GRAND is a federally funded Network of Centres of Excellence involving 25 universities and across Canada and more than 60 industry, government, and nonprofit partners. As a national research network, GRAND works to advance digital media research, training, policies and innovation in Canada, and to realize commercial opportunities for innovative research that generate social and economic benefits to Canadians.

About NeuroDevNet NCE

NeuroDevNet is a Canadian Network of Centres of Excellence (NCE) dedicated to helping children overcome neurodevelopmental disorders. Network investigators seek to understand the causes of neurological deficits, and to transfer this knowledge to health care professionals, policy makers, and communities of interest. NeuroDevNet works with its partners to ensure generated knowledge is translated into tangible diagnostic, preventative, therapeutic, social, economic, and health benefits for all.


Spencer Rose
Communications Officer