Designing Action-based Exergames for Children with Cerebral Palsy


What is the research question?

Children with cerebral palsy (CP) frequently experience a decline in motor function as they age. This decline in function is partly associated with a lack of physical activity, due to the barriers in accessing traditional exercise faced by children with CP. Exergames are a promising way to allow children with CP to participate in physical activity, permitting adaptations of exercise equipment and video games. Fast-paced video games are popular among children with CP and might be particularly effective at motivating physical activity since their fast pace gameplay encourages fast pace exercise. However, limitations in fine and gross motor function, eye-hand coordination and visual spatial reasoning (the ability to understand and remember the spatial relations among objects) associated with CP make it difficult for children with CP to play these games effectively.

With the possibilities and challenges in action-based exergames, researchers tried to answer the question: Can action based exergames that are fun to play over the long term be designed for children with CP?

How did researchers answer this question?

A team made up of a physiotherapist, a physician specialized in CP, computer scientists, a mechanical engineer and a group of children with CP came together to design a series of mini-exergames for kids with CP. The team focused on the abilities, rather than the disabilities, of the participants to design the games. The team created six different action-based mini-games, each with a different gameplay style (including competitive racing, hockey and zombie defense games). Each game used a special recumbent bicycle and a standard game controller, where pedalling and use of the controller caused the game avatar to move and perform specific game actions. Then, they gave these exergames to five children with CP to play. The children were asked to play the games for at least 30 minutes 5 times a week for an 8-week trial. Throughout the trial, the games were modified based on feedback from the players. All the children were able to play the games, and did so enthusiastically over the full 8 weeks.

Video illustrating use of the Liberi Exergame, courtesy of NeuroDevNet

What did we learn?

We learned that it is possible to create action-based exergames that are physically demanding yet enjoyable for children with CP. However, some design guidelines must be had in mind to ensure the games can be played without frustration. These design modifications include:

  • Balancing the games for different abilities to ensure fairness.
  • Limit the number of actions required to play the game.
  • Reduce the consequences of errors in the game.
  • Make sure children find their way inside the game’s virtual world (through on screen directions).
  • Remove the need for precise positioning and aiming.
  • Make the game state visible by making the impact of actions obvious.

Application to CP

As children with CP often have difficulties with certain components of standard action based exergames, their participation in these gaming environments is limited. By designing games that can be played, and are enjoyable to play, active recreational opportunities can be provided for children with CP. Exergames can help motivate kids to do their physical therapy, which may improve range of motion. Increases in physical activity may also prevent the loss of motor function with age which is common in children with CP and is associated with disuse/muscle wasting, poor fitness and changes in body composition. 

Future Steps

After promising results from this study, the researchers hope to test the games with a larger number of participants. The larger trial will help test the usefulness of the games in improving health and social engagement.

Want to know more?

This In Brief was developed as part of the Ontario Brain Institute initiative CP-NET. We also gratefully acknowledge NeuroDevNet for their support of the exergame project. 

Special thanks to Kathy Fruck & Betty Yundt for critically reviewing this document. 

For further information, please contact:

Brie Chauncey


Hamilton Hernandez, Zi Ye, Nicholas Graham, Darcy Fehlings, Lauren Switzer. Designing Action-based Exergames for Children with Cerebral Palsy. CHI 2013 Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, April 27-May 2, 2013, Paris, France.