title: A Comparison of Solo and Multiplayer Active Videogame Play in Children with Unilateral Cerebral Palsy.
abstract: OBJECTIVE
  Active videogames (AVGs) have potential in terms of physical activity and therapy for children with cerebral palsy. However, the effect of social interaction on AVG play has not yet been assessed. The objective of this study is to determine if multiplayer AVG versus solo affects levels of energy expenditure and movement patterns.
  
  
  METHODS
  Fifteen children (9.77 [standard deviation (SD) 1.78] years old) with hemiplegic cerebral palsy (Gross Motor Function Classification System Level I) participated in solo and multiplayer Nintendo(®) "Wii™ Boxing" (Nintendo, Inc., Redmond, WA) AVG play while energy expenditure and punching frequency were monitored.
  
  
  RESULTS
  Moderate levels of physical activity were achieved with no significant differences in energy measures during multiplayer and solo play. Dominant arm punching frequency increased during the multiplayer session from 95.75 (SD 37.93) punches/minute to 107.77 (SD 36.99) punches/minute. Conversely, hemiplegic arm punching frequency decreased from 39.05 (SD 29.57) punches/minutes to 30.73 (SD 24.74) punches/minutes during multiplayer game play. Children enjoyed multiplayer more than solo play.
  
  
  CONCLUSIONS
  Opportunities to play AVGs with friends and family may translate to more frequent participation in this moderate physical activity. Conversely, increased hemiplegic limb use during solo play may have therapeutic advantages. As such, new strategies are recommended to promote use of the hemiplegic hand during multiplayer AVG play and to optimize commercial AVG systems for applications in virtual reality therapy.
authors.affiliation: 1 Institute of Biomaterial & Biomedical Engineering, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Jennifer
authors.initials: J
authors.lastname: Howcroft
authors.affiliation: 2 Department of Paediatrics, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Darcy
authors.initials: D
authors.lastname: Fehlings
authors.affiliation: 3 Department of Physical Therapy, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Virginia
authors.initials: V
authors.lastname: Wright
authors.affiliation: 3 Department of Physical Therapy, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Karl
authors.initials: K
authors.lastname: Zabjek
authors.affiliation: 1 Institute of Biomaterial & Biomedical Engineering, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Jan
authors.initials: J
authors.lastname: Andrysek
authors.affiliation: 1 Institute of Biomaterial & Biomedical Engineering, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Elaine
authors.initials: E
authors.lastname: Biddiss