title: Video-game-assisted physiotherapeutic scoliosis-specific exercises for idiopathic scoliosis: case series and introduction of a new tool to increase motivation and precision of exercise performance.
abstract: BACKGROUND
  It is important to monitor how patients with juvenile and adolescent idiopathic scoliosis comply with their physiotherapeutic scoliosis-specific exercises (PSSE). Physiogame, a newly developed video game using the Game-Trak 3D interactive game controller, combines correct PSSE performance with gaming. It tracks the position of the working limb in 3D space during the exercises as participants aim to hit certain targets and avoid others, and gives direct feedback by stopping the game if the working limb leaves the target 3D space, which is chosen to secure the corrective position according to the Schroth method. Physiogame records the quality and frequency of the exercises performed. We aimed to investigate the influence of this tool on motivation to perform regularly and, correctly, and with self-assessment of performance quality.
  
  
  METHODS
  This case series included 8 consecutive patients with idiopathic scoliosis (thoracolumbar 7, lumbar 1), ages 7-13 years, all female and treated according to SOSORT guidelines; the COBB angle of primary curve at the start of brace therapy was 22-34°. In addition to Full Time Rigid Bracing (FTRB, Cheneau) and PSSE (Schroth), the participants were to perform two standardized Schroth exercises (muscle cylinder in standing position, mainly addressing the thoracic curve, and in side-lying position, mainly addressing the lumbar curve) with video game assistance every day for 6 months. The development (first to last month) of the following parameters was analyzed with descriptive methods: the actual training time to assess motivation, the ratio of the actual playing time versus total playing time to assess exercise improvement, and self-assessment of quality of performance.
  
  
  RESULTS
  The average number of sessions with Physiogame was 217 per study participant (range 24 to 572, the study protocol targeted at least 180); actual training time decreased from 79 to 52 min (first to last month). Actual playing time increased from 73% of the total playing time to 83% (first to last month), and positive hits per second from 0.33 to 0.56. Self-assessment increased from "good" to "very good". The curve angles (°Cobb) were maintained over the study period (upper thoracic mean -1.3°, median -1°; lower thoracic mean 3°, median 2°; lumbar mean 0.5, median 0).
  
  
  CONCLUSIONS
  The improvement we saw in exercise performance, is thought to result primarily from the direct given feedback during the game, as the exercises themselves were already familiar to the patients. The synchronous recording of actual training time allows evaluation of Schroth therapy for idiopathic scoliosis, since both prescribed training time and actual training time are captured. No comparable tool was found in literature.
authors.affiliation: Department of Orthopedic Surgery, Medical University of Graz, Auenbruggerplatz 5, A-8036 Graz, Austria.
authors.forename: Christine
authors.initials: C
authors.lastname: Wibmer
authors.affiliation: University of Applied Sciences, Alte Poststraße 149, A-8020 Graz, Austria.
authors.forename: Petra
authors.initials: P
authors.lastname: Groebl
authors.affiliation: University of Applied Sciences, Alte Poststraße 149, A-8020 Graz, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Nischelwitzer
authors.affiliation: University of Applied Sciences, Alte Poststraße 149, A-8020 Graz, Austria.
authors.forename: Beate
authors.initials: B
authors.lastname: Salchinger
authors.affiliation: Pediatric Orthopedic Unit, Department of Pediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, A-8036 Graz, Austria.
authors.forename: Matthias
authors.initials: M
authors.lastname: Sperl
authors.affiliation: Pediatric Orthopedic Unit, Department of Pediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, A-8036 Graz, Austria.
authors.forename: Helmut
authors.initials: H
authors.lastname: Wegmann
authors.affiliation: Institute of Sport Science, University of Graz, Mozartgasse 14, A-8010 Graz, Austria.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Holzer
authors.affiliation: Pediatric Orthopedic Unit, Department of Pediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, A-8036 Graz, Austria.
authors.forename: Vinay
authors.identifier: 0000-0001-9077-6096
authors.initials: V
authors.lastname: Saraph
keywords: Exercise therapy; Motivation; Scoliosis; Video games