title: Balancing for Gross Motor Ability in Exergaming Between Youth with Cerebral Palsy at Gross Motor Function Classification System Levels II and III.
abstract: OBJECTIVE
  To test how three custom-built balancing algorithms minimize differences in game success, time above 40% heart rate reserve (HRR), and enjoyment between youth with cerebral palsy (CP) who have different gross motor function capabilities. Youth at Gross Motor Function Classification System (GMFCS) level II (unassisted walking) and level III (mobility aids needed for walking) competed in a cycling-based exercise video game that tested three balancing algorithms.
  
  
  METHODS
  Three algorithms: a control (generic-balancing [GB]), a constant non-person specific (One-Speed-For-All [OSFA]), and a person-specific (Target-Cadence [TC]) algorithms were built. In this prospective repeated measures intervention trial with randomized and blinded algorithm assignment, 10 youth with CP aged 10-16 years (X ± standard deviation = 12.4 ± 1.8 years; GMFCS level II n = 4, III n = 6) played six exergaming sessions using each of the three algorithms. Outcomes included game success as measured by a normalized game score, time above 40% HRR, and enjoyment.
  
  
  RESULTS
  The TC algorithm balanced game success between GMFCS levels similarly to GB (P = 0.11) and OSFA (P = 0.41). TC showed poorer balancing in time above 40% HRR compared to GB (P = 0.02) and OSFA (P = 0.02). Enjoyment ratings were high (6.4 ± 0.7/7) and consistent between all algorithms (TC vs. GB: P = 0.80 and TC vs. OSFA: P = 0.19).
  
  
  CONCLUSIONS
  TC shows promise in balancing game success and enjoyment but improvements are needed to balance between GMFCS levels for cardiovascular exercise.
authors.affiliation: 1 Bloorview Research Institute , Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada .
authors.forename: Alexander
authors.initials: A
authors.lastname: MacIntosh
authors.affiliation: 1 Bloorview Research Institute , Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada .
authors.forename: Lauren
authors.initials: L
authors.lastname: Switzer
authors.affiliation: 1 Bloorview Research Institute , Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada .
authors.forename: Hamilton
authors.initials: H
authors.lastname: Hernandez
authors.affiliation: 2 School of Computing, Queen's University , Kingston, Canada .
authors.forename: Susan
authors.initials: S
authors.lastname: Hwang
authors.affiliation: 2 School of Computing, Queen's University , Kingston, Canada .
authors.forename: Adrian L Jessup
authors.initials: ALJ
authors.lastname: Schneider
authors.affiliation: 2 School of Computing, Queen's University , Kingston, Canada .
authors.forename: Daniel
authors.initials: D
authors.lastname: Moran
authors.affiliation: 2 School of Computing, Queen's University , Kingston, Canada .
authors.forename: T C Nicholas
authors.initials: TCN
authors.lastname: Graham
authors.affiliation: 1 Bloorview Research Institute , Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada .|3 Department of Paediatrics, University of Toronto , Toronto, Canada .
authors.forename: Darcy L
authors.initials: DL
authors.lastname: Fehlings
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002547:Cerebral Palsy / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D002648:Child; D015444:Exercise / Q000502:physiology*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D009048:Motor Skills / Q000145:classification* / Q000502:physiology; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D018910:Video Games / Q000145:classification / Q000523:psychology*; D016138:Walking / Q000502:physiology
keywords: Clinical training; Exergames; Fitness; Game mechanisms; Game therapy