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ACTIVE VIDEO GAMES (AVGs) require body movements (eg, swinging arms, stepping) beyond

that of conventional hand-controlled games. Two extremely impactful and high-potential applications of
AVGs are: (1) promoting increased daily physical activity for children with and without disabilities

(2) increasing engagement and participation in physical rehabilitation therapies.

Ambulatory children with CP are less likely to be physically active than their typically developing
peers. As such, these children are at an increased risk for overweight/obesity, diabetes, cardiovascular
disease, cancer, joint disease, and musculoskeletal pain, in addition to reduced psychological and
emotional health. For children with7 and without disabilities, excessive screen time is a causative factor
of physical inactivity. However, screen time activities (ie, television, internet, and video games) are
highly valued by children. One potential strategy to promote physical activity is to replace sedentary
screen time with active screen time using AVGs.

AVGs have been described as “one of the most innovative and promising recent developments
in rehabilitation technology”. Rehabilitation is often a long process involving various repetitive tasks
designed to achieve therapeutic goals. Clinicians are continually challenged to find appealing,
meaningful, and motivating tasks to achieve these goals. The strength of AVGs lies in their potential to
provide an entertaining and immersive virtual reality in which repetitive movements and/or complex
motor tasks can be encouraged with increasing levels of in-game difficulty and rewards. These
characteristics are key to eliciting neuroplastic changes that are so critical to motor rehabilitation.

As such, this study uses a multifaceted assessment protocol to explore the potential of AVGs for
the promotion of physical activity and therapy in children with CP. Specifically, the goals of this study
are: (1) to determine the intensity of physical activity that can be achieved during AVG play by
monitoring levels of EE, (2) to investigate the therapeutic potential of AVG play by quantifying upper
limb kinematics, and (3) to explore practical considerations surrounding the use of AVGs for physical
activity promotion and therapy by assessing: potential risks for muscle strain injuries, individual
variability during AVG play, and the extent of user enjoyment

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