Game-oriented interventions for children with cerebral palsy: a review of efficacy, engagement, and functional...

Cerebral palsy (CP) is the most prevalent cause of childhood physical disability worldwide, affecting approximately 1.6 per 1,000 live births and imposing permanent deficits across motor, cognitive, and psychosocial domains. Conventional rehabilitation is frequently constrained by poor engagement and inadequate practice intensity in pediatric populations. Game-based interventions - encompassing virtual reality (VR), exergaming platforms, serious games, augmented reality, and telerehabilitation systems - address this challenge by embedding intensive therapeutic motor practice within intrinsically motivating play environments. This narrative review synthesizes evidence on the efficacy, engagement profiles, neuroplasticity mechanisms, and functional outcomes of game-oriented interventions for children with CP.

A structured narrative synthesis was conducted using 25 peer-reviewed articles published between 2021 and 2025, identified through a structured literature search of Scopus and Web of Science. Eligible sources included systematic reviews, meta-analyses, randomized controlled trials, feasibility studies, and scoping reviews. Evidence was organized thematically around game technology types, functional outcome domains, neuroplastic mechanisms, and clinical implementation factors.

Converging evidence demonstrates that game-based interventions produce statistically significant, though modest and not yet clinically validated, improvements in gross motor function (GMFM-88 MD = 0.81; 95% CI [0.15, 1.47]), alongside improvements of uncertain long-term durability in upper limb dexterity, balance, gait kinematics, and activities of daily living. VR-assisted exergaming shows a statistically greater improvement than conventional physiotherapy for GMFM walking and standing dimensions, though this has not been shown to reflect a dose-matched or clinically established advantage. Neuroimaging findings are associated with use-dependent cortical reorganization as a proposed neuroplastic mechanism; this evidence is predominantly correlational, and a causal or mediating role has not been directly demonstrated.

Game-based interventions represent a scientifically grounded and clinically feasible modality for pediatric CP rehabilitation that directly addresses the engagement and intensity limitations of conventional therapy. Methodological heterogeneity, small sample sizes, and insufficient long-term follow-up remain the primary evidence limitations. Future priorities include standardized outcome measurement, adaptive AI-driven game systems, and adequately powered telerehabilitation trials. Integration into routine neurorehabilitation practice is supported by the current evidence base.