Home Exercise Program Using Bootle Boot Camp

Testing Bootle Boot Camp - A New Movement Tracking App to Engage Kids in Home Exercise Programs

This study aims to learn about the engagement and lower limb motor outcomes of children with cerebral palsy, ages 6-12 years, GMFCS Levels I-II, engaging in home-based movement practice using a novel therapy exercise Application, Bootle Boot Camp, offered with and without movement-tracking feedback.

Adherence to home exercise programs is low. Interactive computer play (ICP) - any kind of computer game or virtual reality technology that allows users to interact with simulated objects in a virtual environment - offers a fun and motivational way to increase movement practice.

Bootle Boot Camp is a novel ICP technology developed by the Possibility Engineering and Research Lab at Holland Bloorview Kids Rehabilitation Hospital that uses a 3D motion tracking camera to provide real time feedback on skeletal movements during game play. It allows physiotherapists to prescribe personalized lower limb home exercise programs to clients.

The investigator's specific objectives are:

1. To compare participants' level of affective, behavioural, and cognitive engagement with Bootle Boot Camp with and without movement tracking feedback
2. To determine the quality of exercise performance when participants use Bootle Boot Camp with and without movement tracking feedback
3. To estimate the treatment response associated with use of Bootle Boot Camp
4. To explore physiotherapists, children, and their caregivers' experiences with the App.

Children with cerebral palsy (ages 6-12 years, GMFCS Level I or II) will be prescribed a home exercise program by their treating physiotherapist that they will complete independently using the App on their television at home. Bootle Boot Camp exercise sessions offered with movement-tracking feedback will be alternated with sessions offered without feedback for 4 weeks (4 sessions per week). Following this comparison period, the version of the App providing the most therapeutic data pattern based on system data and children's input will be used for an additional 2 weeks. Post 6 weeks of Bootle Boot Camp game play, children and caregivers will be asked to take part in semi-structured interviews to learn more about families' experiences with the home program

Physiotherapist Inclusion Criteria:

• Registered and in good standing with the College of Physiotherapists of Ontario
• Minimum 1-year pediatric clinical experience
• Caseload consists of clients with cerebral palsy (ages 6-12 years; GMFCS Level I-II)
• Works in public sector (Holland Bloorview) or private sector (clinics) within Ontario
• Has technology (e.g., laptop) and internet services needed to use Bootle Boot Camp, complete online surveys and video calls
• Has managerial and institutional approval

Physiotherapist Exclusion Criteria:

* Visual/auditory deficits that would limit the physiotherapist's ability to interact with the App

Child Inclusion Criteria:

• Diagnosis of cerebral palsy (GMFCS Levels I-II)
• Ages 6-12 years
• Minimum 1 lower limb goal
• Able to complete 4 weekly exercise sessions using Bootle Boot Camp for 6 weeks
• Not currently receiving physiotherapy services more than once every two months (on an off block from physiotherapy)
• Normal or corrected to normal vision and hearing
• Child and parent can speak and understand English
• Has technology (e.g., laptop) and internet services needed to use Bootle Boot Camp, complete online surveys, and video calls
• Child's physiotherapist and parent able and willing to also participate in the study

Child Exclusion Criteria:

• Botox injection in the last 6 weeks or orthopedic surgery in the last 6 months
• Has serial casting, Botox injection, orthopedic surgery or other significant medical intervention during the 6-week training period with the App
• Photosensitivity or unstable epilepsy triggered by video games, screen activities or TV light
• Visual or auditory deficits that would limit gameplay
• Respiratory, cardiovascular, or other significant medical condition that would limit safe gameplay
• Engaging in a progressive lower limb muscle strengthening or balance home exercise program as prescribed by a health care provider
• An extensive medical or therapeutic schedule (services scheduled on more than 3 days/week)
• Scheduled event (e.g., family or school trip) that would limit ability to perform 4 sessions/week for 6 weeks during training period with the App