It could be said that Dr. Darcy Fehlings is really going out on a limb to help kids with cerebral palsy (CP) become more active and social.
She’s the head of Holland Bloorview’s Cerebral Palsy Discovery Lab, leading a group of researchers whose work will have a huge impact on the health and well-being of kids and youth with this condition.
CP generally refers to a loss or impairment of motor function, but it’s actually caused by brain damage. The brain damage is caused by brain injury or abnormal development of the brain that occurs while a child’s brain is still developing — before, during, or after birth.
Regardless of how this condition occurs, kids with CP are kids first, stressed Dr. Fehlings.
“They would like to be treated like any other child and be included in everything that other kids are doing so that when they’re out in the world, people see them and not the CP first,” she said.
“And at our Discovery Lab, we’re looking at innovations and interventions that can help kids meet their developmental potential, function better and participate in activities they want to do.”
Exergames proving to be exceptional
Tapping into the popularity of video games, Dr. Fehlings and her team are working with Professor Nick Graham a computer scientist at Queen’s University to continue to develop Liberi Exergames.
Exergames gives kids with CP the chance to play video games powered by specially modified exercise bikes that combine fitness and fun, addressing both physical and social needs.
“When kids with CP become teenagers their body size increases but their muscle strength doesn’t increase as easily and that leads them to become more sedentary,” said Dr. Fehlings.
They’re cardiovascular fitness goes down, as does their activity level. And with that drop comes a decline in social connection.
Exergames helps boost cardiovascular strength while enhancing social interaction by allowing multiple users to play and interact in a virtual world, connecting through headsets and voice chats as the games are played.
New avenues to pursue
Now in its fifth year, Liberi Exergames is a hit.
“The kids all have such big grins on their faces,” said Dr. Fehlings. “We think it improves their quality of life and helps them feel more energized and happier.”
Today, the Exergames program is branching out into exciting new directions.
“The next phase is to figure out how we can allow kids to play in the same game even though they have different cycling abilities,” said Dr. Fehlings.
In other words, how can the game be modified so that a kid with CP can play a typically developing child and the game will still be balanced and competitive for both players.
At the same time, Dr. Fehlings and Dr. Graham are working with other partners to bring Exergames outside her lab.
“We’ve heard from families that would love to have this available as a community resource so we’re working with the Ontario Brain Institute and Kids Brain Health Network to see if we can figure out how to bring it out into the real world,” she said.
Unlocking constraint therapy’s success
Dr. Fehlings is also very interested in getting arms moving as well as legs, leading to ongoing research in a field called constraint therapy.
Kids with hemiplegic CP (the most common type of CP) have one hand that functions better than the other. As a result, they tend to favour their stronger hand and ignore their weaker hand.
Constraint therapy aims to improve hand and arm function of the weaker arm by restraining the stronger arm by placing it in a sling, splint or even a cast. The child then takes part in physiotherapy that focuses on increasing the strength and movement of the weaker arm that’s free.
“If we look back ten years ago, we weren’t providing constraint therapy at all. Now we’re a lead site for constraint therapy for children,” said Dr. Fehlings.
“We’ve shown that hand function can get better,” she continued. “But we don’t really understand what’s going on with the brain. It’s important to understand constraint therapy at a brain mechanism level. That will lead to enhanced insights that will help to make clinical treatments even better.”
This assessment of the brain during constraint therapy is already opening some exciting doors.
“We think part of the mechanism of how constraint may work is a re-balancing of brain activity,” said Dr. Fehlings. “We’ve shown that after constraint therapy the neural network connection between the two sides of the brain that controls motor hand movement is more connected.”
It’s this kind of research that gets Dr. Fehlings’ brain fired up, and with such promising research studies underway, more and more kids with CP will get active and get connected to the activities and people they love.