This generally well-conducted review assessed the evidence for interactive computer play for motor control and learning rehabilitation in children with sensorimotor disorders. A paucity of well-conducted research precluded firm conclusions about these interventions. The authors' conclusions are likely to be reliable based on the evidence presented.

To evaluate the evidence for the use of interactive computer play in the rehabilitation or motor control and learning in children with sensorimotor disorders.

PubMed, Biological Abstracts, AMED, CINAHL, PsycInfo, EMBASE, MEDLINE, Web of Science, Inspec, The Cochrane Library and PEDro were searched between January 1995 to May 2008 for studies published in English; search terms were reported. Reference lists of retrieved articles were searched and contact was made with experts.

Published studies that evaluated the effect of interactive computer play in children under 18 years of age with sensorimotor disorders were eligible for inclusion.

Participants included in the eligible studies were children with cerebral palsy, attention deficit hyperactivity disorder (ADHD), muscular dystrophy, Erb's palsy, unspecified developmental delays and children who were preterm babies. The interactive computer play interventions included use of two-dimensional computer games, touch screens, sensor gloves, EyeToy for PlayStation2, Interactive Metronome and flat-screen virtual reality operated by ordinary keyboards or joysticks (the last intervention was the most commonly used across the studies). The average number of weekly sessions was three per week and average session duration was 60 minutes. Duration of the interventions ranged from three to 12 weeks. Outcomes examined included movement quality, timing, attention, cognitive skills, spatial orientation, wheelchair driving skills, motivation, playfulness and self-efficacy.

Two reviewers independently applied the inclusion criteria; disagreements were resolved by discussion.

The reviewers classified the studies according to the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) for levels of evidence. The methodological quality of the studies was not assessed.

Two reviewers independently extracted data as reported in each study and presented it in tables in the report. No particular outcome of interest was predetermined by the review authors before data extraction commenced.

Results from the trials were presented as a narrative summary with supporting information from tables alongside the text.

Sixteen studies (n=257) comprised three randomised controlled trials (RCTs), two non-randomised controlled trials (non-RCT), three cohort studies, three case series and five case reports. The quality of the included studies was generally low, with inclusion and exclusion criteria not stipulated, lack of blinding and little reporting of power calculations and statistical tests.

Movement quality: One RCT showed significant improvements in attention, motor control, language processing, reading and the ability to regulate aggression after Interactive Metronome training in children diagnosed with ADHD. Another RCT investigated computer game play and showed significant improvements in computer game skill, but not movement or kinematic analysis. The third RCT did not show any differences in upper extremity control between the intervention and control groups after practice with the Interactive Rehabilitation and Exercise system.

Spatial orientation skills and mobility: In one non-RCT, children with cerebral palsy significantly improved on tests of spatial skills after training with two-dimensional and three-dimensional models of mazes. In another study, children with disabilities who were inexperienced wheelchair drivers improved driving performance after simulator training, but did not attain the same level as experienced drivers.

Motivation, self-efficacy and playfulness: In one RCT in children with cerebral palsy, no significant results were shown on measures of self-efficacy after playing interactive games (except for the subtests on social acceptance, in that the children felt they had more friends and were well liked).

Interactive computer play was a potentially promising instrument for the motor rehabilitation of children, but inconsistent results and lack of well-controlled trials made it difficult to draw any conclusions about interactive computer play interventions in the rehabilitation of children.

The review was generally broad in scope. The authors searched relevant databases for published articles and attempts were made to find further information by reviewing reference lists. Unpublished material and non English-language articles were excluded, which may have caused relevant studies to be missed. There was substantial heterogeneity in study designs. Most of the available evidence was comprised of cohort studies, case series and case reports. The paucity of well-controlled studies made it difficult to draw any conclusions about the effectiveness of interactive computer play for children with sensorimotor disorders. The review was generally well-conducted, and the authors' conclusions are likely to be reliable.

Implications for practice: The authors did not state any implications for practice.

Implications for research: The authors stated that despite there being few studies, use of interactive computer play appeared highly promising. There was a need to develop sensitive outcome measures and a common vocabulary within this research field. Before large, well-controlled studies could take place, smaller feasibility studies were required.

The Vardal Institute, Swedish Institute for Health Sciences, JC Kempe Memorial Foundation, Muskelfond Norr and the Northern Ireland Department of Employment and Learning Strategic Priority Fund.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.