Wheelchair Accessible Video Gaming Controller for Improving Health and Function Measures

R2: Efficacy of a Wheelchair Accessible Universal Active Video Gaming Controller in Improving Cardiorespiratory Fitness and Other Health and Function Measures in Adults with Physical Disabilities


A growing body of literature indicates that increases in energy expenditure can be achieved during active video gaming (AVG) play in people with physical disabilities, including those with mobility impairments such as cerebral palsy (CP)1,2, spinal cord injury (SCI)3,4, stroke5, and other neurological conditions6,7.  AVGs are particularly important for people with disabilities given the higher rate of inaccessible features in the built environment and the difficulty in finding activities they enjoy.  Since AVG devices are relatively affordable, they also hold promise as a scalable product for promoting higher levels of physical activity and fitness among people with disabilities.

There continues to be a pressing need to make certain gaming controllers accessible to people who are unable to stand for long periods, cannot stand on a small platform due to poor balance or extreme obesity, or who are unable to stand and are full-time wheelchair users.  The Wheelchair Accessible Active Video Gaming (W-AVG) controller that is being developed in Project D2 will be used in this study to improve health and function in ambulatory and non-ambulatory adults with physical disabilities.


To evaluate the efficacy of a 12-week (36 sessions) AVG exercise intervention using the W-AVG controller in improving cardiorespiratory endurance  health, balance, balance confidence, health-related quality of life, fatigue, pain interference, and depressive symptoms in people with physical disabilities.


A randomized single-blinded 2 x 2 crossover design will be used. A total of 36 eligible participants will be recruited and randomized into one of two groups: (1) W-AVG (immediate intervention), and (2) Control (delayed intervention).

During Visit 1, following informed consent and completion of the baseline assessments, participants assigned to the W-AVG group will be familiarized with the gaming system and how to utilize weight shifting for playing the games.  An appointment will be scheduled for the next visit, approximately 1 week later, when the actual intervention period will begin.

Participants in the W-AVG group will attend individual exercise visits supervised by a member of the research team three times weekly for 12 weeks for a total of 36 sessions.  The intervention will be comprised of various aerobic AVG games (e.g., boxing, running, dancing, and aerobics).  During each session, aerobic games will be played in bouts of 10 minutes separated by lower-intensity balance games, and finishing with 5 minutes of cool-down activities (e.g., stretching, yoga).

The training protocol will consist of repetitions of several games selected from Wii Fit Plus or other similar game packages.  Each game will start at the basic/beginner level, and when a certain score is attained, will automatically advance to the next level.  During the first 4 weeks of training the exercise intervention will be guided by researcher-selected games to ensure an appropriate progression and amount of aerobic activity.  For weeks 5 to 8, the exercise program will be adjusted by the research team based on participant needs with continued progression and balance of activities.  Progression of activities will be guided by participant safety, independence, use of appropriate movement strategies, level of engagement, and fatigue.  In weeks 9 to 12 of training, participants will be free to play games that they enjoyed the most, with the goal of achieving 50 minutes of aerobic activity each session.


Final Outcomes

The W-AVG intervention will result in greater improvement in cardiorespiratory endurance, balance, and self-reported health outcomes compared to a control group.


  1. Howcroft J, Klejman S, Fehlings D, et al. Active video game play in children with cerebral palsy: Potential for physical activity promotion and rehabilitation therapies. Arch Phys Med Rehabil. 2012;93(8):1448-1456.
  2. Rowland JL, Rimmer JH. Feasibility of using active video gaming as a means for increasing energy expenditure in three nonambulatory young adults with disabilities. PM R. 2012;4(8):569-573.
  3. Mat Rosly M, Mat Rosly H, Hasnan N, Davis GM, Husain R. Exergaming boxing versus heavy bag boxing: Are these equipotent for individuals with spinal cord injury? European journal of physical and rehabilitation medicine. 2017.
  4. Burns P, Kressler J, Nash MS. Physiological responses to exergaming after spinal cord injury. Top Spinal Cord Inj Rehabil. 2012;18(4):331-339.
  5. Trinh T, Scheuer SE, Thompson-Butel AG, Shiner CT, McNulty PA. Cardiovascular fitness is improved post-stroke with upper-limb Wii-based Movement Therapy but not dose-matched constraint therapy. Top Stroke Rehabil. 2016;23(3):208-216.
  6. Malone LA, Rowland JL, Rogers R, et al. Active Videogaming in Youth with Physical Disability: Gameplay and Enjoyment. Games Health J. 2016.
  7. Rowland J, Rimmer JH. Feasibility of using active video gaming as a means for increasing energy expenditure in three nonambulatory young adults with disabilities. Phy Med & Rehabil. 2012;4:569-573.