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From dance to play, physical therapy professor Anjana Bhat has a long history of using creative therapies to engage with autistic children. Capitalizing on children's love of video games, the latest study currently underway in her Move 2 Learn Innovation Lab seeks to determine whether Nintendo Switch's Ring Fit can serve as an intervention that promotes motor skills, movement and physical activity in children with autism. Bhat's innovative exergaming study was funded by the Maggie E. Neumann Health Sciences Research Fund.

Video games promote motor skills for kids with autism: youtube.com/watch?v=Ur0udml0dro

Game on!

Photo and video by Ashley Barnas Larrimore

UD physical therapy research finds video games ‘most engaging’ intervention for children with autism

Like most 10-year-old boys, Reed likes exercise. He just doesn’t like to be told to do it. Using Ring Fit on Nintendo Switch, Reed, who has autism, can explore a fantastical world and defeat enemies in an action roleplaying game or play various sports that also help him get his daily dose of exercise. 

He first played the game in Anjana Bhat’s Move to 2 Learn Innovation Lab on the University of Delaware’s STAR Campus. The professor of physical therapy in the College of Health Sciences has a long history of finding creative ways to keep autistic children engaged with the added benefit of improving their flexibility and gross motor skills. She’s used dance and play in the past but is now testing video games to see if they’re a viable intervention to promote movement in this population. 

“Children love video games, and they’re fun,” Bhat said. “But there’s also a lot of evidence that video games with an exercise component have positive effects on cognition, social interactions and general physical activity levels.” 

She added that children with autism have a predilection for technology with a love of computers and robots, but exergaming hasn’t been studied in this population. 

“Technologies that have been tested and studied in children with autism mainly target sedentary functions that look at improvement in executive function and decision-making, but not necessarily exergaming,” Bhat said. “Exergaming has been studied in older populations and healthy children, but not so much in children with autism, so this study is unique.” 

After testing the intervention on a dozen children with autism over eight weeks, the consensus is that it works.

“I’ve never seen anything grab their attention so much. Across the board, this tool is far more engaging than any other tool we’ve used before, including music and movement, yoga, general exercise, and outdoor play, which do not always work for every child,” Bhat said. “With exergaming and the variety of content that exists, most children remain engaged, and that’s what’s so unusual about this intervention compared to past interventions.” 

Games like tennis, volleyball, badminton, golf, sword fighting and bowling focus on the upper extremities, while soccer focuses on the lower extremities. Bhat receives accurate measures of improvement in a child’s ability through accelerometers in the video game controllers. 

“This is one place where children with autism shine,” Bhat said. “Their visual learning and sensory enhancements help them excel. This gives them a sense of self-efficacy and self-assurance that — they’re good at this,” she said. “It also gives them a sense of connection to the community because they can make friends and feel empowered. Video games are a great equalizer.” 

Bhat’s innovative pilot study was funded through a $50,000 award from the donor-created Maggie E. Neumann Health Sciences Research Fund, which targets research and innovation that aims to improve the lives of people with disabilities. Equipped with data from this study, Bhat hopes to expand access to the intervention and test it in the community. It’s already available at D-Fit Plus, an inclusive fitness center in New Castle that aims to help those with special needs explore fitness to build social skills and confidence, grow cognition, and manage stress.

Reed, a 10-year-old boy with autism, gets his daily dose of exercise playing Ring Fit for Nintendo in Professor Physical Therapy Anjana Bhat’s Move 2 Learn Innovation Lab. Jacob Corey (right), a research assistant obtaining his doctorate in biomechanics and movement science, is working with Bhat on an exergaming study to determine whether Ring Fit can serve as an intervention that promotes motor skills, movement, and physical activity in individuals with autism, aged 7-21 years old.
Reed, a 10-year-old boy with autism, gets his daily dose of exercise playing Ring Fit for Nintendo in Professor Physical Therapy Anjana Bhat’s Move 2 Learn Innovation Lab. Jacob Corey (right), a research assistant obtaining his doctorate in biomechanics and movement science, is working with Bhat on an exergaming study to determine whether Ring Fit can serve as an intervention that promotes motor skills, movement, and physical activity in individuals with autism, aged 7-21 years old.

“It’s relatively low cost,” Bhat said. “Another advantage of this intervention is that you don’t need a highly skilled person present to work the intervention because the game leads the activity, making it accessible if embedded in the community.” 

This also provides a social outlet for the child’s parents.

“Community settings bring a sense of connection for the child’s parents, who are always looking for community-based activities, and many environments aren’t suitable for children with autism,” Bhat said. “Many environments are too noisy or distracting. Exergaming removes those barriers and allows the child to engage with the game and maybe another partner.” 

Bhat’s previously published research has shown that 80% of people with autism face motor challenges. Her research is so compelling that she’s made a case to change the definition of autism to include motor impairments so those on the spectrum can get the proper physical therapy or gross motor interventions that could dramatically improve their quality of life.

That’s what drew physical therapist Jacob Corey to this work.

“In my standard physical therapy practice, I’d be working with geriatric and neurological populations or at schools, ensuring children with disabilities have access to their educational environment,” Corey said. “This work is really focused on developing stronger motor skills to play sports or engage in other activities with friends.

“I also love working with this population because of their imagination. They bring so much happiness and a great energy that’s just contagious.” 

Danielle Williams, a senior health behavior science major with a double minor in psychology and health, physical activity, and disability, aspires to be an occupational therapist. This marked her first time working with children with autism. 

“Watching Jacob has taught me so much about this population. I’ve learned how to talk to them and reason with them,” Williams said. “Now, I can better understand their needs and how to accommodate them. It’s solidified that this is the population I want to work with in the future.” 

As an undergrad, Leah Alexander, a sophomore with a double major in neuroscience and psychology, never expected to have so much patient interaction.

“Exergaming is also physical therapy, and that’s what I enjoyed the most,” Alexander said. “It was so cool to see the kids get so much better at the sports they played over time. Working with children with autism has been so fulfilling.” 

Corey obtained his doctorate of physical therapy at UD. Now, he’s pursuing his doctorate in biomechanics and movement science while working as a research assistant in Bhat’s lab. For the exergaming study, which is part of his dissertation work, Corey has developed a series of lower and upper limb and trunk exercises to ensure children are working all parts of their body with minimal fatigue. He’s even added a variety of props, from balance boards to weights, to increase the complexity of the exercises. 

He’s observed significant progress in Reed over the eight-week course of the study. 

“He just loves these games. He doesn’t want to skip any part of it, and he goes through the entire intervention without any rest,” Corey said. “His aerobic capacity really increased. We were doing various running games that required a lot of endurance, and he used to have to take rest breaks because he was tired. Now, he flies through them.” 

Reed’s parents have observed the change, too. 

“It’s almost like occupational therapy for him,” said Reed’s father, John Rigney. “It’s just one more cog in a wheel of things we can do with him and for him that all work together to make him more active.

Reed’s mother, Jill Jordan, said it’s also made him more flexible.

“While there’s a routine, he still has to be flexible,” Jordan said. “Partaking in different activities is fun for him, and while he may not always like them, he usually learns to like them.”

Rigney said his son has gained a greater understanding of how things work.

“Ever since he’s played these games, he’s been focused on using a key to open the front door at home,” Rigney said. 

He also loves working one-on-one with Corey.

“Reed does much better with one-on-one interventions because he’s fully engaged, and we’ve always had such a positive experience in Anjana’s lab at UD,” Rigney said. 

Jordan echoed those sentiments.

“He looks forward to coming to UD for this study,” Jordan said. “It exposes him to new people and building relationships. Several aspects of these studies have had a positive impact on him and our family.” 

The intervention has been so successful that Reed got a Nintendo Switch for Christmas from Santa so he can get his daily dose of exercise at home.

About the fund

Maggie E. Neumann Health Sciences Research Fund was established in 2020 to support research designed to improve health and quality of life outcomes for children and adults with physical and developmental disabilities. While the fund resides at the College of Health Sciences, the intent is to support interdisciplinary research across all UD colleges.

The research fund was created with a gift from Donald J. Puglisi and Marichu C. Valencia in honor of their granddaughter, Maggie E. Neumann. Puglisi is a member of UD’s Board of Trustees, and they both serve on the President’s Leadership Council.

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