The Effects of Neurofeedback and Play Therapy on Dynamic Balance in 4-10 years old Children with Diplegic Spastic Cerebral Palsy

  • Maryam Emami Korande 1 1. MSc Student of Sports Injury, Faculty of Literature, Humanities and Social Sciences, Physical Education and Sport Science Department, Islamic Azad University, Research and Sciences Branch, Tehran, Iran.
  • Amirhossein Barati 2 2. Associated Professor of Sports Injury, Physical Education and Sport Sciences Faculty, Health and Sport Rehabilitation Department, Shahid Beheshti University, Tehran, Iran.
  • Mina Haghighi 3* 3. Assistant Professor of Sports Injury, Physical Education and Sport Sciences Faculty, Biological Sciences Department, Shahrood University of Technology, Semnan, Iran.
  • Javid Peimani 4 4. Assistant professor of Sports Injury, Faculty of Literature, Humanities and Social Sciences, Psychology Department, Islamic Azad University of Karaj, Alborz, Iran.
Keywords: Cerebral palsy, Neurofeedback, Play therapy, Statistic equivalent, Dynamic equivalent


Background: Dynamic balance is one of the most important challenges for kids who suffer from cerebral palsy especially diplegic spastic ones. Therefore, this study designed to compare the neurofeedback and play therapy training on dynamic balance in 4-10 years old diplegic spastic cerebral palsy kids. Methods: Quasi-experimental with three groups and pre-posttest design. This study has involved 26 spastic diplegia cerebral palsy children in 1st and 2nd grades, according to the GMFCS protocol. The researcher performed first, initial tests to evaluate the patient’s equilibrium level, by using the PBS assessment instruments. To investigate the study goals, the patients were divided into two groups with a two-study method of neurofeedback and play therapy. Each group has done their special exercises during 10 sessions in 2 weeks for the first group and 20 sessions in 4 weeks for the second time and finally, the PBS test was repeated. Primary data were analyzed using descriptive and argumentative statistics by Kolmogorov-Smirnov test, independent t-test, Wilcoxon test, and one-way and two-way ANOVA test. All of these analyzes were done by SPSS software. Results: The study’s results confirm that play therapy has shown a meaningful effect (Pvalue=0.042), while the effect of the neurofeedback method does not represent any legal effect on one’s dynamic balance. In the case of the dynamic balance, the play therapy group has shown better operation in post-tests compared with the neurofeedback group. Conclusions: As results show the play therapy method has shown a meaningful effect on dynamic balance so it has been suggested to improving elderlies balance. Keywords: Cerebral palsy, Neurofeedback, Play therapy, Statistic equivalent, Dynamic equivalent.


1. Hammond, D.C., 2005. Neurofeedback to improve physical balance, incontinence, and swallowing. Journal of Neurotherapy, 9(1), pp.27-36. doi: 10.1300/J184v09n01_03.
2. Yi, S.H., Hwang, J.H., Kim, S.J. and Kwon, J.Y., 2012. Validity of pediatric balance scales in children with spastic cerebral palsy. Neuropediatrics, 43(06), pp.307-313. Doi: 10.1055/s-0032-1327774.
3. Behrman PF, Kliegman RM. Nelson essential of Pediatrics. 4th ed. Philadelphia WB, Saunders: 2002; 50-52.
4. Chiu, H.C. and Kuo, P.W., 2015. Effects of virtual reality in children with cerebral palsy: a systematic review. 物理治療, 40(3), pp.136-144. DOI: 10.6215/FJPT.PTS1408241086.
5. Cans, C., De-la-Cruz, J. and Mermet, M.A., 2008. Epidemiology of cerebral palsy. Paediatrics and child health, 18(9), pp.393-398. doi: 10.1016/j.paed.2008.05.015.
6. Mohamadian F, Sourtiji H, Hosseini SMS. [A new approach in rehabilitation of children with cerebral palsy (Persian)]. Journal of Research in Rehabilitation Sciences. MARCH 2011, Volume 7, Number 5 (SUPPLEMENT); Page(s) 758 To 765.
7. Gusi, N, Adsuar, J, Corzo, H, Pozo-cruz, B, Olivares P, Parrac A. Balance training reduces fear of falling and improves dynamic balance and isometric strength in institutionalized older people:a randomized trial. Journal of physiotherapy 2012; 58(2): 97-104.
8. Gholami Borujeni B, Ghasemi B, Moradi MR. A survey on the effect of core stabilization training program on the static and dynamic balance of mentally retarded students. The Journal of Urmia Nursing and Midwifery Faculty 2015; 13(2): 147-153.
9. Tseng MH, Chen KL, Shieh JY, Lu L, Huang CY. The determinants of daily function in children with cerebral palsy. Research in Developmental Disabilities. 2004; 32(1):235-45. doi: 10.1016/j. ridd.2010.09.024.
10. Wenya Nan1, Xiaoting Qu1, Limin Yang1, Feng Wan1, Yong Hu2, Pedro Mou1, Pui-In Mak1, Peng Un Mak1, Mang I Vai1, and Agostinho Rosa, Beta/Theta Neurofeedback Training Effects in Physical Balance of Healthy People© Springer International Publishing Switzerland 2015 D.A. Jaffray (ed.), World Congress on Medical Physics and Biomedical Engineering, June 7-12, 2015, Toronto, Canada, IFMBE Proceedings 51, DOI: 10.1007/978-3-319-19387-8_294.
11. Sandra Radtka, Robert Hone, Charles Brown, Judy Mastick, E. Melnick, and A. Dowling, Feasibility of Computer-Based Videogame Therapy for Children with Cerebral Palsy, GAMES FOR HEALTH JOURNAL: Research, Development, and Clinical Applications Volume 2, Number 4, 2013 MarAnn Liebert, Inc. DOI: 10.1089/g4h.2012.0071.
12. José-Antonio Gil-Gómez1, Roberto Lloréns1, Mariano Alcañiz1,3 and Carolina Colomer2, Effectiveness of a Wii balance board-based system (eBaViR) for balance rehabilitation: a pilot randomized clinical trial in patients with acquired brain injury, Gil-Gómez et al. Journal of NeuroEngineeringandRehabilitation2011,
13. Betker AL, Szturm T, Moussavi ZK, Nett C ,Video Game–Based Exercises for Balance Rehabilitation: A Single-Subject Design January 2006, Puerto Vallarta, Mexico.
14. Belinda lange, Sheryle Flynn, Rachel profit, Chien_yen chang, Albert rizzo, Development of an Interactive Game-Based Rehabilitation Tool for Dynamic Balance Training, Volume 17, 2010 - Issue 5: Advanced Technology Applications in Stroke Rehabilitation and Recovery.
15. Gil-Gómez, J.A., Lloréns, R., Alcañiz, M. and Colomer, C., 2011. Effectiveness of a Wii balance board-based system (eBaViR) for balance rehabilitation: a pilot randomized clinical trial in patients with acquired brain injury. Journal of neuroengineering and rehabilitation, 8(1), pp.1-10. Doi: 10.1186/1743-0003-8-30.
16. Jeon, M.J., Jeon, H.S., Yi, C.H., Kwon, O.Y., You, S.H. and Park, J.H., 2020. Block and random practice: a Wii fit dynamic balance training in older adults. Research quarterly for exercise and sport, pp.1-9. doi: 10.1080/02701367.2020.1733456.
17. Hsieh, H.C., 2020. Preliminary study of the effect of training with a gaming balance board on balance control in children with cerebral palsy: a randomized controlled trial. American Journal of Physical Medicine & Rehabilitation, 99(2), pp.142-148.
18. Hammond, D.C., 2007. What is neurofeedback? Journal of neurotherapy, 10(4), pp. 25-36. doi:10.1300/J184v10n04_04.