CP Fit ‘n’ Fun

As children with cerebral palsy (CP) become teenagers, they experience a decrease in their physical function. Children who are walking with a mobility aid such as a walker often need to start using a wheelchair to get around in the community during adolescence. If they continue with the walker they get tired easily and walk shorter distances. Decreased mobility leads to increased social isolation for the teens and impacts negatively on their quality of life. This loss of function is multifactorial, but poor physical fitness and muscle weakness secondary to disuse are significant contributors. Exercise video games are a novel approach to engage youth in physical exercise and social interaction with their peers. The objective of this study is to develop and evaluate exercise video games to engage youth with CP in physical exercise to improve their physical fitness and increase social interaction with their peers.

Our over-arching research questions are whether exergames can provide health benefits (improved physical fitness) and help enhance leisure participation and quality of life in youth with CP.


Develop and evaluate multiplayer exergames to engage youth with CP in physical exercise to improve their physical fitness and increase social interaction with their peers


  • Dr. Nick Graham (& team), Queen’s University.
  • Dr. Darcy Fehlings, Physician Director, Holland Bloorview, U. Toronto.
  • Dr. Virginia Wright, Physiotherapist, Holland Bloorview.
  • Dr. Ryan Rhodes, Exercise Psychologist. U. Victoria.
  • Dr. Regan Mandryk, Comp. Sc. Prof., U. Saskatchewan.
  • Dr. Annette Majnemer, Prof. Rehabilitation Medicine. McGill U.
  • Dr. Darren Warburton, Prof. Kinesiology, U. British Columbia.

Students From the EQUIS Lab

Students currently working on the project:

Students who have previously been involved:

  • Michelle Brown (Summer research assistant)
  • Quentin Bellay (Internship student)
  • Md Ameer Hamza (MSc student)
  • Tadeusz Stach (PhD student)

Challenges in Making the Games

  • Recognizing and smoothing input that may be affected by muscle spasticity
  • Allowing youth with CP of different physical fitness levels to play together
  • Making the games fun to play to motivate long term engagement
  • Supporting social interactive and collaborative play

Overcoming Challenges

  • Participatory Design sessions involving youth with CP, therapists, game designers, and developers.
  • Rapid iterative refinement and testing of game features. A Game Development Toolkit is being developed for this purpose, and to relieve designers from low level technicalities.

Putting It All Together

Evaluation Plan

  • Collaboration with other specialists to evaluate the effectiveness of exergames in this context.
  • Design of a case series involving 10 kids with CP and assess improvement in physical fitness, social participation, and quality of life.

Future Implications

  • If long term benefits for youth with Cerebral Palsy are found, this finding may have generalizability to individuals with other disabilities as well.
  • This kind of exergames can be considered as an alternate highly motivating and effective rehabilitation treatment for promoting fitness, health, and social integration.
Idea of multiplayer exergaming platform for youth with CP
Idea of multiplayer exergaming platform for youth with CP


For this project, we wanted to build a toolkit for rapid prototyping of games so that we can easily test different game ideas without spending much time in the details of code. The result of this is Meerkat, an entity based games development toolkit that every C# programmer can use. Meerkat is still changing, its most recent working version and documentation can be found here.

The Game

Trying to come up with a joyful and vigorous game that allows the kids to exercise as they have fun with their peers, we have created Liberi, a distributed, persistent, multiplayer exergame. The up to date information about the game can be found here.

For More Information

Hernandez, H.A., Graham, Ye, Z., T.C.N., Fehlings, D., Switzer, L. Designing Action-based Exergames for Children with Cerebral Palsy. Proceedings of the 31st international conference on Human factors in computing systems – CHI ‘13,. Paris, France. April, 2013. To appear.

Hernandez, H.A., Graham, T.C.N., Fehlings, D., Switzer, L., Ye, Z., Hamza, M.A., Savery, C., Stach, T. Design of an exergaming station for children with cerebral palsy. Proceedings of the 30th international conference on Human factors in computing systems – CHI ‘12,. Austin, Texas, USA. May, 2012.

Zi Ye, Hamilton A. Hernandez, T.C. Nicholas Graham, Darcy Fehlings, Lauren Switzer, Md Ameer Hamza, and Irina Schumann. 2012. Liberi and the racer bike: exergaming technology for children with cerebral palsy. In Proceedings of the 14th international ACM SIGACCESS conference on Computers and accessibility (ASSETS’12). ACM, New York, NY, USA, 225-226.