A Gamified Breathing and Postural Awareness Education Model for Children With Cerebral Palsy

NCT07681947 | Not Yet Recruiting DMC

• 1 other identifier: yeditepe03
• Study Type: interventional
• Target: 40
• Locations: 1 country
• Sites: 1

Brief Summary

This project aims to develop an accessible, learning-oriented model based on gamified breathing and posture training that emphasizes active participation for children with cerebral palsy (CP), their families, and educators. Since current practices are largely clinic-centered, there is a growing need for game-based, motivational and widely discernible programs. In this context, the project aims to provide an inclusive model that enhances breathing and postural awareness through digital technology, thereby increasing motivation and adherence.

Conditions

Cerebral Palsy

Keywords

awareness; cerebral palsy; gamification; posture; respiration

Outcome Measures

Primary Outcomes (2)

• Spirometry Assessment FVC

  Spirometric variables will be measured using a calibrated spirometer (Medical International Research Spirodoc®) to evaluate respiratory function. Participants will be instructed to perform maximal inhalation followed by a forceful and complete exhalation into the spirometer in accordance with standardized spirometry guidelines. To minimize measurement error and ensure accuracy, three valid trials will be performed, and the highest recorded values will be used for final analysis. Spirometry is a well-established, reliable, and objective method for assessing pulmonary function in clinical settings.

  8 weeks (from baseline to post-intervention)

• Spirometry Assessment FEV1

  Spirometric variables will be measured using a calibrated spirometer (Medical International Research Spirodoc®) to evaluate respiratory function. Participants will be instructed to perform maximal inhalation followed by a forceful and complete exhalation into the spirometer in accordance with standardized spirometry guidelines. To minimize measurement error and ensure accuracy, three valid trials will be performed, and the highest recorded values will be used for final analysis. Spirometry is a well-established, reliable, and objective method for assessing pulmonary function in clinical settings.

  8 weeks (from baseline to post-intervention)

Secondary Outcomes (3)

• Postural assessment

  8 weeks (from baseline to post-intervention)

• Quality of Life (CPQOL-Child)

  8 weeks (from baseline to post-intervention)

• Thoracic Mobility Assessment

  8 weeks (from baseline to post-intervention)

Study Arms (1)

Experimental Group

EXPERIMENTAL

All 40 children with cerebral palsy aged 6-18 years included in the study will receive the N.E.F.E.S.-CP gamified breathing and postural awareness education model. The training program will be conducted twice a week for 8 weeks at the Spastic Children's Foundation of Turkey (TSÇV).

Behavioral: N.E.F.E.S.-CP Education Model

Interventions

N.E.F.E.S.-CP Education Model BEHAVIORAL

Gamified breathing and postural awareness training, including hands-on workshops with exercises such as candle blowing, boat floating, and triflo simulations, alongside postural imagery techniques supported by visual and auditory stimuli. The program will be conducted twice a week for 8 weeks.

Experimental Group

Eligibility Criteria

• Age: 6 Years - 18 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• Diagnosed with cerebral palsy.
• Classified as Level I-III according to the Gross Motor Function Classification System (GMFCS).
• Aged between 6 and 18 years.
• Having a cognitive level sufficient to understand and follow simple instructions (for active participation in gamified training).

You may not qualify if:

• Presence of uncontrolled medical conditions or systemic limitations.
• Use of medications affecting respiratory function.
• Presence of musculoskeletal problems (other than CP diagnosis) that may affect walking ability, and/or the presence of cognitive and mental impairment that may affect participation and/or motivation.
• Visual or hearing loss that severely restricts participation in digital game and video-based applications (if appropriate adaptation cannot be provided).

Sponsors & Collaborators

• Yeditepe University: lead
• Fenerbahce University: collaborator
• Istanbul University - Cerrahpasa: collaborator

Study Sites (1)

Spastic Children's Foundation of Turkey (TSÇV)

Istanbul, İ̇stanbul, 34755, Turkey (Türkiye)

Location

Related Publications (15)

• Winther L, Milther C, Schroll SM, Nielsen ET, Gjaerde LK, Curtis DJ, Sorensen JL, Stahlhut M. Digital play and rehabilitation for children and adolescents in hospitals, outpatient departments and rehabilitation centres: A scoping review. J Pediatr Rehabil Med. 2025 Aug;18(3):177-188. doi: 10.1177/18758894251341153. Epub 2025 Jun 13.

  PMID: 40509926 BACKGROUND

• Waters E, Davis E, Mackinnon A, Boyd R, Graham HK, Kai Lo S, Wolfe R, Stevenson R, Bjornson K, Blair E, Hoare P, Ravens-Sieberer U, Reddihough D. Psychometric properties of the quality of life questionnaire for children with CP. Dev Med Child Neurol. 2007 Jan;49(1):49-55. doi: 10.1017/s0012162207000126.x.

  PMID: 17209977 BACKGROUND

• Waters E, Maher E, Salmon L, Reddihough D, Boyd R. Development of a condition-specific measure of quality of life for children with cerebral palsy: empirical thematic data reported by parents and children. Child Care Health Dev. 2005 Mar;31(2):127-35. doi: 10.1111/j.1365-2214.2004.00476.x.

  PMID: 15715691 BACKGROUND

• Tas SA, Cankaya T. Effects of structured training on spinal posture and selective motor control in children with unilateral spastic cerebral palsy. Gait Posture. 2024 Mar;109:22-27. doi: 10.1016/j.gaitpost.2024.01.007. Epub 2024 Jan 11.

  PMID: 38244393 BACKGROUND

• Szturm T, Parmar ST, Mehta K, Shetty DR, Kanitkar A, Eskicioglu R, Gaonkar N. Game-Based Dual-Task Exercise Program for Children with Cerebral Palsy: Blending Balance, Visuomotor and Cognitive Training: Feasibility Randomized Control Trial. Sensors (Basel). 2022 Jan 19;22(3):761. doi: 10.3390/s22030761.

  PMID: 35161508 BACKGROUND

• 10.16965/ijpr.2016.197

  BACKGROUND

• S R, Kanniappan V, Santhosh Kanna BS, T S V. Comparing the Effects of Virtual Reality Breathing Exercise and Incentive Spirometry Exercise on Improving Pulmonary Function in Children with Spastic Diplegic Cerebral Palsy. Cureus. 2024 Apr 27;16(4):e59149. doi: 10.7759/cureus.59149. eCollection 2024 Apr.

  PMID: 38803793 BACKGROUND

• Palisano RJ, Hanna SE, Rosenbaum PL, Russell DJ, Walter SD, Wood EP, Raina PS, Galuppi BE. Validation of a model of gross motor function for children with cerebral palsy. Phys Ther. 2000 Oct;80(10):974-85.

  PMID: 11002433 BACKGROUND

• Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997 Apr;39(4):214-23. doi: 10.1111/j.1469-8749.1997.tb07414.x.

  PMID: 9183258 BACKGROUND

• Cemali O, Tiryaki AY, Cemali M, Torpil B. Effects of feeding behavior training on sensory processing and developmental areas in children with cerebral visual impairment: a randomized controlled study. Ital J Pediatr. 2026 Feb 14;52(1):42. doi: 10.1186/s13052-026-02213-w.

  PMID: 41691324 BACKGROUND

• Palmer KN, Kelman GR. Pulmonary function in asthmatic patients in remission. Br Med J. 1975 Mar 1;1(5956):485-6. doi: 10.1136/bmj.1.5956.485.

  PMID: 236066 BACKGROUND

• Keles MN, Elbasan B, Apaydin U, Aribas Z, Bakirtas A, Kokturk N. Effects of inspiratory muscle training in children with cerebral palsy: a randomized controlled trial. Braz J Phys Ther. 2018 Nov-Dec;22(6):493-501. doi: 10.1016/j.bjpt.2018.03.010. Epub 2018 Apr 4.

  PMID: 29636305 BACKGROUND

• de Lima Crispim TR, Neto MG, Crispim TRL, Dias RB, de Albuquerque MDM, Saquetto MB, Magalhaes PAF. Addition of respiratory exercises to conventional rehabilitation for children and adolescents with cerebral palsy: a systematic review and meta-analysis. World J Pediatr. 2023 Apr;19(4):340-355. doi: 10.1007/s12519-022-00642-1. Epub 2022 Nov 15.

  PMID: 36376558 BACKGROUND

• Debouche S, Pitance L, Robert A, Liistro G, Reychler G. Reliability and Reproducibility of Chest Wall Expansion Measurement in Young Healthy Adults. J Manipulative Physiol Ther. 2016 Jul-Aug;39(6):443-449. doi: 10.1016/j.jmpt.2016.05.004. Epub 2016 Jun 23.

  PMID: 27346860 BACKGROUND

• American Thoracic Society/European Respiratory Society. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002 Aug 15;166(4):518-624. doi: 10.1164/rccm.166.4.518. No abstract available.

  PMID: 12186831 BACKGROUND

MeSH Terms

Conditions

Cerebral Palsy; Respiratory Aspiration

Condition Hierarchy (Ancestors)

Brain Damage, Chronic; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Respiration Disorders; Respiratory Tract Diseases; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Central Study Contacts

Rasmi Muammer, Prof., PhD

CONTACT

+90 505 650 28 27; rasmi.muammer@yeditepe.edu.tr

Turgay Arik

CONTACT

0542 646 5394; turgayarik@tscv.org.tr

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: SUPPORTIVE CARE
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: June 24, 2026
• First Posted: July 2, 2026
• Study Start: July 10, 2026
• Primary Completion (Estimated): November 27, 2026
• Study Completion (Estimated): November 30, 2026
• Last Updated: July 2, 2026

Record last verified: 2026-07

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)