"Physiotherapy is Boring and Tiring": The Motivational Impact of Nintendo Wii Fit Plus Exergaming in Children with Cerebral Palsy — A Single-Arm Pre-Post Pilot Study

Background: Children with cerebral palsy (CP) frequently describe conventional physiotherapy sessions as painful and monotonous, which reduces compliance and undermines long-term rehabilitation outcomes. Virtual reality (VR)-based exergaming has emerged as a promising complementary approach to improve engagement and motivation in pediatric rehabilitation. Objective: To evaluate the motivational impact of the Nintendo Wii Fit Plus program on children with CP using the Pediatric Volitional Questionnaire (PVQ). Methods: A single-arm pre-post pilot study was conducted at the Association for the Protection of Motor Disabled Persons, Sfax, Tunisia, over seven weeks (March–May 2023). Eight children with CP participated in individualized Wii Fit Plus sessions lasting a minimum of 30 minutes, three times per week. Motivational outcomes were assessed using the PVQ before and after the intervention. Data were analyzed using non-parametric statistics (Wilcoxon signed-rank test) with an alpha level of 0.05. Results: Overall mean PVQ scores improved significantly from 1.06 ± 0.17 at baseline to 3.80 ± 0.22 post-intervention (Z = -2.52, p = 0.012, r = 0.89). Gains were observed across all three volitional stages: exploration (1.00 → 3.75), competency (1.00 → 3.90), and achievement (1.18 → 3.75). Post-intervention, the majority of items were rated at the highest level of spontaneous engagement (score = 4). Conclusions: A seven-week Nintendo Wii Fit Plus exergaming program produced substantial improvements in volitional engagement in children with CP. These findings support the integration of non-immersive VR-based interventions as a motivating complement to conventional pediatric neurorehabilitation.