Use of virtual reality systems as proprioception method in cerebral palsy: clinical practice guideline

Virtual reality-based fine motor skills training in paediatric rehabilitation: a protocol for a scoping review

INTRODUCTION

Fine motor skill (FMS) development during childhood is essential to many learning processes, especially in school. FMS impairment can have a major impact on children's quality of life. Developing effective and engaging rehabilitation solutions to train FMS that engage children in the abundant practice required for motor learning can be challenging. Virtual reality (VR) is a promising intervention option offering engaging FMS training tasks and environments that align with evidence-based motor learning principles. Other potential advantages of VR for rehabilitation include accessibility for home-based use and adaptability to individual needs. The objective of this scoping review is to map the extent, range and nature of VR applications focused on FMS training in paediatric rehabilitation, including hardware, software and interventional parameters.

METHODS AND ANALYSIS

We are following methodological guidelines for scoping review conduct and reporting from the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews recommendations. We will search four databases (Pubmed, Web of Science, PsycInfo and Scopus) for articles that meet inclusion criteria defined by the Population, Concept, Context method; specifically studies focused on development or evaluation of immersive or non-immersive VR applications to deliver FMS training in paediatric rehabilitation. Different populations of children with FMS impairments will be included (such as children with cerebral palsy, children with developmental coordination disorder or attention deficit hyperactivity disorder). The first search took place in December 2023, and a second is planned for February 2025. One reviewer will complete title, abstract and full paper screening, with consultation by a second reviewer in case of uncertainty. A data extraction framework will be tested by two reviewers on five randomly selected studies to ensure inter-rater reliability, and one reviewer will complete data extraction. Quantitative and qualitative extraction will follow JBI guideline recommendations. Results will be presented in a descriptive and tabular format, including a narrative summary. Results will enhance understanding of the potential of FMS training in VR and inform subsequent directions for research and clinical practice.

ETHICS AND DISSEMINATION

Data for this review will be collected from the published literature. Ethical approval is not required. We will present our findings at scientific conferences and submit this review to a peer-reviewed journal for publication.

EFFECT OF VIRTUAL REALITY TRAINING ON BALANCE AND FUNCTIONALITY IN CHILDREN WITH CEREBRAL PALSY: A RANDOMIZED CONTROLLED TRIAL

Purpose: The aim of this study was to investigate the effectiveness of virtual reality training on balance and functionality in children with Cerebral Palsy. Methods: Children with spastic Cerebral Palsy were randomly divided into the virtual reality training group (27 children, mean age: 9.2 years) and control group (25 children, mean age: 9.4 years). The virtual reality training group received virtual reality training using the XBox One Kinect gaming system and the control group received conventional physiotherapy training for eight weeks. The Pediatric Balance Scale, The Gross Motor Function Measurement-88, The Quality of Upper Extremity Skills Test, The Functional Reach Test, The Sit to Stand Test and The Pediatric Disability Evaluation Inventory were measured at baseline and after treatment sessions. Results: Total motor function, upper extremity skills and balance in both groups improved after training (p < 0.05). A comparison between groups demonstrated that the improvements in upper extremity functions was greater in the control group than in the virtual reality training group (p < 0.05). Conclusion: The results of our study showed that Kinect-based virtual reality training is beneficial in improving balance, motor function and upper extremity skills in children with Cerebral Palsy.

Effectiveness of virtual reality on functional mobility during treadmill training in children with cerebral palsy: a single-blind, two-arm parallel group randomised clinical trial (VirtWalkCP Project)

INTRODUCTION

Treadmill training and virtual reality have been investigated in children with cerebral palsy. However, few studies have assessed the effectiveness of the combination of both treatments on children's functional and balance activities. The project aims to compare the effects of treadmill training with and without virtual reality on walking endurance and speed, static and dynamic balance, gross motor function, functional independence, quality of life and occupational participation in children with spastic cerebral palsy between the ages of 4 and 12 years classified at levels I, II and III of the Gross Motor Function Classification System.

METHODS AND ANALYSIS

This study is a single-blind, two-arm parallel group, randomised, controlled clinical trial. Participants will be recruited at the Pediatric Department of the Vic Hospital Consortium, and the research will be conducted at the University of Vic - Central University of Catalonia. The participants will be randomly allocated into two groups: (1) the experimental group, which will receive the treadmill training at the same time as the virtual reality; and (2) the control group, which will undertake treadmill gait training alone. The training will be provided in 10 sessions over 2 weeks with 30 min for each session. Assessments will be performed on three occasions: 1 week before the intervention, 1 week following the intervention and 1 month after the end of the intervention. The evaluations will involve the 6 min walk test, stabilometry, the Berg Balance Scale, the 10 m walk test, the Gross Motor Function Measure, the Functional Independence Measure, the paediatric quality of life inventory and the Children Participation Questionnaire. For between-within group comparison, a mixed-effect linear model will be used.

ETHICS AND DISSEMINATION

The study has been approved by the Clinical Research Ethics Committee of the Osona Foundation for Health Research and Education (2021061). Results will be published in peer-reviewed journals and presented at international conferences.

TRIAL REGISTRATION NUMBER

NCT05131724.

Proprioceptive accuracy in Immersive Virtual Reality: A developmental perspective

Proprioceptive development relies on a variety of sensory inputs, among which vision is hugely dominant. Focusing on the developmental trajectory underpinning the integration of vision and proprioception, the present research explores how this integration is involved in interactions with Immersive Virtual Reality (IVR) by examining how proprioceptive accuracy is affected by Age, Perception, and Environment. Individuals from 4 to 43 years old completed a self-turning task which asked them to manually return to a previous location with different sensory modalities available in both IVR and reality. Results were interpreted from an exploratory perspective using Bayesian model comparison analysis, which allows the phenomena to be described using probabilistic statements rather than simplified reject/not-reject decisions. The most plausible model showed that 4-8-year-old children can generally be expected to make more proprioceptive errors than older children and adults. Across age groups, proprioceptive accuracy is higher when vision is available, and is disrupted in the visual environment provided by the IVR headset. We can conclude that proprioceptive accuracy mostly develops during the first eight years of life and that it relies largely on vision. Moreover, our findings indicate that this proprioceptive accuracy can be disrupted by the use of an IVR headset.