Article Summary of Virtual Reality on UE Function of Children with Cerebral Palsy
Title of Article: Effects of Virtual Reality-Based Rehabilitation on Upper Extremity Function amongst Children with Cerebral Palsy
Authors: Hyun Jung Chang , Kyo Hun Ku, Young Sook Park, Jin Gee Park, Eun Sol Cho, Jae Sam Seo, Chang Woo Kim and Se Hwi O
The patient population that was focused on in this article was children with the neurodevelopmental condition of Cerebral Palsy. The purpose of this article was to evaluate if there were improvements in upper extremity function and caregiver assistance in children with CP when doing a combined therapy approach of conventional occupational therapy with VR based rehabilitation when compared to only conventional occupational therapy. The reason why it is believed that there may be additional benefits for utilizing VR-based rehabilitation is because of the ability to provide motivation, fun, and interactivity when compared to the traditional rehab therapy that is quite repetitive.
There were 17 children chosen and placed into 2 groups (10 SG, 7 COT). The ages of the participants ranged from 4 to 7 years old. The first group was the RAPAEL Smart Glove (SG) group that received the VR-based rehab while the other group was the conventional occupational only (COT) group. Both groups met for two rehabilitation treatments per week for 8 weeks. The SG group had a combined treatment session of 20 min VR-based rehab with 10 minutes of conventional occupational therapy. The COT group on the other hand only received 30 minutes of straight conventional occupational therapy. Both groups were given two outcome measures pre and post intervention, these being the Quality of Upper Extremity Skills Test (QUEST) and the Pediatric Evaluation of Disability Inventory (PEDI). The QUEST measures four domains of UE function which are: dissociated movements, grasps, protective extension, and weight-bearing. The PEDI measures a child’s functional abilities in the three domains of self-care, mobility, and social function in the 3 dimensions of: functional skills, caregiver assistance, and modifications. Statistical analyses were then performed on the results using the SPS 21.0, Shapiro- Wilk for quantitative data, and the Mann-Whitney test or comparison of characteristic between groups. The results showed that there was no significant different of gross motor classification, age, manual ability, QUEST and PEDI scores between both groups at baseline. After the 8 weeks though, the SG group showed significant improvement in their QUEST scores and the domains associated with it. The COT group only showed a significant change in their QUEST scores after treatment. With the PEDI scores, the SG group showed a significant improvement while the COT group did not show improvements that were considered significant.
The article was able to show that the usage of VR rehabilitation in combination with conventional occupational therapy can lead to improvements in not only wrist and forearm function, but also improvements in control of shoulder and hand as well. When working with children, it can be difficult to keep them motivated with the repetitive tasks that are done in rehabilitation. This article showed that having the VR option that had 35 games categorized for specific function (cognition, ROM, coordination, timing, etc.) allowed the children to be motivated longer. While the article was able to show that VR can be beneficial in improving UE function in children with CP, the article does have quite a few limitations. This is considered to be a non-blinded retrospective study and the PEDI questionnaire was reported by the caregiver of the patient, therefore it could have been biased. The main limitation that can be found in this article is the sample size and follow-up period. Since the sample size utilized in this article is considered to be small, it cannot be a guarantee this will be the results for that population. The follow-up period was also not long enough to notice if the improvements that were noted in the VR group were temporary or permanent. Research remains limited in the area of benefits for CP patients with usage of virtual reality. As more research comes out in the future, one can hope to see more definitive answers on the lasting effects VR might have on UE function.
2 responses to “Article Summary of Virtual Reality on UE Function of Children with Cerebral Palsy”
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Hello Suz!
When I was reading your summary, I remembered that I gave a presentation on the VR device listed in this article (RAPAEL Smart Glove) during our neuro module! At the time, the research I was looking at was primarily how this VR could promote motor learning and cortical reorganization for individuals who have undergone a stroke. It is very encouraging to see that positive outcomes resulted with individuals with CP as well.
This device is quite costly, however, starting at $99 per month if the family is only renting it. I do wonder how long lasting the VR treatment results would be for the SG group since it is unlikely they will have the device at home to continue using for practice.
Hello Megan!
This idea of utilizing VR is definitely an interesting topic and I am excited to see more research surfacing in the next few years. Hopefully as more companies come out with VR devices, there will be a reduction of price or be found more in the typical outpatient clinic setting!