Treadmill Training with Virtual Reality: Gross Motor Function Measure Article Summary
Title: Treadmill Training with Virtual Reality Improves Gait, Balance, and Muscle Strength in Children with Cerebral Palsy
Authors: Chunchee Cho, Wonjeong Hwang, Sujin Hwang, Yijung Chung
The purpose of this article was to determine the effects of treadmill training in patients with spastic Cerebral Palsy (CP). However, the researchers acknowledged children often become “bored” with treadmill training. Therefore, they enrolled 18 children, ages 4-16 years old, in a research study in which 9 of them used virtual reality while treadmill training and the other 9 used a basic treadmill training program. The researchers assessed a few variables but one of the main variables being assessed was gross motor function using the Gross Motor Functional Measure (GMFM). The GMFM assessed 5 areas of participation. These areas were: lying down and rolling, sitting, crawling on hands and knees and kneeling, standing, and walking, running, and jumping. Other outcome and objective measures collected included: manual muscle testing, Pediatric Berg Scale, 10-meter walk test, and 2-minute walk test.
The researchers utilized the Nintendo Wii Fit program as a means of virtual reality to motivate patients. The other group used only a standard treadmill training program with no outside utilization of resources for entertainment or motivation. Each group received general physical therapy (PT) sessions which included range of motion and gait training. Both groups received these PT sessions for 30 minutes per day, 3 days per week, over a period of 8 weeks. In addition to the PT sessions, each group received 3 days of their assigned treadmill training for 30 minutes per day for 8 weeks. Following the interventions, each group was reassessed to determine improvements in the outcome and objective measures previously mentioned. Specifically, as it pertains to the GMFM, gross motor function increased in both groups. The virtual reality group experienced an increase in GMFM scores for standing from 63.1 ± 22.4 to 72.2 ± 21.5. Additionally, the virtual reality group experienced an increase in GMFM scores for walking, running, and jumping from 52.7 ± 24.9 to 57.9 ± 24.8. For the standard treadmill training group, GMFM scores for standing improved from 62.0 ± 27.3 to 65.2 ± 27.0 while GMFM scores for walking, running, and jumping increased from 47.1 ± 25.8 to 51.2 ± 26.0. The researchers deemed the scores in the standing category of the GMFM were significant improvements.
Strengths of this study included the ability of the authors to utilize multiple outcome and objective measures to assure for accurate and thorough assessment of the patient population. I think another strength of this study was the acknowledgement of boredom in children undergoing CP interventions. Therefore, the entire construct of the study was a strength, in my opinion, due to their ability to adjust for that lack of interest. I think a potential weakness of this study was the utilization of only 18 kids with a wide range in age. Ideally, a larger population would have been ideal, in my opinion. Additionally, the researchers utilized two physical therapists, each one being assigned to a group. Therefore, I believe there is a potential for interrater reliability to be skewed due to the limitation of clinicians.
This study concluded that virtual reality and basic treadmill training may be utilized to gain improvements on GMFM scores. Standing seemed to be the most affected variable of the GMFM. However, increases were also noted in the walking, running, and jumping categories. Increases were more notable in the virtual reality group; however, both groups increased their GMFM scores. Additionally. It is concluded that virtual reality not only increases GMFM scores but it also appropriately motivated patients who are otherwise unmotivated. Therefore, it may be utilized as a method of distraction so accurate assessment of gait parameters may be assessed. A few limitations on the study that were mentioned was the lack of a long-term time frame and only one type of CP (spastic) was assessed.
References:
Cho C, Hwang W, Hwang S, Chung Y. Treadmill Training with Virtual Reality Improves Gait, Balance, and Muscle Strength in Children with Cerebral Palsy. Tohoku J Exp Med. 2016 Mar;238(3):213-8. doi: 10.1620/tjem.238.213. PMID: 26947315.
2 responses to “Treadmill Training with Virtual Reality: Gross Motor Function Measure Article Summary”
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This is a super interesting take on making PT more fun and applicable to a younger age group while reaping the same if not better outcomes. Do you know which Wii games they utilized? I wonder if the games are based on a child’s interests if they are more likely to continue and make progress on their own.
Lindsey, they did not name specific games that were used. They mentioned the Wii Fit Program was utilized and under that program I believe many different game modes exist. However, they did not go into specifics. Thank you for your curiosity!