Effect of Virtual Reality Versus Traditional Physical Therapy on Functional Balance in Children With Down Syndrome: A Randomized Comparative Study

Abstract

Background: Children with Down syndrome (DS) have difficulties with equilibrium, balance, and protective responses leading to delay in postural control and locomotion. Improvement in balance can produce greater stability while performing activities of daily living or work related tasks. Virtual reality (VR) allows individuals to experience activities and events similar to those they might encounter in real life. It can be used clinically to improve strength, range of motion, coordination, attention span, balance and posture. However, the absolute effects of VR as a single treatment to improve balance are not yet investigated.The purpose: of this study was to compare the effectiveness of virtual reality using Wii games versus traditional physical therapy in enhancing functional balance in children with DS. Materials and methods:Twenty six children with Down syndrome from both sexes participated in this study. Their ages ranged from 6-9 years and randomly distributed into two groups. Group (A) received traditional physical therapy and Group (B) received Wii balance program. Treatment sessions were 30 minutes, 3 times per week for 8 weeks. The primary outcome measures were pediatric balance test, the timed up and go test, and the five-times-sit-to-stand test.Results: All measured outcomes were significantly improved in both groups from pre to post-intervention. Children in group (B) showed significant improvements as compared with those of group (A). Conclusion:Wii games based balance training has the potential to improve the functional balance in children with Down syndrome and it can be used as an alternative modality whenever conventional physical therapy is not feasible.

Efeitos da realidade virtual no desenvolvimento motor, equilíbrio e força muscular respiratória da criança com Síndrome de Down: relato de caso

“…Porém não visa a melhora da produção de força muscular de tronco, principalmente, para desempenhar um aumento da velocidade e diminuir o tempo de reação do COP. Ainda sobre o equilíbrio, o estudo de Ghafar et al 7 reforça a eficácia da RV na melhoria do equilíbrio funcional em estudo com 26 crianças com SD, no qual comparou-se o treinamento de equilíbrio com jogos Wii versus a fisioterapia tradicional e identificou-se melhorias significativas com o uso da RV.…”

Current Approaches to Improve Balance in Down Syndrome Population-A Systematic Review

“…Three studies [20,21,25] reported a low risk of bias. However, one study [16] showed unknown risk while the remaining studies demonstrated high-risk bias [5, 10-12, 15, 17-19, 22-24, 26-28].…”

“…Among the eighteen experimental studies, fourteen studies were Randomized Controlled Trials; three were Quasi-experimental, while only one was Nonrandomized controlled trial. A study conducted by Alsakhawi et al [15], Eid et al [20], Ghafar et al [21], and Reis et al [22] investigated the effects of traditional/conventional physiotherapy with an adjunct intervention such as treadmill, core stability, isokinetic training, and virtual reality, and the investigation revealed that conventional therapy in combination with an adjunct intervention was more effective than solitary to improve balance among DS patients. Gheitasi et al [16] and Ghaeeni et al [26] showed the efficacy of core stability exercises, either alone or in combination with the swiss ball or resistance training, in improving static balance.…”

“…All the included studies showed a low risk of bias. [5,[10][11][12][15][16][17][18][19][20][21][22][23][24][25][26][27][28].…”

“…Ghafar et al [21] used VR based Wii training constituted of football heading game that improves movements of trunk and extremities, Ski Slalom that elicits balance strategies and loading of the lower limbs, Table Tilt game elicits control over the whole body through dynamic balance on a virtual balance board. Likewise, Reis et al [22] used two games from Kinect Adventures®, i.e., River Rush® and Hall of ricochets® that leads to improved quality of motor responses and a higher balancing score statistically significant.…”