Effects of innovative virtual reality game and EMG biofeedback on neuromotor control in cerebral palsy

Abstract

Sensorimotor control dysfunction or dyskinesia is a hallmark of neuromuscular impairment in children with cerebral palsy (CP), and is often implicated in reaching and grasping deficiencies due to a neuromuscular imbalance between the triceps and biceps. To mitigate such muscle imbalances, an innovative electromyography (EMG)-virtual reality (VR) biofeedback system were designed to provide accurate information about muscle activation and motivation. However, the clinical efficacy of this approach has not yet been determined in children with CP. The purpose of this study was to investigate the effectiveness of a combined EMG biofeedback and VR (EMG-VR biofeedback) intervention system to improve muscle imbalance between triceps and biceps during reaching movements in children with spastic CP. Raw EMG signals were recorded at a sampling rate of 1,000 Hz, band-pass filtered between 20-450 Hz, and notch-filtered at 60 Hz during elbow flexion and extension movements. EMG data were then processed using MyoResearch Master Edition 1.08 XP software. All participants underwent both interventions consisting of the EMG-VR biofeedback combination and EMG biofeedback alone. EMG analysis resulted in improved muscle activation in the underactive triceps while decreasing overactive or hypertonic biceps in the EMG-VR biofeedback compared with EMG biofeedback. The muscle imbalance ratio between the triceps and biceps was consistently improved. The present study is the first clinical trial to provide evidence for the additive benefits of VR intervention for enhancing the upper limb function of children with spastic CP.

Review of Therapeutic Interventions for the Upper Limb Classified by Manual Ability in Children with Cerebral Palsy

“…6 This approach combines engagement and motivation to succeed at the game while working on specific active range of motion (AROM) with the overall aim of improving function. 7,8 This technology has been reported in the literature for MACS levels I to IV as a means of engaging children with CP in activities targeting bimanual control, 9 functional strength, and motor ability. 6,10 The literature has shown that participants in virtual reality-, web-, and computer-based interventions have the potential for improving muscle activation and functional muscle strength as well as increasing overall physical engagement.…”

“…6,10 The literature has shown that participants in virtual reality-, web-, and computer-based interventions have the potential for improving muscle activation and functional muscle strength as well as increasing overall physical engagement. [6][7][8] However, overall evidence is insufficient; more robust randomized controlled trials are needed to determine the effectiveness of these interventions.…”

Virtual reality applications toward medical field

“…By using a VR headset, one can see the patient body and their parts digitally in different angles. [10][11][12] This technology increases the confidence of the patient by decreasing their fear when they are using VR glasses as it provides information closer to the real-life situation. By using this technology, a heart surgeon can now check the heart rate of the patient and its changes in rate.…”

A Usability Study of a Serious Game in Cognitive Rehabilitation: A Compensatory Navigation Training in Acquired Brain Injury Patients

“…Physical rehabilitation focusses on motor abilities and sensorimotor functioning. Serious games have been developed to aid in the rehabilitation of balance impairments ( Betker et al, 2006 ), motor functions of the hand ( Afyouni et al, 2017 ) and the upper limbs ( Broeren et al, 2008 ; Yoo et al, 2014 ), for instance. Motor rehabilitation games take a restitution-based rehabilitation approach, in which the aim is to restore impaired functions through intense and repeated stimulation of that function ( Wolf et al, 2002 ).…”