Virtual reality rehabilitation in children with brain injury: a randomized controlled trial

Abstract

Aim To investigate the efficacy of a virtual reality rehabilitation system of wearable multi‐inertial sensors to improve upper‐limb function in children with brain injury. Method Eighty children (39 males, 41 females) with brain injury including cerebral palsy aged 3 to 16 years (mean age 5y 8mo, SD 2y 10mo) were assessed as part of a multicentre, single‐blind, randomized controlled trial. The intervention group received a 30‐minute virtual reality intervention and a 30‐minute session of conventional occupational therapy while the control group received 60 minutes of conventional occupational therapy per session, with 20 sessions over 4 weeks. The virtual reality rehabilitation system consisted of games promoting wrist and forearm articular movements using wearable inertial sensors. The Melbourne Assessment of Unilateral Upper Limb Function‐2 (MA‐2), Upper Limb Physician’s Rating Scale, Pediatric Evaluation of Disability Inventory Computer Adaptive Test, and computerized three‐dimensional motion analysis were performed. Results Both groups (virtual reality, n=40; control, n=38) significantly improved after treatment compared to baseline; however, the virtual reality group showed more significant improvements in upper‐limb dexterity functions (MA‐2, virtual reality group: Δ=10.09±10.50; control: Δ=3.65±6.92), performance of activities of daily living, and forearm supination by kinematic analysis (p<0.05). In the virtual reality group, children with more severe motor impairment showed significant improvements compared to those with less severe impairment. Interpretation The virtual reality rehabilitation system used in this study, which consists of wearable inertial sensors and offers intensive, interactive, and repetitive motor training, is effective in children with brain injury. What this paper adds Both virtual reality rehabilitation and conventional occupational therapy were effective for upper‐limb training. Virtual reality training was superior in improving dexterity, performance of activities of daily living, and active forearm supination motion. The effect of virtual reality training was significant in children with more severe motor impairments.

Visual Neuropsychology in Development: Anatomo-Functional Brain Mechanisms of Action/Perception Binding in Health and Disease

“…Accordingly, the knowledge summarized here sustains the importance of adopting a systemic approach even in the evaluation of the impact of supposedly purely visual deficits, which indeed can affect also motor skills, cognition, social skills, and emotional processing. Addressing such a complexity is the fundamental requirement of current implementations of systemic approaches for visuallyrelated training in typical conditions or in response to visual disorders, including virtual reality (Adams et al, 2018;Choi et al, 2021), robotics (Mirkowski et al, 2019;Zhexenova et al, 2020), and touch screen technology (Aslam et al, 2016;Sheehan and Uttal, 2016;Dalecki et al, 2019).…”

Gaming Technology for Pediatric Neurorehabilitation: A Systematic Review

“…Our search identified nine longitudinal studies as reported in Table 1 (34)(35)(36)(37)(38)(39)(40)(41)(42). According to the PEDro scores, one of the most interesting paper was the one by Choi et al (35), showing that children with chronic brain injury (including CP), treated by virtual reality and occupational therapy, significantly improved upper-limb dexterity functions, performance of daily activities, and forearm supination, as compared to the control group. Wider improvements were observed for children with more severe motor impairment.…”

Development and Feasibility of a Kinect-Based Constraint-Induced Therapy Program in the Home Setting for Children With Unilateral Cerebral Palsy

“…VR, which presents a computer simulation of the real world that allows the user to experience the simulation through a human-machine interface ( Holden, 2005 ), has been widely explored as a training tool for motor rehabilitation in children with CP ( Snider et al, 2010 ; Chen et al, 2014a ; Choi et al, 2021 ). In most of the studies to date, motor rehabilitation with a VR system has been found to improve children’s motivation to participate in motor training programs ( Harris and Reid, 2005 ; Tatla et al, 2013 ).…”