VR on UE in Children with CP: Meta-analysis

Effect of Virtual Reality on Upper Extremity Function in Children with Cerebral Palsy: A Meta-analysis
Chen, Y-P., Lee, S-Y. & Howard A.M. Pediatric Physical Therapy 2014:00 1 - 12
DOI: 10.1097/PEP.0000000000000046

Link to abstract:
www.ncbi.nlm.nih.gov/pubmed/24819682

Purpose: To systematically examine studies that consider the effect of active video games, virtual reality and robot therapy (VR) on improving upper extremity motor function in children with CP.

Method: A considered search strategy was used to include 14 research articles. A scoring system was used for the 3 RCTs, for 10 case series and one cohort study; a level of evidence was assigned to each based on the Oxford Centre for Evidence Based Medicine rating system.

Results: The RCT studies compared VR to traditional therapy, and the case series compared children before and after VR interventions. 5 studies were based on commercially available systems: Wii (1), Sony EyeToy Play (1), Gesturetek (3); the rest were experimental, custom engineered systems (7) or robot assisted interventions (2). The meta-analysis reports the 3 RCTs showed effectiveness for VR vs. traditional therapy, and ‘at least one positive change in one outcome measure in all the case series’. No relationship was seen between effectiveness and intervention length, duration, or frequency. Engineer-built experimental systems are found to be more effective than commercial systems. Commercially available active video games do not meet children’s needs as they cannot be adjusted individually to the child. Overall, the evidence was poor to fair. This meta-analysis makes no conclusive recommendations.

The GestureTek Virtual Reality system in Rehabilitation: a Scoping Review

Scoping Review

Glegg, S.M.N., Tatla, S.K. & Holstii, L., Disability and Rehabilitation Assistive Technology 2014, 9(2); 89 – 111

Link to abstract:
www.ncbi.nlm.nih.gov/pubmed/23713408

Objective: This scoping review examines research literature with quantitative data specific to the GestureTek virtual reality system used in physical and cognitive rehabilitation. The purpose of this scoping review is to determine the practicality of a systematic review, to identify areas for further research, “…and to allow therapists to be able to seek out readily pertinent evidence to support their clinical decisions about their use of the technology”.

Method: An explicit search strategy was used, resulting in 44 included studies mostly relating to stroke. For cerebral palsy, five studies were reported with evidence level I, II or III: one single case study reported level III evidence for balance and mobility improvement, and another single case reported level I evidence for improved reach, by American Academy for Cerebral Palsy and Developmental Medicine criteria.

Findings: Few strong quality or high level evidence studies are available: lack of common outcome measures limits the possibility of a systematic review. High level, larger studies are needed. This scoping review provides a database of rated studies related to cerebral palsy habilitation and outcomes of balance, mobility and upper extremity improvement.

Robot therapy for children’s arm rehabilitation

Effects of robotic therapy on upper-extremity function in children with cerebral palsy: A systematic review

Chen, Y-P & Howard, A. M.

Development Neurorehabilitation, Early Online 1-8, 2014
DOI: 10.3109/17518423.2014.899648

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/24724587

Objective: To systematically review the evidence of robotic therapy for the effects on upper extremity function for children with cerebral palsy.

Process: Robotic therapy is understood here to be “the application of electronic, computerized control systems to mechanical devices designed to perform human functions”. A literature search resulted in nine articles (7 case studies, one single case study and one randomized crossover design) relating to three robotic systems; CosmoBot, InMotion2, and NJIT-RAVR. These were reviewed on 11 qualitative scales, with results ranging from 3/11 to 9/11 and averaging 6/11, using a protocol developed by Kwakkel et al and Cambach et al. The studies’ outcome measures were grouped using the ICF model: range of motion, muscle tone and kinematics outcomes were classified as either body structure and function; or activity outcomes, which were scored on the QUEST, Melbourne or Fugl-Meyer scales; or on parent questionnaires. Effect sizes were calculated using the Cochrane Review Manager.

Results: Studies all reported either increased reach duration, smoothness, reduced tone or improvement in some clinical measure. The majority of case studies in this systematic review limit the recommendations that could come from more robust, group design studies. No recommendations can be made.

Wii balance board for rehabilitation

Review

Using the Wii Fit as a tool for balance assessment and neurorehabilitation: the first half decade of “Wii-search”

Goble, D. J., Cone, B. L. & Fling, B. W., Journal of Neuroeng Rehabil. 2014; 11:12

DOI: 10.1186/1743-0003-11-12

Link to full text article: www.jneuroengrehab.com/content/11/1/12

Objective: to review the Wii balance board controller (WBB) as a balance force platform measurement tool and as a neurorehabilitation intervention.

Process: WBB was compared with a scientific grade balance platform.

A literature search for “Wii Fit system or WBB for the assessment or training of balance ability” resulted in 11 papers that “trained balance in healthy adults” and 8 papers “that rehabilitated balance in clinical populations”; these were reviewed.

Outcomes: Custom applications have potential to provide low-cost ways to assess balance. Wii research using custom software is “an extremely promising area of exploration”. Research using Wii metrics for measuring balance is “far less convincing to date”. There is little correlation between Wii outcomes and clinical balance tests.

Wii is a motivating tool that typically generates improvements in balance. More robust research is required for the Wii Fit system as a balance intervention.

Balance measurement: Wii vs. BOT-2

Instrument Assessment

Evaluating the Nintendo Wii for Assessing Return to Activity Readiness in Youth with Mild Traumatic Brain Injury

DeMatteo, C., Greenspoon, D., Levac, D., Harper, J. A. & Rubinoff, M., Physical and Occupational Therapy in Pediatrics, Early online 1-16 2014-02-26

doi: 10-3109/01942638.2014.855103>/p>

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/24547689

Intent: “Post-injury assessments that challenge activity tolerance and balance are needed to determine readiness return to activity.” The maximal exertion and a count of loss-of-balance instances while playing Wii is compared to balance measures within Bruininks – Oseretsky Test of Motor Proficiency 2 ed. and the Community Balance and Mobility Scale.

Process: 24- 9 to 18 year olds who had experienced mild traumatic brain injury within the past year played a suite of Wii games one time. Losses of balance requiring a protective response were counted during game play and exertion as measured by heart rate, respiration rate and calorie expenditure.

Results: The technique of counting losses of balance during game play did not prove to be a useful assessment of balance and did not correlate with balance measures in BOT-2 and CBM. Of 6 games played, maximal exertion was generated by “Wii Fit Basic Run”.

A new video game assessment tool?

Instrument Development

Development and Use of an Observation Tool for Active Video Gaming and Movement (OTAGM) to Measure Children’s Movement Skill Components During Active Video Game Play

Rosa, R.L., Ridgers, N.D. & Barnett, L.M. in Perceptual and Motor Skills 117:3 (2013) 935-949

doi: 10.2466/03.25.PMS.117x28z4

Link to abstract amsciepub.com/doi/abs/10.2466/03.25.PMS.117x28z4

Objective: There is a growing interest in usefulness of active video games (AVG) for improving movement skills for children with CP. The Observation Tool of Active Gaming and Movement (OTAGM) is an observational tool for movement skills during AVG play. It aims to “capture and quantify specific skill components of children’s movement skills” during free play of AVG. The OTAGM was developed from the Test of Gross Motor Development-2ed (TGMD-2) with a subset of items that mesh with Nintendo Wii game offerings: strike, throw and roll. Specific components of movement skills are coded as well as task engagement, coded as ON/OFF; and body movement, further categorized as stationary-no movement, stationary-some movement, arm movement, leg movement, whole body movement.

This article reports on development, pilot testing and within-rater reliability of the measurement tool.

Process: 18 typically developing children 5 – 8 y/o played Nintendo one hour a week for six weeks. During play, 55-10 minute observations were coded. One child was videotaped for rating after a ten day interval.

Results: The tool needs to have further clarification between categories. Within-rater reliability was at least 83% across all categories. The usefulness of this tool will grow as it is tested in differently-abled populations and as it is able to report typical changes in the motor skills of children with CP.

AbleGamers Holiday Guide

"AbleGamers Charity proudly announces the launch of this year’s Holiday Gift Guide for gamers, with gaming systems, video games and assistive devices for the disabled. This year we have several recommendations on which games were the most accessible and which assistive devices are the best bets to help the disabled gamer in your life, but we also included several items you may want to avoid altogether".

Link to guide: www.ablegamers.com/ablegamers-news/ablegamers-2013-holiday-gift-guide.