Futures for Virtual Reality in Cerebral Palsy Management

Review

Role of Virtual Reality for Cerebral Palsy Management

Weiss, P. T., Tirosh, E. & Fehlings, D.
Journal of Child Neurology, 2014, 29(8): 1119 – 1124

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/24799367

Virtual reality can occupy a unique space in rehabilitation when designed by therapists as it can provide a motivating yet challenging place to learn transferrable skills and to capture performance feedback.

Objective: This article overviews several topics: virtual reality and clinical gaming for the population of children with cerebral palsy, key studies that identify different components of virtual reality systems as children with cerebral palsy interact with them, and aspects of virtual reality interaction beyond the enjoyable and motivating aspects of gameplay to measuring deeper emotional and psychological characteristics like autonomic responses to gaming.

"Virtual reality for rehabilitation has become more accessible and less expensive and more popular for clinicians… who want to take advantage of virtual reality’s assets for rehabilitation while ensuring that it is best suited to the client’s cognitive, motor and emotional abilities in the context of specific therapeutic goals". "Available data suggest exciting prospects for the use of virtual reality in the rehabilitation of children with physical disabilities."

VR Rehab Reviewed

Virtual Reality in Rehabilitation of Children with Cerebral Palsy

Review article

Gunel, M. K., Kara, K. O., Ozal, C. & Turker, D. (2014) In E. Svraka (Ed) Cerebral Palsy - Challenges for the Future (pp. 273-301). InTech: DOI: 10.5772/56981 Creative Commons BY 3.0 license

Link to full text: dx.doi.org/10.5772/57486

Chapter 9, Virtual Reality in Rehabilitation of Children with Cerebral Palsy, is found within the book Cerebral Palsy - Challenges for the Future, published as an open source volume by InTech. The book develops the following ideas… "lifelong re/habilitation (habilitation and rehabilitation) in persons with cerebral palsy is the first part of this book which has four chapters about management in children and adults with cerebral palsy through the life span, providing evidence-based and family-centered support and services. Three chapters of the second part are exploring the new therapy options which could improve the family quality of life. Third part has two chapters about complementary therapies with new possibilities for the future."

The chapter on virtual reality therapy begins with an ICF perspective. In CP treatment, VR (re)habilitation modalities are identified separately as ‘evidence-based and clinical’ applications. The authors provide an extensive review of CP rehabilitation from the ICF perspective, and connect to a history of VR. They consider the theoretical base of VR therapy and include a neurology lesson and a review of virtual reality systems used in pediatric rehabilitation (immersive or desktop). A classification of VR systems for rehabilitation from (Galvin and Levac) is provided. The chapter finishes with a review of VR studies relating to upper extremity, lower extremity, postural control, fitness and other topics.

Reference
Galvin, J. and Levac, D. (2011). Faciliating clinical decision-making about the use of virtual reality within paediatric motor rehabilitation: describing and classifying virtual reality systems. Developmental neurorehabilitation, 2011:14 (2):112-22

Virtual vs. Real: Strategies for validity testing virtual reality

Instrument design

The potential value of virtual environments in rehabilitation
Lehman, L. A.
Journal of Mobile Technology in Rehabilitation 4:3 October, 2015

Link to full text: www.journalmtm.com/2015/the-potential-value-of-virtual-environments-ves-in-rehabilitation/

Virtual Reality is a “computer-generated, immersive, interactive simulation”. How do rehabilitation activities performed in a virtual environment compare with activities in the real world? The object of this paper is to create a pathway to test rehabilitation virtual environments for internal and external validity, compared to real world activities.

Face validity helps to determine that an assessment is evaluating what it is expected to be testing. This is done by first polling clinicians and experts using focus groups, surveys and meetings. Then end users can be asked how accurate the assessments are. External validity is the degree to which a test can be generalized. It is necessary to establish that a task completed in the virtual reality environment is similar to results in a real environment. Here, the same results in virtual and ‘real’ settings would see how well the virtual tasks mimic the real life activities.

Gaming vs.Bobath: Function and Ability

Randomized Trial

Video-game based therapy performed by children with cerebral palsy: a cross-over randomized controlled trial and a cross-sectional quantitative measure of physical therapy

Zoccolillo, L., Morelli, D., Cincotti, F., Muzzioli,L., Gobbetti, T., Paolucci, S. & Iosa, M.
Eur J Phys Rehabil Med. 2015 Feb 5.

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/25653079

Objective: In children with cerebral palsy, does video gaming intervention improve upper limb motor movements, hand function (and have more movements) compared to conventional, Bobath-based therapy?

Method: 22 children, 4 to 14 years old, with cerebral palsy (GMFCS levels I – IV) received 16 sessions of conventional therapy before or after 16 sessions of video game therapy, over a period of 8 weeks. QUEST (Quality of Upper Extremity Skills Test) was used to assess upper extremity function and Abilhand-kids for hand ability. Instrumentation was applied to the childrens’ forearms to quantify movements.

Findings: Upper limb functioning measured by QUEST improved more with video gaming than with conventional therapy. Manual ability improved better with conventional therapy. Video gaming resulted in more movements than conventional therapy.

Wii Balance Boards: One is as good as another

Measurement study

Interchangeability of the Wii Balance Board for Bipedal Balance Assessment

Bonnechere, B., Jansen, B., Omelina, L., Rooze, M & Van Sint Jan, S.

JMIR Rehabilitation and Assistive Technologies 2015; 2(2):e8
DOI:10.2196/rehab3832

Link to full text: rehab.jmir.org/2015/2/e8

Objective: How well do different Wii Balance Boards compare with each other, and with laboratory force plate measurements?

Process: Six subjects used four (out of the box, uncalibrated) Wii Balance Boards three times each in order to compare the Wii Balance Boards with each other and a laboratory force plate.

Findings: Balance and posture measurements from Wii Balance Boards did not differ significantly from one to another. The Balance Boards each compare very well to the laboratory force plate. Multi-site studies and use of larger populations can be accessed for research.

Video Game Treatment for Kids with Developmental Disabilities

Single group

Upper-Limb Rehabilitation with Adaptive Video Games for Preschool Children with Developmental Disabilities

Hsieh HC, Lin HY, Chiu WH, Meng LF & Liu CK.

American Journal of Occupational Therapy 2015 Jul-Aug;69(4):6904290020p1-5.

doi: 10.5014/ajot.2015.014480.

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/26114467

Objective: For children with developmental disabilities, does active video game play, compared before and after the intervention, increase motor function and visual-motor integration?

Method: 20 children with developmental disability (Beery-Buktenica Developmental Test of Visual Motor Integration (VMI) score of less than 80) played a novel video game for 30 minutes, 3 times a week for 5 weeks. Before and after, the children were scored on VMI and the Peabody Developmental Motor Scale – 2 (PDMS-2).

Findings: Game play had a positive and significant effect on visual-motor integration as measured by the VMI, and on motor function as measured on the fine motor quotient, gross motor quotient and total motor quotient subscales of the PDMS-2.

Measuring Upper Extremity Function - Systematically

Systematic Review

Upper limb function evaluation scales for individuals with cerebral palsy: A systematic review

Journal of Physical Therapy Science 27:1617 – 1620, 2015.

Santos, C. A., Franco de Moura, R. C., Lazzari, R. D., Dumont, A. J., Braun, L. A. & Oliveira, C. S.

Link to full text: www.ncbi.nlm.nih.gov/pmc/articles/PMC448345

Objective: What is the state of the evidence for scales and methods used to evaluate upper extremity function in cerebral palsy?

Method: Two reviewers independently assessed randomized controlled (RCT) trial articles published between 2006 and 2014. The Physiotherapy Evidence Database (PEDRO) scale was used to evaluate studies to see if there is sufficient accompanying information for (internal) validity and for the reader to interpret and reproduce results.

Findings: Five studies achieved 6/10 “good” or higher on PEDRO (1 – 9/10, 1 – 8/10, 2 – 7/10, 1 – 6/10). The various studies analyzed:

• Quality Upper Extremity Skill Test and the Besta scale (Fedrizzi et al.)
• Upper Extremity Functional Test and Peabody Developmental Motor Scales-2 (PDMS-2), Xu et al.
• PDMS-2, Bruninks-Oseretsky Test of Motor Proficiency and Pediatric Motor Activity Log, Lin et al.
• Melbourne Assessment of Unilateral Upper Limb Function, Koman et al.
• Redman et al. used the Pediatric Quality of Life Scale.

"…no consensus has been reached on the most appropriate scale or which has ideal clinical applicability to this population".

References
PEDRO www.pedro.org.au/

Fedrizzi E, Rosa-Rizzotto M, Turconi AC, et al. : GIPCI Study Group: Unimanual and bimanual intensive training in children with hemiplegic cerebral palsy and persistence in time of hand function improvement: 6-month follow-up results of a multisite clinical trial. J Child Neurol, 2013, 28: 161–175. [PubMed]

Xu K, Wang L, Mai J, et al. : Efficacy of constraint-induced movement therapy and electrical stimulation on hand function of children with hemiplegic cerebral palsy: a controlled clinical trial. Disabil Rehabil, 2012, 34: 337–346. [PubMed]

Lin KC, Wang TN, Wu CY, et al. : Effects of home-based constraint-induced therapy versus dose-matched control intervention on functional outcomes and caregiver well-being in children with cerebral palsy. Res Dev Disabil, 2011, 32: 1483–1491. [PubMed]

Koman LA, Smith BP, Williams R, et al. : Upper extremity spasticity in children with cerebral palsy: a randomized, double-blind, placebo-controlled study of the short-term outcomes of treatment with botulinum A toxin. J Hand Surg Am, 2013, 38: 435–46.e1. [PubMed]

Redman TA, Finn JC, Bremner AP, et al. : Effect of upper limb botulinum toxin-A therapy on health-related quality of life in children with hemiplegic cerebral palsy. J Paediatr Child Health, 2008, 44: 409–414.[PubMed]