ABSTRACT
Objective: Assess the effect of nonimmersive virtual reality (VR) training as complementary rehabilitation on body oscillation in children with cerebral palsy (CP) while standing on different bases of support and surfaces. Materials and Methods: Twenty-three children with unilateral CP randomly allocated to an intervention group (IG, n = 12) or control group (CG, n = 11). The IG underwent two weekly 50-minute sessions of VR training over 8 weeks, associated with conventional therapy, while the CG was submitted to two 45-minute sessions of conventional neurodevelopmental-based physiotherapy a week over the same time period. Participants were evaluated on a force platform under control conditions (CCs) (rigid surface, feet parallel); semitandem stance; flexible surface (FS) with feet parallel; and flexible surface in a semitandem (FSST) stance. The effect of the group and time factors on the center of pressure oscillation variables was analyzed by repeated-measures analysis of variance (ANOVA), with significance set at 0.05. Results: The main effect observed was for time on the FS, with a decline in the amplitude of mediolateral (ML Amp) (P = 0.01) and mediolateral root mean square (P = 0.01) after intervention. In the IG, ML Amp also declined after intervention under CCs (P = 0.02) and total velocity increased for FSST (P = 0.04). The percentage change was significant only in the IG. Conclusion: VR training as complementary rehabilitation can help improve body oscillation in children with CP and mild functional impairment. Nonimmersive VR can be considered a complementary tool for the physical rehabilitation of children with CP. This study was registered with the Brazilian Clinical Trials Registry (RBR-3zty4w).
Subject(s)
Cerebral Palsy , Video Games , Virtual Reality Exposure Therapy , Child , Humans , Cerebral Palsy/rehabilitation , Physical Therapy ModalitiesABSTRACT
Objective: This study aimed to investigate the effects of nonimmersive virtual reality (VR) as complementary rehabilitation on functional mobility and gait in children with mild unilateral cerebral palsy (CP). Methods: Prospective, randomized, controlled, clinical trial. Twenty-two children with unilateral CP were randomized into two groups: intervention group (IG) (n = 11) and control group (n = 11). After baseline assessments, the participants either started the VR intervention (IG) associated with conventional therapy, or continued conventional physical therapy (control group). Participants in the IG attended 45-minute training sessions twice a week for 8 weeks (total: 16 sessions and 12 hours of training). Participants in the control group underwent standard therapy for 50 minutes, twice a week. Timed Up and Go test (TUG), gait spatiotemporal variables, and pelvic angles were measured at baseline and after treatment sessions. Results: When compared with the control group, the IG performed the following activities in decreased time: TUG, and stride time. Also, the IG increased the velocity of walking and the pelvis retroversion, and decreased the pelvis interval/external rotations and amplitude of pelvis rotation while walking. Conclusions: A rehabilitative approach based on a nonimmersive VR as complementary rehabilitation may improve functional mobility and change joint mobility functions during gait of children with mild unilateral CP. The results of the study demonstrate that the insertion of a therapy based on VR may help in better strategies in the gait of children with CP. Thus, rehabilitation professionals can use this tool combined with conventional therapy.
Subject(s)
Cerebral Palsy/therapy , Gait/physiology , Rehabilitation/instrumentation , Virtual Reality , Cerebral Palsy/physiopathology , Child , Child, Preschool , Female , Humans , Male , Physical Therapy Modalities , Postural Balance , Prospective Studies , Rehabilitation/methods , Statistics, NonparametricABSTRACT
BACKGROUND AND PURPOSE: Virtual reality is an adjuvant technique to rehabilitation of children with cerebral palsy (CP). It has been gaining prominence in this field because of its accessibility and great levels of motivation it promotes in treatment. However, there is a lack of studies addressing the effects of virtual reality-based therapy on activity levels regarding postural stability, especially considering the level of evidence presented by studies addressing this issue. Therefore, we aim to evaluate the effects of intervention in body sway and gross motor function of children with CP using an active video game. MATERIALS AND METHODS: In this blind randomized controlled trial, fifteen children with CP, Gross Motor Function Classification System (GMFCS) I-II, regularly attending conventional physical therapy programs, were randomly assigned to an intervention (IG:nâ¯=â¯7) or to a control group (CG:nâ¯=â¯8). In both groups, children remained attending conventional therapy. In addition, IG underwent intervention using an active video game twice a week for 45â¯min and eight weeks. Standing body sway was assessed using a force plate, and Gross Motor Function Measure (GMFM) dimensions D (Standing) and E (Walking, Running and Jumping) were tested. RESULTS: Following the virtual reality-based intervention, the IG only showed significant improvements in the GMFM dimensions D (pâ¯=â¯0.021) and E (pâ¯=â¯0.008). Improvements were clinically significant (Dâ¯=â¯10.8%; Eâ¯=â¯14.0%). For the CG, no variable analyzed showed differences after eight weeks. CONCLUSIONS: Intervention using an active video game is a promising tool that can improve the gross motor function of children with CP, GMFCS I-II.
Subject(s)
Cerebral Palsy/physiopathology , Motor Skills , Physical Therapy Modalities , Virtual Reality Exposure Therapy/methods , Female , Humans , Infant , Longitudinal Studies , Male , Running/physiology , Single-Blind Method , Walking/physiologyABSTRACT
RESUMO Crianças com paralisia cerebral (PC) comumente são identificadas como diferentes de seus pares típicos devido à sua condição neuromotora, o que afeta a motivação e consequentemente o desempenho em atividades. A realidade virtual (RV) pode ser uma ferramenta potencial para melhora de aspectos motivacionais e desempenho motor durante a reabilitação. O objetivo deste estudo foi verificar o efeito de um programa de intervenção fundamentado em RV utilizando um videogame ativo no autoconceito, equilíbrio, desempenho motor e sucesso adaptativo de crianças PC. Participaram do estudo oito crianças entre 5 e 14 anos (10,37±3,29), com diagnóstico de PC, níveis I e II no GMFCS. O autoconceito foi avaliado com a Escala Infantil de Autoconceito Piers-Harris, o equilíbrio por meio do domínio quociente motor 3 da Escala de Desenvolvimento Motor. Para avaliação do desempenho motor foi utilizado o quociente motor geral, e as pontuações dos jogos avaliaram o sucesso adaptativo no ambiente virtual. A intervenção aconteceu durante oito semanas, sendo duas sessões semanais de 45 minutos cada. Foram utilizados quatro jogos ativos com demandas de equilíbrio, coordenação motora, saltos, agachamentos e deslocamento lateral do corpo. O teste de Wilcoxon foi usado para verificar as diferenças pré e pós-intervenção. Constatou-se diferença após a intervenção nos domínios: ansiedade, intelectual, popularidade, aparência física, satisfação, felicidade, equilíbrio, desempenho motor, e pontuação dos jogos. Conclui-se que a RV pode influenciar na forma com que essas crianças se enxergam quanto ao autoconceito, equilíbrio, desempenho motor geral e sucesso adaptativo, ajudando os profissionais a desenvolver formas de terapia que possam melhorar tais aspectos.
RESUMEN Niños con parálisis cerebral (PC) comúnmente se identifican como distintos de sus pares típicos debido a su condición neuromotora, lo que afecta la motivación y consecuentemente el desempeño en actividades. La realidad virtual (RV) puede ser una herramienta potencial para la mejora de los aspectos motivacionales y para el desempeño motor durante la rehabilitación. El objetivo de este estudio ha sido certificar el efecto de un programa de intervención basado en RV utilizando un videojuego activo en el auto concepto, en el equilibrio, en el desempeño motor y en el éxito adaptativo de niños PC. Ocho niños entre cinco y 14 años (10,37±3,29), con diagnóstico de PC, niveles I y II en el GMFCS. El auto concepto ha sido evaluado con la Escala Infantil de Auto concepto Piers-Harris y el equilibrio por medio del dominio Cociente Motor 3 de la Escala de Desarrollo Motor. Para la evaluación del desempeño motor ha sido utilizado el Cociente Motor General y las puntuaciones de los juegos han evaluado el éxito adaptativo en el ambiente virtual. La intervención ha ocurrido durante ocho semanas, siendo dos sesiones semanales de 45 minutos cada. Han sido utilizados cuatro juegos activos con demandas de equilibrio, coordinación motora, saltos, sentadillas y desplazamiento lateral del cuerpo. La prueba de Wilcoxon ha sido usada para certificar las diferencias pre y pos intervención. Se ha constado la diferencia después de la intervención en los dominios: Ansiedad, Intelectual, Popularidad, Apariencia Física, Satisfacción, Felicidad, Equilibrio, Desempeño Motor y puntuación de los juegos. Se concluye que la RV puede influenciar la manera con que esos niños se ven cuanto al auto concepto, al equilibrio, al desempeño motor general y al éxito adaptativo, ayudando a los profesionales a desarrollar maneras de terapia que puedan mejorar tales aspectos.
ABSTRACT Children with cerebral palsy (CP) commonly perceive themselves different from their typical peers due to their neuromotor condition, affecting their motivations and activity performance. Virtual reality (VR) seems to be an effective tool to improve motivation and motor performance in rehabilitation. The aim of this study was to verify the effects of VR-based intervention by means of active videogame on self-concept, balance, motor performance and adaptive success in children with CP. Eight children with CP, 10.37 years (±3,29), levels I and II of Gross Motor Function Classification System were submitted to a VR-based intervention, twice a week with sessions of 45 minutes during 8 weeks. The games used in intervention addressed balance, motor coordination, jumps, squats and lateral displacement of the body. Self-concept was tested using Childhood Scale of Self-concept Piers-Harris, balance using Motor Development Scale (MDS) (motor quotient 3), motor performance using MDS (general motor quotient). The games scores were used to test adaptive success on virtual environment. We found significant differences after intervention for all the testes areas. For self-concept scale, the differences appeared in the domains: Anxiety, Intellectual, Popularity, Physical Appearance, Satisfaction and Happiness. It seems that VR-based intervention might interfere with the way children with CP perceive themselves, apart from improve their balance, motor performance and adaptive success. Thus VR-based intervention is a potential tool to assist rehabilitation professionals to improve these aspects of children's health condition.
ABSTRACT
OBJECTIVE: To verify the effect of an intervention protocol using virtual reality (VR) on the motor performance and balance of a child with cerebral palsy (CP). CASE DESCRIPTION: To comply with the proposed objectives, a 7-year old child with spastic hemiplegic cerebral palsy (cP), GMFcS level I, was submitted to a physiotherapy intervention protocol of 12 45-minute sessions, twice a week, using virtual reality-based therapy. The protocol used a commercially-available console (XBOX(®)360 Kinect(®)) able to track and reproduce body movements on a screen. Prior to the intervention protocol, the child was evaluated using the Motor Development Scale (MDS) and the Pediatric Balance Scale (PBS) in order to assess motor development and balance, respectively. Two baseline assessments with a 2-week interval between each other were carried out for each tool. Then, the child was re-evaluated after the twelfth session. The results showed no changes in the two baseline scores. After the intervention protocol, the child improved his scores in both tools used: the PBS score increased by 3 points, reaching the maximal score, and the MDS increased from a much inferior motor performance to just an inferior motor performance. COMMENTS: The evidence presented in this case supports the use of virtual reality as a promising tool to be incorporated into the rehabilitation process of patients with neuromotor dysfunction.
Subject(s)
Cerebral Palsy/therapy , Postural Balance , Psychomotor Performance , Virtual Reality Exposure Therapy , Child , Humans , Male , Treatment OutcomeABSTRACT
OBJECTIVE: To verify the effect of an intervention protocol using virtual reality (VR) on the motor performance and balance of a child with cerebral palsy (CP). CASE DESCRIPTION: To comply with the proposed objectives, a 7-year old child with spastic hemiplegic cerebral palsy (CP), GMFCS level I, was submitted to a physiotherapy intervention protocol of 12 45-minute sessions, twice a week, using virtual reality-based therapy. The protocol used a commercially-available console (XBOX(r)360 Kinect(r)) able to track and reproduce body movements on a screen. Prior to the intervention protocol, the child was evaluated using the Motor Development Scale (MDS) and the Pediatric Balance Scale (PBS) in order to assess motor development and balance, respectively. Two baseline assessments with a 2-week interval between each other were carried out for each tool. Then, the child was re-evaluated after the twelfth session. The results showed no changes in the two baseline scores. After the intervention protocol, the child improved his scores in both tools used: the PBS score increased by 3 points, reaching the maximal score, and the MDS increased from a much inferior motor performance to just an inferior motor performance. COMMENTS: The evidence presented in this case supports the use of virtual reality as a promising tool to be incorporated into the rehabilitation process of patients with neuromotor dysfunction...
OBJETIVO: O estudo buscou verificar o efeito de um protocolo terapêutico baseado em realidade virtual (RV) sobre o desempenho motor e o equilíbrio funcional de uma criança com paralisia cerebral (PC). DESCRIÇÃO DO CASO: Uma criança com PC hemiplégica espástica de 7 anos, nível de GMFCS I, foi submetida a um protocolo de intervenção fisioterapêutica de 12 sessões de 45 minutos, numa frequência de duas vezes semanais, com o uso de terapia baseada em RV. Utilizou-se um console comercialmente disponível (XBOX(r)360 Kinect(r)) capaz de rastrear a movimentação corporal, reproduzindo-a em uma tela. Anteriormente à intervenção, foram realizadas avaliações de seu desenvolvimento motor e equilíbrio por meio dos instrumentos: Escala de desenvolvimento Motor (EDM) e Pediatric Balance Scale (PBS), respectivamente. Foram realizadas duas avaliações com espaço de uma semana como linha de base e uma reavaliação após as 12 sessões. Não foram observadas diferenças nos escores dos instrumentos nas duas avaliações iniciais. Depois do protocolo de intervenção, o paciente aumentou o escore do instrumento PBS em três pontos, atingindo o teto da escala e, no instrumento EDM, passou de um desempenho motor muito inferior para apenas inferior. COMENTÁRIOS: As evidências apresentadas pelo presente relato apoiam o uso da RV como uma promissora ferramenta a ser incorporada no processo de reabilitação de paciente com disfunções neuromotoras...
